Testicular cancer is a malignant tumor that develops from the germ cells, the precursors of the spermatozoa.
The terms "testicular cancer", "testicular cancer", "germ cell tumor" mean the same thing. The malignancy of testicular cancer lies in the fact that it is able to quickly destroy healthy testicular tissue and spread to all other organs of the body. Without treatment, the disease unequivocally leads to death - 30 years ago almost all the sick people died. Today, with timely treatment, testicular cancer can be cured in most patients. Testicular cancer occurs predominantly in young men between the ages of 20 and 40. In this age group, testicular cancer is the most common cancer.
In Germany, about 4,100 young men develop testicular cancer every year. The causes of testicular cancer have not been fully determined. Already during the development of the fetus, “incorrectly programmed” testicular cells can appear in the womb, from which cancer cells can subsequently develop. After birth, these "incorrectly programmed" cells are at rest. During the period of teenage hormonal activity, these cells (TEN - cells, TEN - testicular embryonic neoplasia) can be activated, they can develop testicular cancer. TEN cells can be detected by microscopic examination many years before testicular cancer develops.
Risk factors for testicular cancer are:
- congenital undescended testis into the scrotum;
- hereditary predisposition.
Worldwide, the incidence of various forms of testicular cancer has increased significantly over the past 20 years, the reason for this has not been established.
Depending on the type of tumor tissue, several forms of testicular cancer are distinguished: seminoma, teratoma, mixed form of cancer. It is important to distinguish between these forms, since treatment directly depends on the type of tumor.
Most men self-discover signs of testicular cancer. Typical signs of the disease are:
- usually painless swelling of the testicle or the formation of nodes in it;
- back pain due to an increase in the lymph nodes of the retroperitoneal space;
- enlargement or tenderness of the breasts.
If you find such signs, you should consult a doctor. A specialist in this field is a urologist.
If testicular cancer is suspected, the doctor performs a careful manual examination of the diseased organ. Then a highly informative ultrasound examination (ultrasound) is performed. In the blood, specific proteins are determined that are produced by the tumor and the concentration of which is therefore increased (tumor markers). As a result of these simple and painless examinations, it is possible to diagnose the tumor. The final diagnosis is made after surgical sampling of tissues from the diseased testicle by an incision in the inguinal region. If the diagnosis is confirmed by histological examination, the affected testicle is removed during the same operation. The remaining healthy testicle completely takes over its function, so that long-term complications do not arise.
After the operation, further examinations should be carried out in order to determine the spread of the tumor in the body. This is done using computed tomography (CT) of the abdomen and lungs. Repeated blood tests determine the level of tumor markers. Through all these examinations, the stage of the disease is determined: in the 1st stage, the tumor is limited to the testicle, in the 2nd stage it penetrates into the lymph nodes of the retroperitoneal space, in the 3rd stage, daughter tumors (metastases) are determined outside the abdominal cavity or in other organs.
Testicular cancer can be cured at every stage of the disease. Experts guarantee the maximum therapeutic effect when conducting a combination therapy consisting of surgery, chemotherapy or radiation therapy.
Since we are talking about young patients, the issue of sperm conservation is discussed. This is followed by - depending on the stage and type of tumor - careful observation, chemotherapy, radiation therapy and possibly surgery.
A strategy of just careful observation is possible when the tumor is non-aggressive and has not spread beyond the testis. If we are talking about seminoma, then metastases in the lymph nodes can be subjected to radiation therapy. Mixed tumors or teratomas are treated at this stage with chemotherapy.
Radiation therapy aims to destroy cancer cells. High-energy beams damage cancer cells and block their reproduction. Irradiation is a local type of therapy (as opposed to chemotherapy); as a rule, the patient is exposed to radiation 5 days a week for 5 minutes. The duration depends on the spread of the tumor.
Chemotherapy it is mainly used for teratomas, as they do not respond to radiation therapy. Chemotherapy is based on the principle of destruction of a rapidly dividing cell by a chemotherapy drug. Cytostatics block tumor growth by interfering with the process of cell division. Because testicular tumors are very fast growing cancers, they respond well to chemotherapy. Chemotherapy is a highly effective "cocktail" (combination of drugs) of various cytostatics. They are administered intravenously in the arm for 1-4 cycles of 5 days. There is a two-week break between cycles. At the same time, side effects (hair loss, vomiting) cannot be completely avoided.
If, after such an initial treatment, remnants of the tumor are found in the body, they are removed by surgery. When this phase of treatment is completed, the next phase begins: observation. Its purpose is:
- register new manifestations of the disease in a timely manner;
- identify and treat comorbidities and complications;
- help in solving mental, physical and social problems. This includes the rehabilitation of disorders caused by the disease and the restoration of working capacity.