Treatment of testicular cancer in men and possible complications of the pathology

Testicular cancer affects men of all ages, from children and teenagers to the elderly, but the greatest number of diseases occurs at the age of 30-35 years. There are different types and stages of cancer.

If the tumor is detected at the first stage and treated immediately, the probability of complete healing is 95-100%; as the disease progresses, the chances of a favorable outcome decrease. Therefore, if you experience pain in the testicles or detect lumps, you should not hesitate to visit a doctor.

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Classification and stages of testicular cancer

There are several classifications of the stages of this cancer. The most common classification distinguishes 3 stages of testicular cancer, taking into account the presence and spread of metastases.

The third stage, in turn, is divided into 3 substages, A, B and C, in addition to the spread of metastases, the level of cancer markers is taken into account.

The international TNM classification distinguishes 4 stages of the disease depending on the tumor site:

• at the first stage (T1) it is localized within the tunica albuginea, and there are no pronounced testicular deformations;
• T2 – deformation and enlargement of the affected testicle occurs;
• T3 – epididymis affected by tumor;
• at the last (T4) stage it extends beyond the testicle.

This classification also evaluates the condition of the lymph nodes; depending on the presence and severity of metastases, 3 stages are distinguished - N0, N1 and N2 (metastases are absent/detected by X-ray (radioisotope) examination/detected by palpation). Another evaluation parameter is the presence (M1) or absence (M0) of distant metastases.

To prescribe treatment and prognosis, it is necessary to take into account not only the stage of the disease, but also the histological type of cancer, that is, the type of cells that form the tumor.

Malignant testicular tumors are divided into seminomas (tumors from cells involved in the production of sperm) and non-seminomas (tumors from other cells).

Non-semenomas, in turn, are divided into tumors of the following type:

• embryonal cancer;
• yolk sac;
• teratoma;
• Choriocarcinoma.

Stage 1

The tumor is localized within the testicle, without affecting the lymph nodes and other organs, there are no metastases. If cancer is diagnosed at this stage, the chance of complete cure exceeds 95% .

Regardless of the type of tumor, it is removed along with the testicle. In some cases, treatment is limited to this, but the patient is prescribed medical supervision for 10 years.

In more complex cases, antitumor drugs or radiation therapy or chemotherapy are prescribed after surgery. These same treatments may precede surgery to shrink the tumor.

If the tumor is non-seminoma, the risk that the disease will progress is higher , in some cases it is necessary to resort to surgical removal of the lymph nodes located in the abdominal cavity.

Stage 2

As testicular cancer progresses, it primarily affects the retroperitoneal lymph nodes, as well as the para-aortic ones. The second stage of the disease is characterized by the presence of metastases.

For seminomas, the probability of healing at this stage is 85-90%. For non-seminomas, for example, if choriocarcinoma or embryonal testicular cancer is diagnosed, the prognosis is less favorable, the probability of recovery without recurrence is reduced to 70%. Teratoma and yolk sac tumor are more treatable.

Treatment, as with stage 1, is surgical; in addition to the testicle, it is often necessary to remove the affected lymph nodes. 3-4 courses of chemotherapy or radiation are required.

1. 3A – the mediastinal lymph nodes located between the lungs and/or the lungs themselves are affected.
2. 3B – metastases penetrate the lungs and distant lymph nodes, while the level of markers is moderately high.
3. 3C – the level of markers is much higher, and metastases spread to other internal organs, and can affect the liver and brain.

Stage 3C is sometimes considered stage 4 testicular cancer. Even at this stage, the prognosis is favorable in at least 48% of cases; after surgery, the patient can live 5 years or more.

As in the early stages, a radical orchiectomy is required - removal of the testicle affected by the tumor. In the postoperative period, the use of antitumor drugs is combined with chemotherapy, and several courses are carried out.

If metastases in distant organs have reached a sufficiently large size (from 3 cm), their surgical removal is also recommended. The patient should undergo regular thorough examinations for timely detection of metastases.

What else do you need to know about testicular cancer?

The main symptoms of testicular cancer are:

• dull pain in the lower abdomen, scrotum, back;
• change in the size of one of the testicles, enlargement of the scrotum, usually asymmetrical;
• the appearance of round-shaped seals;
• low-grade fever, weakness and fatigue, weight loss characteristic of any cancer;
• in the later stages - cough, shortness of breath, pain in the liver.

Diagnostics

Along with the signs that can be detected during self-diagnosis and during a medical examination, hardware examinations and laboratory tests are carried out.

A blood test is aimed at identifying cancer markers. At an early stage, an ultrasound of the scrotum is performed, and to detect metastases, computed tomography or magnetic resonance imaging of the organs where they can spread is necessary.

Treatment

Radical orchiectomy is the main treatment for testicular cancer, regardless of type and stage , and is usually performed under general anesthesia. After the operation, a histological examination of the removed testicle is performed, which makes it possible to establish the type of tumor and make a decision regarding the advisability of using other methods.

As a rule, cancer treatment should be combined; in addition to surgery, the following methods are used for different types and stages of cancer :

• antitumor therapy;
• chemotherapy;
• irradiation (radiotherapy).

