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Testicular Cancer – Symptoms, Diagnosis And Treatment

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Testicular Cancer – Symptoms, Diagnosis And Treatment

Testicular tumors are relatively rare, but serious through their rapid evolution and by the fact that usually affect young men, between 20-35 years. The etiology is unknown, but  a number of predisposing factors have been discovered:

  • Genetic
  • Local, in which case ectopic testicle, it was observed that testicular tumors are 40 times more common in man with ectopic testicle;
  • Local injuries
  • Circulatory disorders
  •  Endocrine disorders
  •  Viral diseases  like urlian orchitis, even if it cause testicular atrophy, can cause tumors.

Testicular Tumors Pathology

Macroscopic, the testicle with the tumor is enlarged, irregular, asymmetric, harder to touch, with hypervascularized albuginea. Testicular tumors are classified into two histological categories:

1. Germ cell tumors (90%):

  • Seminoma;
  • Embryonal carcinoma;
  • Teratoma;
  • Choriocarcinoma.

2. Gonadal stroma  and sexual cords tumors (10%):

  • Leydig cell tumors;
  • Sertoli cell tumors;
  • Gonadoblastoma.

Seminoma is the most common tumor from the germ series testicular tumors (50%). Occurs unilaterally, has a smooth or lobulated surface, is hard, poorly demarcated, gray-white color on section. This type of testicular tumors has three forms: classic seminoma, spermatocistic seminoma and anaplastic seminoma, from which the last type is the one with the worst prognosis.

Embryonal carcinoma is the second most common type of testicular tumors (15-35%). This tumor has a gray-white color and can present areas with necrosis. It is one of the most aggressive testicular tumors, because is invading the epididymis and albugineea in 20% of cases.

Teratoma in child is invariably a benign tumor. In adult, this type of testicular tumors is considered potentially malignant, even if, morphologically,  it is well differentiated.

Choriocarcinoma is a rare form of testicular tumors, but with increased malignancy.

In approximately 50% of cases, germ cell tumors are histological mixed, many forms coexist, which is important in determining a proper therapy.

Leydig cell tumors in 90% of cases are benign. This type of tumor has a increased secretory function of androgen or estrogen or both type of hormones.

Testicular Cancer Stages

Testicular Cancer Stages

Testicular cancer extension is done quickly trough the lymphatic ways into lumbar lymph nodes. The lymphatic ways are parallel with the spermatic vein. From the lumbar lymph nodes, extension of the cancer is done trough the thoracic duct into supraclavicular lymph nodes. The lung is the firs organ, where testicular tumor metastasize.

Testicular Tumors Symptoms

Characteristic for testicular tumors is the slow and painless increase in volume of the testicle. It may take months until the patient is addressing to the doctor. Sometimes the phenomenon is associated with a minor local trauma.

In approximately 5% – 7% of cases of testicular tumors, the first symptoms of the disease are caused by metastasis:

  • Back pain or lumbosacral pain by trapping nerve roots into lymph node metastases;
  • Pleuropulmonary syndromes with chest pain, cough, bloody sputum (mediastinal adenopathy, pleuropulmonary metastases);
  • Pathological fractures (bone metastasis);
  • In some cases, gynecomastia and sexual disorders can occur (testicular tumors that secrete hormones).

Testicular Tumors Diagnosis

Clinical examination is the most important for diagnosis. Testicle is enlarged, uniform or not, smooth or lobulated and painless. Epididymis has a normal volume or can be moved by the tumor, but is always delimited by the tumor. Spermatic cord and deferens duct have a normal appearance, palpation rarely can shows their tumoral infiltration.

Testicular Tumors

Testicular Tumors

  • Ultrasound examination of the testis may contribute significantly to diagnosis;
  • Chest radiography shows lung metastases;
  • Limfography provides data on lumbar metastases.
  • Cavography can show the deviation of inferior vena cava or catching of inferior vena cava in metastases.
  •  Urography examination can show the deviation or catching the ureter by lumbar metastases.
  • Laboratory tests may provide significant elements: human chorionic gonodotrofin (Beta HCG) and alpha fetoprotein elevated.
  • Abdominal ultrasound examination and computed tomography can provide information about the presence of retroperitoneal lymph node metastasis and their size.

Percutaneous testicular puncture biopsy is strictly contraindicated because it favors the metastasis.

Evolution and prognosis of testicular tumors:

Testicular tumors generally have a rapid evolution, especially choriocarcinoma.  In case of seminoma and teratoma, the progress is slow. The prognosis of testicular tumors is severe because it affects young ages and lymphatic dissemination is rapid.

Testicular Tumor

Testicular Tumor

Testicular Tumors Treatment

The treatment of testicular tumors is surgical, followed by radiotherapy or chemotherapy, depending on tumor histology. The surgery is represented by radical orchiectomy.

In the case of seminoma, radical orchiectomy is followed by radiotherapy, knowing that these tumor is one of the most radiosensitive tumor. Including metastatic forms,  survival at 5 years is possible in 90%-95% of cases.

In the case of carcinomas is performed high orchiectomy followed by chemotherapy with cisplatin, bleomycin and vinblastine.
In case of teratomas, high orchiectomy performed in most cases should be sufficient.