Testicular Cancer

Testicular cancer occurs when cells begin to grow uncontrollably in the testicles. To understand this cancer, it is helpful to know the normal structure and function of the testicles.

The testicles are two organs of the male reproductive system located within a sac of skin called the scrotum, which hangs below the base of the penis. Their two main functions are:

• To produce male hormones (androgens), such as testosterone.
• To produce sperm, which are the male cells that fertilize the female sex cell (ovum), and thus begin a pregnancy.

Sperm cells are produced in long, thin ducts located within the testes called seminiferous tubules. These cells are stored and mature in the epididymis, a small, coiled tube located behind each testicle.

During ejaculation, sperm cells travel from the epididymis through the vas deferens to the seminal vesicles, where they mix with fluids produced by the seminal vesicles, the prostate gland, and other glands to form semen. Finally, this fluid enters the urethra (the tube inside the penis through which urine and semen pass) to be expelled from the body.

Testicular cancer typically presents as a painless, recently appearing scrotal mass. In some cases, the testicular tumor may initially be metastatic, due to local progression, retroperitoneal spread, or distant metastasis. In such cases, the symptoms will depend on the tumor's location.

There are several types of testicular tumors. Their prognosis and nature vary, and depending on their histological type, they will respond better to certain treatments.

The best initial diagnostic test is a physical examination and scrotal ultrasound. Testicular ultrasound is the gold standard and provides a great deal of information about the presence or absence of a tumor, its local impact, and invasion of neighboring organs.

If a testicular tumor is suspected based on examination or ultrasound, the next step is to perform tumor marker tests, which have diagnostic and prognostic value. These are usually performed before surgery (Beta-HCG, alpha-fetoprotein, LDH) and also during disease follow-up. In addition, it is important to order a chest and abdominal CT scan to detect the presence of lymph nodes or metastases, which testicular cancer can produce early on.

Treatment is usually performed surgically. The first step is the total or partial removal of the testicle. The former is generally preferred, although partial surgery can be performed safely provided the tumor is no larger than one-third of the testicle.

Orchiectomy is performed through an inguinal incision. The spermatic cord structures are monitored early to prevent the spread of tumor cells, and the tumor is removed. Penile prosthesis implantation may be chosen for cosmetic purposes, depending on the man's preference.

The postoperative period is usually short and benign. It is common for the patient to be discharged even on the same day as the surgery, with a follow-up appointment scheduled approximately 15 days later to discuss the biopsy results.

In cases of high-risk testicular cancer, or cancer presenting with metastasis or lymphadenopathy at the time of diagnosis, chemotherapy is generally very effective. Even in advanced cases, it is a curable disease thanks to a combination of chemotherapy and, sometimes, radiation therapy and surgery.

However, testicular tumors can recur quickly, so initial monitoring must be very intensive and thorough.