Prevention

The most effective method of preventing testicular cancer is regular self-diagnosis , examination and palpation of the testicles to detect compactions, changes in shape, weight and size. It should be done monthly after hygiene procedures.

Pain in the scrotum and lumps in the testicles are not necessarily a sign of cancer, but if symptoms appear, it is necessary to consult a urologist to clarify the diagnosis .

Forecasts

Testicular cancer is not a death sentence ; even in the later stages of this disease there are fairly high chances of cure. But the prognosis is most favorable if the disease is detected at the first stage, when metastases have not yet appeared.

Regular self-diagnosis, medical consultations and examination when alarming symptoms are detected increase the chances of a successful outcome. Early diagnosis, combined treatment and long-term observation in the postoperative period are important for patients.

Video on the topic: how to recognize testicular cancer in the early stages?

A noticeable enlargement of the testicles can be a symptom of other diseases, for example, testicular hydrocele in men.

What is epididymal cancer and what are its symptoms - find out all the details.

Oncological diseases in men often metastasize to the throat. How surgery is performed for laryngeal cancer on this page: https://man-up.ru/bolezni/onkologiya/rak-gortani/operatsiya-pri-rk-gort.html

Source: https://man-up.ru/bolezni/onkologiya/rak-yaichka/stadii.html

Symptoms of testicular cancer in men, treatment, consequences:

Testicular cancer is rare, but this is not a mitigating factor, because a man who is diagnosed with testicular cancer can die within 3 years of the disease. Because of this, it is worth taking your health seriously and being able to prevent illness in advance. To do this, you need to know the main symptoms of testicular cancer in men.

What are we dealing with?

Testicular cancer is a malignant tumor that can form unpredictably. This tumor appears in the gonad and can later spread throughout the body. Specifically, it develops in organs such as the brain and bone marrow, liver, and lungs.

According to statistics, most often a malignant testicular tumor is found in men aged 15 to 35 years. Diagnosis is carried out using diaphanoscopy, ultrasound of the scrotum and testicular biopsy. During treatment for testicular cancer, the patient undergoes unilateral or bilateral orchidectomy, radiation therapy and chemotherapy.

Prognosis of the disease may depend on its stage and histological type. Symptoms of testicular cancer in men will be discussed below.

Type of cancer

Testicular cancers are divided into the following classes:

• A germ cell tumor is formed from a man’s semen and is the most common.
• A non-germ tumor is formed from the testicular stroma.
• A mixed tumor may contain cells of both of the above types.

Why can testicular cancer develop in men?

This disease has symptoms (photos can be seen in our article), but they only appear at a late stage. But what causes the pathology?

It’s hard to say what exactly can cause testicular cancer, but there are some patterns and factors in the appearance of this terrible disease:

• Most patients are men with tall stature and thin build.
• The presence of an immunodeficiency virus may increase the risk of developing a malignant tumor.

• Often, patients with testicular oncology are people who belong to the white race, while the average African American or Asian suffers from this pathology ten times less often.
• Damage to the scrotum.
• Endocrine pathology.
• After exposure to radiation.
• Transmission of oncology by inheritance.
• Congenital underdeveloped testicles.
• A twisted testicle.
• Oncology often occurs in smokers addicted to nicotine.
• Early puberty can also trigger the disease.

Symptoms of testicular cancer in men

Testicular cancer is often caused by hardening of the tissue in the genital organs, which causes them to enlarge. Such processes can occur both painfully and painlessly. In this case, the patient complains of pain in the abdomen, scrotum, and swelling of the testicles.

Signs such as lethargy, weight loss, and a temperature around 37.5 C may appear. The scrotum begins to swell and may noticeably increase in size. The patient may notice a partial or complete lack of sexual attraction to the opposite sex.

When testicular cancer occurs in men, the symptoms (photos of the organs confirm the presence of pathology) are varied:

• There is a thickening of the tissue of the genital organs, which is not always accompanied by pain.
• Deformation of the genital organs.
• Swelling of the testicles.
• Pain appears in the area of ​​the seminal canal and in the lower abdomen.
• Painful sensations are observed in the dorsal and thoracic regions.
• Dyspnea.

These are the main signs of testicular cancer in men.

What else happens when you get sick?

Bleeding and necrosis of tumor tissue may also develop, in which case the pain can be very noticeable, and every tenth man with testicular oncology complains about it. With the accumulation of metastases in the lymph nodes of the abdominal region, severe pain is observed in the lower back.

If the formation of a tumor begins to spread metastases to the bone marrow, this is also accompanied by pain. In cases where tumor masses appear outside the initially infected organ, this changes the condition of the patient as a whole. This condition is expressed by fever, fatigue, and lack of strength.

This is how cancer of the right testicle manifests itself in men. Symptoms may vary from person to person.

Some tissue formations behave quite aggressively. Such manifestations may include damage to organs such as the lungs, liver, bone marrow, brain, skin and lymph nodes.

Self-examination

A man himself is able to identify testicular cancer in its first stages. This can be done by ordinary palpation. If it begins to look something different, becomes too hard or soft, swollen, lumpy, or changes in shape or size. The disease can make itself felt by painful sensations.

