Testicular cancer

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What is it about ?

The testes produce sperm. Most malignant testicular tumors start from cells that play a role in the production of sperm, known as “germ cells”. Cancers originating from germ cells are subdivided into “seminomas” and “non-seminomas”. The term comes from the Latin “semen”, which means seed.

Where and how often?

Testicular cancer is the 20e most common form of cancer in Belgium. It is rather rare. Most cases start before the age of 35. It usually doesn’t affect boys until puberty. In 2017, it affected 387 men, mostly between the ages of 20 and 40.

Seminoma is the most common form in men aged 30 to 35, while non-seminoma most commonly affects men aged 25 to 29.

The testicle, in the embryo, forms in the womb. Then the testicle descends into the scrotum. In some cases it doesn’t come down. Men who have an undescended testicle have a higher risk of developing testicular cancer. If the undescended testicle is treated before the age of 2, the risk of testicular cancer is not increased.

How to recognize it?

The main feature is a abnormal, hard, painless swelling in the testicle. Usually a lump can be palpated. Other symptoms are enlargement of the testicle, a change in consistency, vague pain, and prolonged inflammation of the testicle. Cancer spreads easily and quickly, especially in the stomach, which can cause stomach pain. Sometimes you can also feel swollen glands in the groin.

How is the diagnosis made?

The doctor has 2 objectives: to diagnose the tumor and to detect possible metastases. This second objective is called “staging”, that is to say, we determine the stage at which the cancer is. It is important for the treatment.

The first examinations consist of a regular clinical examination, a blood test and a ultrasound testicles.

If the presence of a tumor is confirmed, tumor markers will be sought and measured during a blood test. Tumor markers are substances that the body or tumor makes in response to cancer growth. Later, the effect of the treatment can be measured by decreasing these markers.

To determine the extent of the cancer and detect any metastases, the doctor schedules a CT scan of the chest, stomach and pelvis with injection of a contrast medium. If the CT scan is not possible (for example in case of allergy to the contrast medium), an MRI examination of the belly is a good alternative.

After the operation, the tumor tissue is analyzed in the laboratory to identify the exact nature of the tumor. This is important for the rest of the treatment.

What can the doctor do?

Testicular cancer is usually treated well.

The basis of all treatment is the removal of the testicle (orchiectomy). Men with testicular cancer are generally younger and may want to have children. After treatment for testicular cancer, the fertility may be reduced. Fertility is however preserved in 65% of cases. In order to give all men the opportunity to have children later, it is often suggested to freeze their sperm before treatment.

Men with stage I cancer without metastasis are followed closely, without further treatment. In the event of recurrence or metastasis, a chemotherapy is started.

At all other stages, a chemotherapy is indicated. After treatment, the situation is assessed. The doctor looks for any lumps or metastases left. If it is found, treatment will depend on the type of tumor. If it is a seminoma, treatment will consist of chemotherapy and an radiotherapy. If it is a non-seminoma, the metastases will be removed surgically.

Post-treatment follow-up

After the treatment, checks will be scheduled regularly in order to detect as quickly as possible any possible recurrence and / or formation of metastases. This follow-up lasts 5 years.

  • Stage I seminoma : a blood test is taken every 3 months for the first 2 years, then every 6 months, to measure tumor markers. The first 2 years, a CT scan of the belly and pelvis is also performed every 6 months.
  • Stage I non-seminoma : A blood test is performed every month for the first year, every 2 months for the second year, every 3 months for the third year, and every 6 months for the fourth and fifth year. A CT scan of the belly and pelvis is scheduled after 3 and 12 months.
  • TO all other stages, so in all those who have had a chemo or some rays (radiotherapy), a blood test is carried out every 3 months for the first 2 years, then every 6 months for the following 3 years.

Testicular cancer usually affects just one testicle. The other healthy testicle is monitored by means of a ultrasound during regular checks.

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