Testicular cancer – how to recognize the symptoms!

Testicular cancer is a rare, malignant disease of the male sex organ. Since there are no preventive medical check-ups, regular testing of the testicles plays a vital role in detecting the tumour. How can you palpate testicular cancer, and what other symptoms can occur? What are the therapy options, is the fertility impaired by an operation, and what are the chances of survival? You can read that and more here.

What is testicular cancer?

Testicular cancer – also testicular tumour or testicular carcinoma – is a malignant (malignant) change in the testicles (scrotum). This can be distinguished from benign changes, such as inflammation of the epididymis (epididymitis) or accumulation of fluid in the testicles (hydrocele testis).

In the case of malignant testicular tumours, a distinction is made between seminoma and the group of non-seminomas. Seminomas develop from the sperm-producing germ cells (spermatogonia) in men. In non-seminoma cases, further forms are subdivided depending on their origin (yolk sac tumour, teratoma, choriocarcinoma, stromal tumour or embryonic cell carcinoma). Examining the affected tissue under the microscope makes the distinction between the two forms of testicular cancer. The classification is particularly relevant because the forms differ in therapy and prognosis.

 

How common are testicular tumours?

More than 4,000 men were diagnosed with testicular cancer in Germany in 2018. In the same year, on the other hand, more than 35,000 men were diagnosed with lung cancer. This comparison is intended to illustrate the rarity of the disease.

At what age do you get testicular cancer?

Testicular cancer mainly occurs between the ages of 25 and 45, which is relatively early compared to other types of cancer . In addition, there is a second frequency peak from the age of 70.

However, testicular cancer can also occur in infancy. For example, the yolk sac tumour, a subtype of non-seminomas, is the most common testicular tumour in children under three.

 

Causes: What is the trigger for testicular cancer?

Certain risk factors can increase the likelihood of developing testicular cancer. These include:

• Hodenhochstand (Maldescent witness)
• Testicular cancer in the family (especially in the parents or siblings)
• previous testicular cancer on the other testicle

Undescended testicles are characterized by the fact that they are not in the scrotum but outside of it, for example, in the inguinal canal (groin testicles) or the abdomen (abdominal testicles). The wrong position of the testicles is caused by the fact that they usually migrate from the abdomen to their final position in the scrotum before birth. If the scrotum remains empty after birth, the affected testicle often moves into its natural position over the first year.

However, if the process is not yet complete by the end of the first year of life, then surgery is usually used to help. The increased temperature in the abdomen compared to the cooler temperatures in the scrotum increases the risk of malignant degeneration of the tissue and can, therefore, be a cause of testicular cancer. However, a smaller but still increased risk of testicular cancer remains even after corrective surgery.

According to current research, carrying a mobile phone in your pocket does not appear to be a risk factor for the development of testicular cancer.

Symptoms: how to recognize testicular cancer

Although testicular cancer is a rare disease, regular examination of the testicles plays a crucial role in detecting changes at an early stage, especially if one or more of the risk factors mentioned above are present.

Testicular cancer can manifest itself through the following signs:

• Appearance: Testicular cancer often causes unilateral enlargement of the testicle.
• Pain: This enlargement is usually painless, but there can also be accompanying testicular pain.
• Palpable Hardening: The testicle may feel hardened in testicular cancer. A hard lump inside the scrotum can also be an indication.
• Pulling and heaviness: Occasionally, there may be a feeling of tightness and heaviness in a testicle or groin.

However, the signs mentioned are not specific to testicular cancer; they can also occur with benign changes in the testicles. These can only be clearly distinguished from malignant tumours by special examinations.

Excessive hormone production can also cause unilateral or bilateral breast enlargement (gynecomastia).

Occasionally, the testicular tumour can only be noticed through the symptoms caused by the secondary tumours (metastases). These symptoms can include, for example, back pain caused by metastases in the spine.

How do you know if you have testicular cancer?