At the first suspicion of this insidious disease, you should contact a specialist for diagnosis.

When a man goes to the clinic on time with his problem, it is much easier to solve it, but if suspicious symptoms of the disease are ignored, the outcome can be quite disastrous.

We have looked at the symptoms of testicular cancer in men and will deal with the consequences.

What could be the consequences?

If oncology is detected in the early stages, the patient has a great chance of being cured of the disease completely without any consequences.

But, unfortunately, according to statistics, most men do not immediately turn to a specialist, but only after a while. In such situations, the chance of success is significantly reduced.

The patient may be offered to undergo an orchiectomy procedure, that is, removal of the affected testicle, in which case men develop an inferiority complex. But externally, the problem can be eliminated without problems by implanting a prosthesis in place of the organ that was removed.

Treatment of the disease should not be delayed, as it tends to progress quickly and spread to other organs, which can lead to death. This is the danger of testicular cancer in men.

The symptoms and consequences of the disease are, of course, terrible, but timely diagnosis and treatment are of great importance for human life.

Diagnosis of testicular cancer

Diagnosis of a patient is one of the most important stages on the path to treatment. After a quality examination, the doctor can make an accurate diagnosis and give instructions on the next steps.

To determine testicular cancer, the doctor first palpates the scrotum area; regardless of the simplicity of the procedure, it provides enough information to take further action.

Diagnostics allows you to examine and identify the affected tissue, and palpation helps you find out what the consistency and size of the testicle is, as well as the location of the tumor. Palpation should begin from the healthy side of the organ.

A malignant tumor most often has tissue compaction and painlessness, but with inflammation of the organ, pain can still occur. It is definitely worth examining the lymph nodes, which are most likely to contain metastases.

By palpating the abdomen, tumors can be detected, and when examining the mammary glands, gynecomastia can be detected.

There is also laboratory diagnostics, which includes a mandatory stage of examining the patient, since an increased level of a certain indicator in the blood can indicate not only the activity of the tumor, but also its dynamic development.

Examination stages

• Collecting information and conducting analysis on complaints about the disease (how long ago the pain began to appear, where exactly it manifests itself, heaviness in the scrotum, detection of formations in the testicle, increase in the size of the scrotum).
• Analysis of medical history (how the disease was tolerated, surgery, whether there were injuries in the scrotum area).
• Can oncology be inherited by a patient (detection of a similar disease in the patient’s relatives).
• Tactile examination, palpation of the lower abdomen.
• An ultrasound examination of the scrotum will allow you to get a clear picture of the internal organ and analyze any changes in the body.
• Undergoing an X-ray examination of the chest area.
• Biopsy (examination of genital tissue using a microscope) of the testicle.
• Blood test for hCG levels (beta hCG, human chorionic gonadotropin).
• MRI (magnetic resonance imaging, one of the ways to obtain a diagnostic image, it is safe for the human body).
• CT (computed tomography, x-ray examination, which allows you to obtain an image by displaying it on a computer screen).
• You can also consult an oncologist.

How to treat?

We looked at the symptoms of testicular cancer in men. How long do they live? If left untreated, the average life expectancy is from 1 to 3 years.

Testicular cancer can respond well to therapy even when the tumor has begun to metastasize. But it is best to consult a doctor immediately if you notice any symptoms of the disease.

By delaying going to the doctor, you may wait until it is too late to do anything during your appointment with the oncologist.

The main treatment method is surgery. The tissue where the cancer is spreading is removed. After removal of the testicle, the patient undergoes radiotherapy (radiation of the tumor) or chemotherapy (cure the patient with the support of anti-cancer drugs). This is why it is so important to identify epididymal cancer in men. The symptoms will help with this.

Determine the type of cancer

It is possible to begin therapy only after the type of cancer has been determined. The localized form is treatable in most cases. This form is sensitive to radiotherapy.

After chemotherapy, most of the tissue formations gradually disappear within a few months.

If after a while there are no changes and the metastases have not disappeared completely, you should undergo a course of radiotherapy or resort to surgery followed by removal of the infected organ.

In cases where nonseminoma or mixed testicular cancer is diagnosed in men, a radical inguinal orchiectomy and monthly monitoring may be prescribed. Chemotherapy is prescribed in cases where, after analysis, abnormalities are still shown.

Usually everything is managed with standard chemotherapy, but if this gives insufficient results, then a more intensive treatment regimen is used and bone marrow autotransplantation is performed.

If, after a biopsy, carcinoma is detected in patients, radiotherapy will be prescribed, which will give a 100% effect and recovery of the patient.

If signs of testicular cancer are detected in men (symptoms described above), hospitalization and medical supervision are strongly recommended. Self-medication for this disease is prohibited and can have serious consequences.

What drugs will help cure testicular cancer?

Treatment with pills and other medications prescribed by a doctor, along with undergoing procedures, brings much more benefits. During therapy the following drugs are taken:

• "Cisplatin";
• "Vinblastine";
• "Etoposide";
• "Bleomycin";
• "Kemoplat";
• "Ifosfamide."

