Testicular tumors

Testicular tumors account for approximately 1% of all malignant tumors, but the most common cancer in men suffering until the 45th Of age. Because they cause no pain, early detection is of great importance. Men should therefore be encouraged to sample their testicles regularly to respond to a swelling immediately. The disease incidence is increasing.

There are 4 types of testicular tumors, which occur sometimes in mixed form

    Seminoma
    embryonal carcinoma
    Choriocarcinoma
    Teratocarcinoma



Of these, the most benign of seminoma, choriocarcinoma, the most dangerous tumor. Testicular tumors occur mainly between the 20th - 40th Age at which teratomas rather earlier, the seminomas rather something later. Since testicular tumors at an early stage tumors (metastases), they are very serious diseases. They metastasize via the lymphatics of the spermatic cord through the inguinal canal directly into the nearby lymph nodes next to the aorta (para-aortic lymph nodes) in the abdominal cavity. Deviations are possible after prior inguinal or testicular surgery. Only about 3% of cases of metastasis via the blood. Today it is possible, despite the severity of curing these tumors. The tumors are according to the WHO - classification divided into:

    ptx if no exposure of the testis was
    pT0 tumors intratubular
    pTis tumor confined to the testis
    pT1 tumor grows beyond the tunica albuginea or in the epididymis
    pT2 tumor grows into the spermatic cord
    pT3 tumor grows into the scrotum (scrotal) a
    Nx Regional lymph nodes can not be assessed
    N0 no lymph node metastases
    N1 metastasis less than 2 cm in size in solitary lymph nodes
    N2 metastases 2-5 cm in size in solitary or multiple lymph nodes
    N3 metastasis than 5 cm in size solitary or multiple lymph nodes
    Mx Distant metastasis can not be assessed
    MO, it is no distant metastasis present
    M1a involvement of non-regional lymph nodes or lung metastases
    M1b other distant metastases



Cause:
The cause is unknown. Compromised, however, (descended testes has not reduced during its development, is not moved into the scrotum =) especially men who have testicular retention was present or cryptorchidism = abdominal testes. These men have a 40-fold at the risk of developing a testicular tumor. Predisposition may be present, as first-degree relatives of a man with testicular cancer also have an increased risk. One also suspects a correlation with environmental factors. What is certain is that all testicular tumors arise from a precursor of testicular intraepithelial neoplasia (TIN), which leads even during the later embryonic germ cells of patients with developmental disabilities due to an excess of estrogen in germ cell fate. The atypical germ cells remain there, survive birth and infancy and later to TIN - cell. After puberty, it comes eventually to malignant transformation, with the time of the conversion can not be predicted, however, to develop about 50% of the tin - cells into malignant tumors. TIN may be termed precancerous = precancer. By an almost risk-free testicular biopsy of a rice grain-sized piece of (preferably a double biopsy to increase the security) can not and their investigation will be determined by a competent examiner, if a cancer hazard posed by the testicles, which treatment is necessary then or whether it can be seen. The advantage is that these precancerous lesions can be treated without the testicles are removed. As a treatment option is to remove the testes, but then has to replace the hormone testosterone activity by a lifetime gift. One can irradiate the testicles with a dose of 20 Gy, the TIN completely destroyed and replaced by the hormonal activity in approximately 75% of cases, making it rare to Hyogonadismus (hormone hypofunction of the gonads) occurs. With the irradiation of the patient is also sterile. Chemotherapy is unreliable in TIN. The biopsy is especially useful in patients with unilateral testicular tumor, because the risk of getting the second testis a malignant tumor at 5 - 6%, especially when the second testicle is (re-formed) atrophy and the patient is younger than 30 years . Even with primary retroperitoneal germ cell tumor, the biopsy should be performed. These rare tumors regress from still unknown origin, while their metastases grow at the same time. Even with microlithiasis testicular biopsy may be useful or if there is an overall increased risk of testicular cancer.

Complaints:
Typical is a painless, unilateral enlargement of the testicle, often associated with a drawing in the spermatic cord. Because of this analgesia is often diagnosed too late. If metastases are present, can occur over the left clavicle lymph nodes. Sometimes it also comes to back pain.

Notice of this disease:
With a simple scan of the testicle, a transillumination (illuminate with a strong light source, to estimate the tissue density) and a painless ultrasound test can already be clarified whether it is in the swelling, for example, a harmless hydrocele ("water bag") of the testis or whether a tumor is present. One has the suspicion of a tumor, the testicles are exposed surgically. In the necessary blood test can beta-HCG (beta human Chorionginadotropin) be increased in choriocarcinoma, but also the teratoma or seminoma, alpha - fetoprotein may be increased in all testicular tumors, as well as LDH (lactate dehydrogenase), optionally, the PLAP (placental alkaline phosphatase in seminomas). The aforementioned blood values ​​also serve to monitor the progress of therapy. Chorionic gonadotropin (a pregnancy hormone) in choriocarcinoma can be detected in urine. Be determined after a confirmed diagnosis of testicular tumor has the stage. For this, a computerized tomography (CT) of the abdominal and pelvic cavity and the lung are needed. When seminoma can do without a CT scan of the lungs. A magnetic resonance imaging (MRI) is only in X-ray contrast medium intolerance essentials, a positron emission tomography (PET) only to clarify the question of whether there are still residual tumor after therapy. A bone scan should be performed with far advanced disease or with elevated alkaline phosphatase. Here, then, a CT scan of the skull is necessary.

= Forecast prognosis:
These are the stage and type of fabric depends. Good prognosis (about 90% 5 - year - survival rate), all patients with seminoma, which has not yet formed no metastases and all of the testicles or primarily the retroperitoneal tumors confined without metastases and with low tumor markers (ie AFP of 1000 ng / ml, ß-hCG below 1000 ng / ml, LDH less than 1.5 of normal). Mean cure rates (5 - year - survival rate of approximately 80%) have all seminomas with not in the lungs located metastases and any Tumormarkeröhe and all other testicular tumors without metastases with moderately elevated tumor markers (ie AFP between 1000-10000 ng / ml, p HCG between 1000-10000 ng / ml and LDH less than 1.5 - 10 x the normal value). A poor prognosis (median 5 - survival rate around 50%, all non-seminomas with metastases outside the lung or high tumor markers (ie AFP more than 10 000 ng / ml, p - HCG more than 10 000 ng / ml, LDH over 10 x the normal value).

Treatment:
Be surgically removed in all testicular tumors, the affected testicle (semi-castration), which is done through an incision in the groin. That speaks to the only seminoma testicular tumor to radiation. Irradiating the entire lymphatic drainage up to the clavicle. In the other testicular tumors after surgery is removal of the lymph nodes, radiation and chemotherapy. The radical lymph node dissection improves survival.
Prior to treatment should be determined in case of infertility testosterone, LH (luteinizing hormone) and FSH (follicle stimulating hormone) and perform a semen analysis as well as offer the possibility of storing sperm (Kryospermakonservierung) in azoospermia (absence of mature sperm in the ejaculate, precursors but present) indicate the possibility of obtaining sperm on testicular sperm extraction.
During treatment and 1 year after contraceptive measures should be carried out, since it may cause the treatment to an increased rate of miscarriage (loss of the unborn).
If it is determined as a result of the treatment to a deficiency of male hormones (androgens), testosterone and LDH, and should take hormone replacement therapy should be considered.