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Testicular Cancer – Causes, Symptoms and Treatment

Testicular cancer is a malignant tumor of the testis that most commonly affects young men between the ages of 15 and 40. It is highly treatable and has excellent survival rates when detected early.

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Things worth knowing about "Testicular Cancer"

Testicular cancer is a malignant tumor of the testis that most commonly affects young men between the ages of 15 and 40. It is highly treatable and has excellent survival rates when detected early.

What Is Testicular Cancer?

Testicular cancer is a malignant condition in which abnormal cells grow uncontrollably within the testis. It is the most common cancer in men aged 15 to 40, though it remains relatively rare overall. Importantly, testicular cancer is one of the most curable forms of cancer, even when diagnosed at an advanced stage.

Causes and Risk Factors

The exact causes of testicular cancer are not fully understood. However, several risk factors are known to increase the likelihood of developing the disease:

Undescended testicle (cryptorchidism): A testicle that did not descend into the scrotum is the most significant known risk factor.
Family history: Having a father or brother with testicular cancer increases personal risk.
Carcinoma in situ (CIS): Precancerous cells in testicular tissue may develop into cancer over time.
Previous testicular cancer: Men who have had cancer in one testicle have a higher risk of developing it in the other.
Infertility: Men with reduced fertility appear to have a slightly higher risk.

Types of Testicular Cancer

The vast majority of testicular cancers originate from germ cells -- the cells responsible for sperm production. There are two main types:

Seminoma: Grows more slowly, typically affects men in their 30s and 40s, and responds very well to radiation therapy.
Non-seminoma: Grows more rapidly and includes subtypes such as embryonal carcinoma, teratoma, yolk sac tumor, and choriocarcinoma. More common in younger men.

Symptoms

Testicular cancer is often painless in its early stages, which is why it may go unnoticed for some time. Common signs include:

A painless lump or hardening in the testicle
A feeling of heaviness or dragging in the scrotum
A noticeable change in the size of one testicle
Occasionally: breast tenderness due to hormone-producing tumors
In advanced cases: back pain, cough, or swollen lymph nodes

Any unusual change in the testicle should be evaluated by a doctor without delay.

Diagnosis

Diagnosis typically involves several steps:

Ultrasound of the scrotum: The primary imaging method for detecting testicular tumors.
Blood tests (tumor markers): Proteins such as AFP (alpha-fetoprotein), beta-hCG, and LDH can indicate the presence and type of testicular cancer.
Surgical removal of the testicle (orchiectomy): The definitive diagnosis is made by microscopic examination of the removed tissue.
CT or MRI scan: Used to determine whether cancer has spread to lymph nodes or other organs.

Treatment

Treatment depends on the type and stage of the cancer:

Surgery

The first step in nearly all cases is surgical removal of the affected testicle (inguinal orchiectomy). This serves both diagnostic and therapeutic purposes.

Radiation Therapy

For seminomas, radiation to the lymph nodes in the abdomen is often recommended after surgery to address potential microscopic spread.

Chemotherapy

For advanced-stage tumors or non-seminomas, chemotherapy -- typically the BEP regimen (bleomycin, etoposide, cisplatin) -- is highly effective and widely used.

Active Surveillance

For early-stage tumors with low recurrence risk, close monitoring without additional therapy after surgery may be appropriate, especially in motivated patients.

Prognosis

The prognosis for testicular cancer is outstanding. Cure rates exceed 95% in early-stage disease, and even metastatic testicular cancer can be cured in the majority of cases. Early detection and prompt treatment are key to the best outcomes.

Prevention and Early Detection

There is no established way to prevent testicular cancer. However, regular self-examination of the testicles from puberty onward is strongly recommended. Men should check monthly for any lumps, hardness, or size changes. Any abnormality should be promptly assessed by a healthcare professional.

References

Albers P. et al. - EAU Guidelines on Testicular Cancer, European Association of Urology (EAU), 2023.
American Cancer Society: Testicular Cancer -- Early Detection, Diagnosis, and Staging, 2023.
Robert Koch-Institut (RKI): Cancer in Germany 2019/2020. Berlin, 2023.

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