If testicular cancer is detected, you should immediately contact doctors such as: oncologist, urologist, oncologist surgeon, endocrinologist. At the beginning of treatment, the patient undergoes a number of procedures, the main of which are tissue collection for subsequent analysis and palpation of the testicles.

If it is increased in size and has compaction, then this is an alarming sign. Induration and swelling in the scrotal area makes it necessary to palpate the other testicle and other lymph nodes.

The patient can also be diagnosed during surgery. Urgent morphological studies can often be combined with radical inguinal orchiectomy, but not with transscrotal biopsy. The latter is not recommended, as it has a high risk of local dissemination.

Conclusion

Now, having sufficient knowledge, it is possible to prevent a malignant tumor when the first signs of the disease appear. If at least one of the syndromes occurs, you should immediately consult a doctor. If the disease is truly detected, it can be easily eliminated in the initial stages of development. Timeliness in this case is the key to health!

The article discusses a disease such as testicular cancer in men. Symptoms, treatment, consequences are also described.

Source: https://www.syl.ru/article/307359/simptomyi-raka-yaichek-u-mujchin-lechenie-posledstviya

Testicular cancer: signs and symptoms, treatment and prognosis

Testicular cancer is a cancer that develops in the testicles (testicles), which are part of the human reproductive system.

Men, from a young age to old age, are at risk of developing testicular cancer. More than half of patients with this diagnosis are under 35 years of age.

Although the disease itself occurs in only 3% of cases in men, it has an aggressive course and is often the cause of death for the patient. Based on this, the male sex needs to take great responsibility to monitor their health in order to timely identify signs of the disease and provide an emergency response.

The disease was assigned a code in accordance with ICD-10: C62

The testes (also called testes) are part of the male reproductive system. These two organs are contained in a leather sac called the scrotum. The scrotum hangs below the base of the penis.

Illustration showing the testicles in relation to the penis, urethra, bladder, prostate, scrotum, vas deferens and appendages.

Testes perform two main functions:

1. They produce male hormones (androgens) such as testosterone.
2. They make sperm, the male cells needed to fertilize an egg to start a pregnancy.

Sperm are produced in long thread-like tubes inside the testicles called seminiferous tubules. They are then stored in a small spiral tube behind each testicle called the epididymis, where they mature.

During ejaculation, sperm are transported from the epididymis through the vas deferens to the seminal vesicles, where they mix with fluids produced by the vesicles, prostate and other glands to form sperm. This fluid then enters the urethra, the tube in the center of the penis through which both urine and semen leave the body.

The testicles are made up of several types of cells, each of which can develop into one or more types of cancer. It is important to distinguish these types of cancer from each other because they differ in treatment approach and life prognosis.

Non-germinogenic - arise from the testicular stroma, occurs less frequently than in 5% of episodes, and refers to them:

Testicular germ cell tumors originate in the seminiferous epithelium and are the most common (95% of cases). Such tumors include:

• seminoma (more than 35% of all cases);
• yolk sac tumor, etc.

Mixed - contain both non-germ cells and germ cells.

• There are several classifications for the development of testicular cancer. So, based on the international criteria according to the TNM system, there are the following stages of the disease:
• T-1 - the tumor does not extend beyond the tunica albuginea;
• T-2 - the formation is limited to the tunica albuginea, but there is deformation in the scrotum, and the testicles are enlarged;
• T-3 - tumor cells pierce the tunica albuginea and grow into the adnexal organs;
• T-4 - the tumor extends beyond the borders of the testicle, grows in the testicular cord or scrotal tissue;
• N-1 - there are metastases in the structures of the lymph nodes, and they are detected by radioisotope or x-ray diagnostics;
• N-2 - there are metastases, enlarged lymph nodes are detected during examination by palpation.
• M-1 - metastases affect distantly located organs: liver, kidneys, lungs, bone tissue and brain.
• There is a classification in which there are 3 stages, with the stage being divided into substages A, B and C, they take into account the cancer marker, as well as the degree of distribution of metastases to internal organs and lymph nodes. This classification is more common and has the following stages:
• Stage 1 - the tumor process is limited to the testicle, there are no metastases, other organs and lymph nodes are not damaged, symptoms of testicular cancer in men are practically absent, and complete recovery occurs in 98% of cases;
• Stage 2 - tumor cells affect the para-aoral and abdominal lymph nodes, metastases germinate, recovery occurs in 50% of cases;
• Stage 3A - damage to the lymph nodes that are located in the lungs or between them;
• Stage 3B - metastases form in distant lymph nodes and lungs, has an average marker level;

Stage 3C - metastases spread to internal organs (liver, kidneys, etc.), has a high level of marker.

The main symptom that indicates the development of a malignant tumor is the appearance of a dense neoplasm in the scrotum and the enlargement of this organ. These lumps may be painless or painful.

It is usually discovered by chance or during self-examination. It is important to seek help from a specialist at the first detection of such manifestations, because this can save lives in the future.

