Testicular Cancer

Testicular cancer is the abnormal proliferation of cells within the testes. This excess tissue accumulates to form malignant tumors composed of cells that grow rapidly and uncontrollably.

It is a relatively uncommon type of cancer but is the most common solid tumor in young men, particularly between 15 and 45 years of age.

Thanks to advances in diagnostics and therapy, testicular cancer is one of the cancers with the best prognosis, with very high cure rates even when diagnosed at advanced stages.

Depending on the cells of origin, testicular cancer can be classified into three types:

• Germ cell tumors: the most common type, arising from the cells responsible for sperm production.
• Seminomas: slow-growing tumors that are highly sensitive to radiotherapy and chemotherapy.
• Classical seminoma: characterized by large, round cells with well-defined cell membranes, usually presenting as a localized mass within the testicle.
• Spermatocytic seminoma: very rare, extremely slow-growing, and generally does not spread to other organs.
• Non-seminomas: rapidly growing tumors composed of various cell types.
• Embryonal carcinoma: fast-growing, often spreading to adjacent tissues, with cellular features resembling early-stage embryos.
• Yolk sac tumor (or orchyoblastoma): cells resemble those of the embryonic yolk sac, also called yolk sac carcinoma.
• Choriocarcinoma: small, multinucleated cells; grows very rapidly with poor prognosis due to early dissemination to other organs.
• Teratoma: cells include the three embryonic layers (endoderm, mesoderm, ectoderm); usually not pure tumors but part of mixed germ cell tumors.
• Stromal tumors: arise from the stroma, the tissue responsible for hormone production in the testes.
• Leydig cell tumors: originate in androgen-producing cells; mostly benign cysts that rarely metastasize. When metastasis occurs, prognosis is poor.
• Sertoli cell tumors: develop in cells supporting germ cell maturation during spermatogenesis; usually benign but aggressive if metastasized.
• Carcinoma in situ: also known as intratubular germ cell neoplasia, occurring in the seminiferous tubules where spermatogenesis takes place. Composed of large cells with prominent nuclei and abundant glycogen, providing a high-energy source.

Testicular cancer is uncommon, representing approximately 1% of all cancers diagnosed in adults in Western countries. Most cases are detected at early stages, with cure rates around 90%. Even in metastatic cases, survival can reach 80%, reflecting the typically indolent nature of this cancer.

Symptoms

The most characteristic symptoms of testicular cancer include:

• Painless lump in the testicle
• Swelling of the scrotum, the tissue surrounding the testes and spermatic cord
• Discomfort, heaviness, or pain in the scrotum
• Occasionally, testicular pain
• Enlargement of breast tissue (gynecomastia)

Causes

The exact causes of testicular cancer, as with most cancers, remain unknown. However, it is established that genetic alterations in DNA lead to uncontrolled cell proliferation and prolonged survival, resulting in tumor formation.

Risk Factors

The risk of developing testicular cancer is higher in:

• Age: most common in men aged 15–45; yolk sac tumors are more frequent in children
• Cryptorchidism: undescended testicle during fetal development
• Family history of testicular cancer
• HIV infection

Complications

The main, though uncommon, complication of testicular cancer is metastasis, i.e., spread to other organs. This cancer typically spreads to nearby lymph nodes, lungs, or brain.

Long-term, testicular cancer and its treatment may cause infertility due to hormonal changes.

Prevention

Although testicular cancer cannot be prevented, maintaining a healthy lifestyle may reduce overall oncological risk:

• Balanced diet rich in fruits and vegetables
• Regular physical activity
• Maintaining healthy body weight
• Avoiding smoking
• Limiting alcohol consumption

Which Specialist Treats Testicular Cancer?

Early signs are often identified in primary care or urology consultations. Definitive treatment is managed by Medical Oncology and Radiation Oncology specialists.