Testicular cancer

Although testicular cancer is a relatively rare malignant disease in general, it is the most common tumour in 20- to 44-year-old men. Testicular cancer can still occur in later years but becomes rarer with increasing age.

Certain cells in the testicles most likely already have a tendency to degenerate at birth. Unlike lung cancer, for example, which can be triggered by smoking, there are hardly any factors that trigger testicular cancer that are controllable by the patient. The greatest risk factor for the development of a testicular tumour is the presence of undescended testicles in children. Early surgery can reduce this risk.

There is no screening for testicular cancer. However, patients usually feel a testicular tumour themselves because abnormalities on the testicle are easily noticeable. During the examination, the testicles should be palpated individually between the thumb and index finger. The soft structures that sit behind the testicles on both sides are the epididymis. These serve to store the seminal fluid. A self-examination should check for hardening of the testicles, as this can be an indication of testicular cancer. The earlier testicular cancer is detected, the better the chances are for successful treatment. For this reason, regular self-examination is recommended.

As with any cancer, a testicular tumour can be threatening. Surgery is normally necessary, and in often cases chemotherapy as well. With timely treatment, the chances of recovery are better than with almost any other form of cancer.

The most reliable way to determine testicular cancer is by palpation. The urologist also performs an ultrasound examination, which can assess tumours very well. Certain values, known as tumour markers, can also be elevated in the blood. However, these are less important for the diagnosis and are more useful for the choice of treatment and later assessment of the course of the disease.

Although no detrimental effects on sexuality and potency are expected if the other testicle is healthy, the ability to conceive may be limited and may even become worse in case of chemotherapy or radiotherapy. For this reason, men who wish to have children are advised to freeze sperm cells before the surgical procedure (cryopreservation).

Surgery must be performed for any suspected testicular tumour.

If the urologist suspects a testicular tumour, surgery should be performed as soon as possible. The affected testicle and its spermatic cord are pulled upwards out of the scrotum after an inguinal incision. If there is any doubt about the malignancy, a sample is taken during the procedure and the tissue is examined under a microscope. If the presence of a tumour is confirmed, the testicle is removed.

Inpatient stay is recommended for about 2-3 days. The patient should avoid physical exertion for a while. Examination of the tissue provides information on the type of tumour. Computer tomography, magnetic resonance imaging, and blood tests show whether the tumour has already spread. A decision is made whether further treatment is necessary on the basis of the findings. Chemotherapy is often recommended, but in special cases radiotherapy can also be useful. In any case, regular check-ups are necessary for at least 5 years.

As with any operation, there are general risks such as bleeding, inflammation, and disruption of wound healing. During the procedure, a sample is taken from the healthy testicle through a small incision in the scrotum to rule out an additional tumour. There is minimal risk to the healthy testicle. If it is not affected, no detrimental effects on sexuality and potency are expected. It is possible to insert a testicular prosthesis during the procedure for cosmetic purposes upon request of the patient. All possible risks of the surgical intervention are discussed in a detailed consultation before the procedure.