So, we list all the possible symptoms of testicular cancer in men:

• the disease begins with the presence of compaction in the scrotum area, testicular swelling, a feeling of pressure in the testicular area;
• signs inherent in any cancer: increased fatigue, weakness in the body, headache, low-grade fever, sudden weight loss, loss of appetite;
• a feeling of pain, heaviness in the spermatic cord and in the abdomen below the navel;
• when the appendages are affected, a hormonal disorder occurs, for example, painful sensations appear in the mammary glands and their enlargement (gynecomastia);
• difficulty breathing, shortness of breath;
• increased size of lymph nodes;
• decreased libido or its complete absence;
• impaired sensitivity in the genitals;
• disturbances in the outflow of urine, the development of hydronephrosis and pilonephritis;
• increased hair growth on the body and face before puberty;
• as a result of metastases in the brain, the psyche changes and neurological disorders occur;
• when metastases appear in bone tissue, fractures and pain syndromes occur;

It should be noted that the appearance of symptoms of testicular cancer depends on the location of the tumor, the period of the disease, the presence of metastases, as well as on the condition of the body as a whole. Thus, for some they manifest themselves clearly, but for others they go unnoticed.

It is impossible to reliably say what causes the development of testicular cancer. However, there are some patterns and risk factors in the course of this cancer, these include:

• Diseases of the genital organs: cryptorchidism, testicular torsion, congenital underdevelopment of the testicles and others.
• History of testicular tumor.
• Trauma to the scrotum, its systematic overheating.
• Pathology of the endocrine system.
• Exposure to radiation and radiation, hypothermia.
• The human immunodeficiency virus increases the likelihood of developing cancer, as well as other viruses and infections.
• Unlike African Americans and Asians, this pathology occurs 10 times more often in white men.
• Tall and thin men are more susceptible to testicular cancer.
• Long-term smoking, alcoholism, drug addiction.
• In rare cases, such a pathology may develop due to Down or Klinefelter syndrome.

If testicular cancer is detected early in the development of the pathology, complete recovery is possible in 90% of patients. But according to statistics, most men who discover signs of the disease do not immediately consult a doctor, but only after the advanced stages have occurred. Treatment in these cases is usually not successful and may have some consequences.

Thus, when a testicle affected by tumor cells is removed, generally, the man begins to develop an inferiority complex. Although from the physiological point of view, the second testicle copes with the tasks perfectly. This problem is most often solved by implanting a prosthesis to replace the testicle that was removed.

If treatment required chemotherapy or radiation exposure, this can lead to certain complications:

• Infertility as a result of high doses of radiation.
• Lack of sperm (azoospermia) as a result of cisplatin chemotherapy. Eliminates completely within 5 years.
• Toxic kidney damage as a result of anticancer drugs (ifosfamide, cisplatin).
• Violation of the bone marrow structure.
• Nausea and vomiting, hair loss and other manifestations of radiation or chemotherapy.
• It is important to understand that testicular cancer progresses very quickly and delays in treatment contribute to its development, the formation of extensive metastases that disrupt the functioning of various organs, which ultimately leads to death.

If you suspect the development of testicular cancer, you should immediately seek help from a specialist (urologist-andrologist) who can properly examine and palpate the scrotum.

Sometimes, already at this stage, suspicions arise about the presence of a malignant tumor, which is usually distinguished by a dense formation in the scrotum.

In addition, the doctor will examine the lymph nodes in the groin, abdominal cavity, mammary glands and supraclavicular glands, and will also take into account the presence of complaints, whether the man has signs of testicular cancer, medical history and heredity.

Upon completion of the examination by the doctor, the patient is referred for the following instrumental diagnostic studies:

A complete diagnosis helps the doctor select the most appropriate therapy.

How to detect testicular cancer at an early stage?

To do this, it is important to conduct self-diagnosis. To do this, men need to carefully monitor their health and systematically independently examine their testicles.

To carry out this procedure, it is necessary to feel the entire area of ​​the testicles to detect any seals (nodules).

If you experience pain during the examination or detect lumps on the testicle, you should urgently contact a medical facility for additional tests.

With proper and timely treatment of testicular cancer, it is possible to completely get rid of it. Therapy is selected based on the type of tumor and the stage of cancer development, and it is based on surgical, radiation and chemotherapy.

Surgical intervention involves removing the tumor along with the testicle, and it is also possible to remove the affected lymph nodes and metastases in the organs.

In addition to removing the testicle, at the first stage antitumor drugs are prescribed, and in some cases chemical and radiation therapy is performed before surgery to reduce the size of the tumor.

In the second and third stages of the disease, after removal of the testicle and affected lymph nodes, several courses of chemotherapy or radiation and antitumor medications are required.

Let's look at treatment methods in more detail. Five types of standard therapy are commonly used:

Upon completion of the treatment procedure, it is important to continue careful monitoring with a specialist, not to miss a single meeting, to carry out the necessary tests and procedures to detect possible consequences of the disease and timely detection of cancer relapse.

