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Pathology – Testicular cancer is a heterogeneous disease that occurs during or after puberty (Pyle & Nathanson, 2016). Most testicular cancers are germ cell tumors from the sperm and can be classified into two subtypes: seminomas, which are the most common, and nonseminomas, the more aggressive type.
Etiology – The cause of testicular cancer is unknown, but incidences are higher by genetics, typically, among close male relatives. It is the most common malignancy affecting males between the ages of 15-35.
Risk factors – Non-modifiable risk factors include gender, ages 15-35, family history, and genetic disorders including Klinefelter syndrome and Down syndrome (Pyle & Nathanson, 2016). Cancers can be caused by changes in chromosomes that turn off tumor suppressor genes which slow down cell division or turn on oncogenes which help cells grow and divide. Most testicular cancer cells have extra copies of a part of chromosome 12 which may be a contributing factor (Pyle & Nathanson, 2016). Men with a history of cryptorchidism and prior orchiopexy are also at increased risk. Some studies show a mild association between risk of testicular cancer and high intake of saturated fat, dietary cholesterol, and dairy products. Additionally, regular use of marijuana may increase the risk about twofold.
Signs/symptoms – Testicular tumors typically present as a nodule or swelling of one testicle that is typically painless. Male patients will report a dull ache or a heavy sensation in the lower abdomen, perianal area, or scrotum (Bjelaković et al., 2020). If it is metastatic, symptoms may vary depending on the site including neck mass, cough, or dyspnea related to pulmonary metastasis, anorexia, nausea, vomiting, and/or bone pain. Additionally, gynecomastia may occur due to a systemic endocrine manifestation of testicular germ cell tumors (Bjelaković et al., 2020). A testicular examination is essential as abnormalities of firm, hard, or fixed areas within the tunica albuginea should be considered suspicious. Testicular tumors are ovoid and may spread to the epididymis or spermatic cord.
Diagnostics – A physical examination is essential, in which both testicles should be examined and compared for size, tenderness, symmetry, and presence of nodules. A scrotal ultrasound is the gold standard for diagnosis, which is a rapid and reliable technique for suspected testicular tumor, as well as, to exclude hydrocele or epididymitis (Bjelaković et al., 2020). Radiographic testing and serum tumor markers, such as beta-human chorionic gonadotropin and alpha-fetoprotein, are helpful to determine the histologic type and extent of the disease. A CT is recommended if the metastatic disease involves the chest/peritoneum.
Treatment – Regardless of staging, radical orchiectomy is done initially. If Testicular cancer has spread, treatments including radiation or chemo should be considered.
References
Bjelaković, M. D., Vlajković, S., Bjelaković, G., & Antić, M. (2020). Testicular cancer stem cell hypothesis – diagnostic and therapeutic implications. Vojnosanitetski Pregled: Military Medical & Pharmaceutical Journal of Serbia, 77(11), 1210–1215. https://doi.org/10.2298/VSP170821197D
Pyle, L. C., & Nathanson, K. L. (2016). Genetic changes associated with testicular cancer susceptibility. Seminars in Oncology, 43(5), 575–581. https://doi.org/10.1053/j.seminoncol.2016.08.004