The signs already explained are best recognized by regular palpation of both testicles. This allows you to feel the testicular cancer in yourself in some cases. If any abnormalities occur during scanning, it is advisable to consult a urologist as soon as possible.

Unlike, for example, colon, skin or prostate cancer, there is no particular check-up for this type of cancer. Self-examination is, therefore, the most important precaution.

 

How Fast Does Testicular Cancer Grow?

Malignant testicular tumours have a tumour doubling time of 10 to 30 days. This means that the tumours can double in size within this time. Testicular tumours proliferate compared to many other types of cancer. This also explains why a doctor should promptly examine a change in appearance or abnormal tactile findings.

Testicular cancer is divided into different stages. In the current “Lugano classification”, one speaks of stage 1 if all lymph nodes are cancer-free. If lymph nodes are already affected, this is stage 2. Stage 3 is when metastases affect not only the lymph nodes in the area but also more distant lymph nodes, other organs or the bone.

However, other classifications can be used to determine the cancer stage somewhat differently.

Diagnosis: What examinations are carried out?

If you go to a urological practice with a change in the testicles, the affected testicles are first inspected and palpated.

An ultrasound examination of the testicles can be carried out as further diagnostics. In addition, unique tumour markers (α1-fetoprotein (AFP) and human chorionic gonadotropin (β-HCG)) can be determined with the help of a blood test.

Tissue removed during the operation can be examined under the microscope to confirm the presence of testicular cancer and to plan further surgical procedures. This procedure is referred to as a “quick cut”. In further examinations under the microscope, the type of tumour (seminoma or non-seminoma) can also be determined. Imaging methods such as magnetic resonance imaging ( MRI ), computed tomography (CT) and X-rays also help search for possible metastases.

How is testicular cancer treated?

Malignant testicular tumours should usually be surgically removed. Surgery usually involves unilateral removal of the testicles (orchiectomy).

If certain risk factors are present (small testicles, malposition of the testicles, functional limitations of the testicles or age under 40), tissue (biopsy) of the unaffected testicle can also be taken in some cases to examine it for malignant cells.

Even if the removal of a testicle does not necessarily result in infertility, freezing sperm (sperm conservation) before treatment is recommended if you later want to have children. In addition, after the testicles have been removed, a so-called “testicle prosthesis” can also be used, which fulfils a purely optical function.

Depending on the type of tumour and the stage of the tumour in which the affected person is, various additional treatment methods must be decided on individually in each case:

• In some cases, the so-called “active surveillance” is recommended, in which regular check-ups are carried out, but no further treatment measures are initiated. This option is suitable, for example, depending on the tumour size and the extent of the tumour in stage 1 (according to the Lugano classification).
• Complementary chemotherapy can also be carried out.
• A third option is to treat testicular cancer with radiation (radiation therapy).

 

What are the chances of surviving testicular cancer?

Fortunately, testicular cancer is one of those cancers that has a relatively good prognosis. However, the individual chance of survival with this cancer depends on the stage one is in and what type of tumour shows up under the microscope (seminoma or non-seminoma). In non-seminomas, metastases are often already present at diagnosis, so they have a worse overall prognosis than seminomas. The occurrence of metastases can also significantly reduce life expectancy without treatment.

In the early stages of the disease without distant metastases, the 5-year survival rate is 90 to 97 per cent. The prognosis has dramatically improved, particularly with the introduction of chemotherapy as a treatment option.

The chances of recovery worsen when distant metastases are present. This term refers to secondary tumours, not near the tumour or its surrounding lymph nodes but further away, for example, in the spine or abdominal organs. The lungs are particularly frequently affected by metastases, but in the case of testicular cancer, lung metastases do not significantly worsen the prognosis.

The 5-year survival rate for distant metastases outside the lungs is 50 to 80 per cent, depending on the type of tumour. This means that even in these tumour stages, up to 80 per cent of those affected survive the first five years after diagnosis.