Methods for preventing and treating the disease:

• diet, nutrition must be balanced: exclude fried foods and fatty foods, eat more fresh fruits and vegetables;
• give up various bad habits;
• increase physical activity;
• stop wearing tight underwear;
• avoid injury to the scrotum;
• promptly treat diseases of the genital organs;

Successful treatment of testicular cancer is influenced by several factors:

• A positive prognosis for this oncology is possible only at an early stage of detection of the disease, and in this case the survival rate is about 90-95%;
• If the disease was detected at stages 2 or 3 of development, which are characterized by the presence of metastases, then complete change is impossible, but the probability of five-year survival is 50%;
• To plan future paternity, cryopreservation of seed material is carried out before treatment.
• To prevent testicular cancer, it is necessary to timely eliminate cryptorchidism, prevent injuries to the scrotum, eliminate the possibility of irradiation of the genitals, their overheating, and lead a healthy lifestyle. And systematic self-examination and timely contact with a specialist if any symptoms are detected contribute to the timely detection of cancer.

Source: https://ProtivRaka.su/organy/rak-yaichka.html

Treatment of testicular cancer: methods and prognosis

Despite its extremely aggressive course, in the vast majority of cases, testicular cancer is highly treatable. The best results are observed in the treatment of patients with seminomas. These malignant tumors grow from tissue cells that produce sperm.

Non-seminomas - teratomas, embryonal carcinomas, choriocarcinomas, yolk sac tumors - respond somewhat worse to oncology therapy. However, the use of modern drugs and methods allows specialists to successfully deal with these types of tumors.

Prognosis for the treatment of testicular cancer at different stages

• The 5-year survival rate of patients practically reaches 100% if the tumor can be detected at stage 1, that is, when the lesion has not yet spread beyond the testis. It is necessary to immediately clarify that the meaning of the medical term “survival” is often misinterpreted. In fact, this statistical indicator refers to the percentage of patients who have not had a relapse of the disease for a given number of years. But this does not mean that the life of the treated patient is limited to just one, two or five years.
• In stage 2 testicular cancer, tumor cells are found in nearby lymph nodes, which requires expanding the scope of treatment, but only slightly worsens the prognosis: the five-year survival rate reaches 90-95%.
• Therapy for patients with metastases (stage 3-4 testicular cancer) can also be very successful: in 80 out of 100 such patients, the disease does not return in the next five years. There is another positive point: if a relapse does occur, then, most often, it can also be stopped.

Testicular cancer treatment methods

In addition to the stage, the volume, composition and treatment regimen are influenced by the location and type of tumor, as well as the level of specific proteins (tumor markers) in the patient’s blood and his general health.

Surgery

Surgery to remove the affected testicle (orchiectomy) in patients with stage 1 seminomas can be chosen as the only method of treatment if the neoplasm behaves non-aggressively and the risk of the disease returning is minimal.

If tumor markers indicate an aggressive nature of the process, a course of chemotherapy is prescribed after surgery.

If preliminary diagnosis casts doubt on the malignancy of the process, in some cases surgeons may decide to try to save the testicle by removing only the tumor itself. To do this, the tumor is excised and express histology is performed. If atypical cells are detected, the operation is continued, if absent, it is completed.

Surgical intervention is used at all stages of the disease, including advanced ones. Its nature depends on both the prevalence and the type of cancer. In addition to the affected testicle and appendages, lymph nodes in the lower part of the abdominal cavity, as well as in the thoracic aorta and lungs, can be removed if tumor foci remain there after chemotherapy.

Orchidectomy according to the standard procedure is performed under general anesthesia or using spinal anesthesia (a type of local anesthesia). The duration of such an operation takes no more than half an hour. For extended surgical procedures, general anesthesia is always required.

Radiation therapy

Radiotherapy is commonly used in treatment regimens for locally advanced seminomas. Although this method is inferior in effectiveness to chemotherapy, it is more gentle.

Therefore, men with stage 2A seminomas after surgery are usually prescribed irradiation of the lymph nodes of the lower abdomen.

Radiation treatment may also be chosen as an adjunct to surgery in patients with stage 2B seminomas.

• The course of radiotherapy lasts from 3 to 4 weeks with breaks for rest and recovery on weekends.
• At later stages of development of seminomas, as well as in complex therapy with non-seminomas, priority is given to chemotherapy.
• Chemotherapy for testicular cancer

Chemotherapy is one of the main and most effective methods of combating malignant testicular tumors with a high risk of relapse and a widespread process. The duration of cycles, their number and frequency depend on the type of cytostatics, the characteristics of the disease and the patient’s health status.

For chemotherapy for testicular cancer, courses of intravenous drip injections can be used:

• bleomycin, etoposide and platinum drugs (BEP);
• paclitaxel, ifosfamod and cisplast (TIP);
• vinblastine, ifosfamide and cisplastine (VeIP), as well as combination therapy with the POMB/ACE regimen or monotherapy with cisplastine, etoposide or carboplatin.

In the intervals between cycles, the patient is discharged home for 1-2 weeks.

According to the results of clinical trials conducted by specialists from British specialized oncology centers and urological oncology surgeons from the Russian Cancer Research Center named after. Blokhin, when diagnosing a non-germ testicular tumor at stage 1, a course of adjuvant chemotherapy can increase the 2-year relapse-free survival rate in patients with this diagnosis from 70% to 97%, and the overall survival rate to 99%.

Doctor of Medical Sciences, Professor Sergey Alekseevich Tyulyandin recommends including adjuvant chemotherapy in treatment regimens for patients with non-seminomas.

Consequences of treatment

In the absence of general postoperative complications (bleeding, etc.), you are allowed to move within 2 days after removal of the testicle, but pain in the groin can persist for up to 7-10 days. It is eliminated with the help of painkillers.

During radiotherapy and in the first days after its completion, gradually progressive weakness and a feeling of fatigue sometimes develop, skin soreness, pain in the lower abdomen, and stool disorders (diarrhea).

The effect of chemotherapy is manifested by a number of transient disturbances, including loss of appetite and weight, weakness, weakness, decreased resistance to infections, bruising and bleeding.

Therefore, the use of any dietary supplements is possible only with the permission of the attending physician.

Since the disease develops at a young age, one of the most noticeable and undesirable long-term consequences of radiotherapy and chemotherapy treatment for testicular cancer in men is the likelihood of decreased fertility. Preliminary collection of sperm, its freezing in liquid nitrogen and storage in special storage facilities - sperm banks, which today exist in almost every Russian region, help preserve the possibility of procreation.

Recovery after treatment

The duration of the recovery period depends on the nature and composition of the treatment, the severity of side effects (if any), as well as the general health of the man.

At this time, it is necessary to lead a measured lifestyle, get proper rest, avoid heavy physical activity (at least 6 weeks), and exclude the possibility of infection in the postoperative area.

During the recovery process, patients with diarrhea are advised to drink plenty of fluids and adhere to a special diet, excluding bran, dried fruits, cabbage, bread and whole grain cereals from the diet, and reducing the consumption of fresh fruits and vegetables, and juices. It is useful to add bananas to the menu.

If you follow doctors' recommendations regarding nutrition, regimen and personal hygiene, complete healing of postoperative sutures occurs within a few weeks, the side effects of radiotherapy disappear within 1-2 weeks, chemotherapy - within a few days.

If you need a second opinion to clarify your diagnosis or treatment plan, send us an application and documents for consultation, or schedule an in-person consultation by phone.

+7 499 490-24-13

Expert opinion

1. Scientific degree: Candidate of Medical Sciences
2. Specialization: oncologist, hematologist, chemotherapy
3. Position: chief physician

Place of work: “Outpatient Oncology and Hematology Clinic”

Moscow city

Worked in leading cancer centers in the USA and UK. Trained in medical management in Canada, Germany, Singapore. Author of a number of publications, participates in scientific programs as a principal investigator.

Invited expert on thematic radio and television broadcasts on TV channels “Dozhd”, “Mir”, “RBC”, etc., Radio Liberty, “Echo of Moscow”, “Mayak”, etc.

Publishes articles and gives interviews to journalists from popular publications “AIF”, “Women’s Health”, etc.

Source: https://rakanet.ru/rak-yaichek/lechenie-raka-yaichek/

Testicular cancer

What are testicles?

The testicle is a paired organ located in the scrotum. The function of the testicles is to produce sperm necessary for fertilization. In addition, male sex hormones are formed in the testicles - androgens, which are responsible for the development and maintenance of secondary sexual characteristics. The testicles are supplied with blood by the testicular arteries. The outflow of blood from the testicles occurs through the testicular veins.

Lymph from the testicles flows into the lymph nodes of the retroperitoneum. These lymph nodes are located along the main vessels of the body - the aorta and the inferior vena cava, lying on the posterior abdominal wall, in front and on the sides of the spine.

Lymph nodes are part of the lymphatic system, which fights infection and disease, and serve as filters for foreign agents.

What is testicular cancer and why is it dangerous?

The growth of a testicular tumor can lead to a significant enlargement of the scrotum, germination of the skin by the tumor, and the appearance of ulceration of its surface. However, the main danger of this disease lies in the early and rapid spread of the tumor, primarily to the retroperitoneal lymph nodes and lungs.

If appropriate treatment is not carried out, the appearance and growth of metastases in the retroperitoneal lymph nodes can lead to compression of the ureters with the development of renal failure, and can also compress the intestine and cause intestinal obstruction. These complications of testicular cancer are the most common causes of death in patients.

In addition, testicular cancer can affect the liver, supraclavicular lymph nodes, mediastinal lymph nodes, kidneys, adrenal glands and brain.

How common is testicular cancer?

Testicular tumors account for 1-2% of all malignancies in men and are the leading cause of death among malignancies in this age group. Testicular tumors most often occur between the ages of 14 and 44 years. Recently, there has been a steady increase in the incidence of testicular cancer.

What causes testicular cancer to develop?

The exact cause of testicular cancer is unknown. There is an increased risk of developing this disease in patients with a testicle that has not descended into the scrotum (cryptorchidism), including after testicular descent.

The effect of testicular trauma on the likelihood of tumor development has not been confirmed. Men with testicular hypo- or atrophy also have an increased risk of developing cancer of this location.

Consanguinity increases the likelihood of developing testicular cancer for fathers and sons of patients by 2-4 times, and for brothers of patients - by 8-10 times compared with the male population

Clinical manifestations of testicular cancer

The clinical picture of a testicular tumor consists of symptoms caused by the presence of the primary tumor and metastases. The most common manifestation of a testicular tumor is pain, an increase in the size of the corresponding half of the scrotum with the appearance of a palpable tumor in it.

Symptoms caused by metastases of testicular cancer are determined by which organ is compressing the tumor node. Back pain may indicate enlargement of the retroperitoneal lymph nodes, which compress the nerve roots, or involvement of the lumbar muscle in the tumor process.

Compression of the inferior vena cava and blockage of the lymphatic pathways lead to the appearance of edema of the lower extremities. Impaired urine flow through the ureters can lead to the development of renal failure.

A significant enlargement of the retroperitoneal lymph nodes may result in intestinal obstruction.

When the tumor spreads above the diaphragm (the muscular partition between the abdominal and thoracic cavities), the lymph nodes of the mediastinum are affected, resulting in complaints of shortness of breath and cough. In addition, the supraclavicular lymph nodes may enlarge.

With some testicular tumors, hormonal disorders may develop. These include enlarged mammary glands, decreased libido, impotence in adults and early enlargement of the penis, pubic hair, voice mutation, premature development of the skeletal and muscular systems, and frequent erections in children.

Diagnosis of testicular cancer

If your doctor suspects that you may have a testicular tumor, he should refer you to a specialized hospital. A specialist urologist will conduct an examination, which will include palpation of the abdomen, external genitalia, mammary glands and all groups of lymph nodes.

You will have blood taken from a vein for clinical and biochemical analysis, urine for general analysis, and electrocardiography (ECG) will be performed. If necessary, your doctor will prescribe other types of examination.

Tumor markers

If testicular cancer is suspected, the level of tumor markers in the blood - alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) and lactate dehydrogenase (LDH) - must be determined.

Ultrasound examination (ultrasound)

• Ultrasound examination is a safe and painless examination method that does not require special preparation. Ultrasound allows you to detect the presence of a testicular tumor, assess its size and structure. Ultrasound makes it possible to diagnose testicular cancer metastases in the retroperitoneal lymph nodes, liver and other organs of the abdominal cavity and retroperitoneal space. The correctness of the ultrasound conclusion depends on the qualifications of the doctor performing the examination, as well as the thickness of the anterior abdominal wall and the presence of gas in the intestines.

X-ray of the chest organs

• A chest x-ray is performed to determine the presence or absence of lung metastases.

Intravenous urography

• Intravenous urography is a method of x-ray examination that allows you to assess the condition of the upper urinary tract - the renal pelvis and ureters. This is necessary for planning treatment tactics, since metastases of testicular cancer in the retroperitoneal lymph nodes can compress the ureters. Intravenous urography is performed after the injection of a contrast agent into a vein, which is excreted in the urine that fills the urinary tract. This allows them to be imaged when taking an x-ray. The contrast agent contains iodine, so if you are allergic to it, you should tell your doctor.

Computed tomography (CT)

• Computed tomography (CT) is a special type of x-ray examination that allows you to obtain cross-sectional images of the body. A CT scan is performed after a contrast agent is injected into a vein, which allows for a clearer image. The contrast agent contains iodine, so if you are allergic to it, you should tell your doctor. CT makes it possible to diagnose testicular cancer metastases in the retroperitoneal lymph nodes, determine their exact location, size, relationship to the walls of the aorta and inferior vena cava, as well as diagnose metastases in the liver, kidneys, adrenal glands, mediastinal lymph nodes, and lungs. CT is the preferred method for examining patients with testicular cancer.

Angiography

• Since testicular cancer metastases are most often located in the retroperitoneum in close proximity to large vessels such as the aorta and inferior vena cava, in some patients, preoperative imaging of these vessels is necessary when planning surgical treatment. To do this, under local anesthesia, a special catheter is inserted into the femoral artery, which is passed into the vessel whose course interests the surgeon. A contrast agent is injected through the catheter. After this, a series of x-rays is taken with the required image of the great vessels. The contrast agent contains iodine, so if you are allergic to it, you should tell your doctor. After the procedure, a pressure bandage is applied to the puncture site of the femoral artery for 24 hours. The risk of bleeding from the femoral artery after angiography is extremely low, however, it exists, so bed rest should be observed for 24 hours after the procedure.

Orchidectomy

• Based on the examination, a preliminary diagnosis of testicular cancer is established, after which in all cases an orchidectomy is performed (removal of the testicle with the epididymis and spermatic cord). This operation is needed not only to remove the testicular tumor, but also to examine the tumor tissue under a microscope (histological examination). Accurate results of histological examination are extremely important for choosing further treatment tactics.

Classification of testicular cancer

After receiving all the examination results, including the level of tumor markers and histological conclusion, an accurate diagnosis and stage of the disease is established. Testicular cancer is divided into two groups that are fundamentally different in their clinical course: seminomas and non-seminomas. In the group of nonseminomas, several types of tumors are distinguished. Mixed testicular tumors are common.

It is possible to assume that a tumor belongs to any group even before removal of the testicle based on studying the level of tumor markers. With seminoma, the level of AFP, hCG and LDH is normal, and with non-seminoma, it is elevated. Depending on the initial level of markers, one can predict how the disease will progress: the higher the level of markers, the worse the prognosis.

This means that with very small non-seminoma tumor nodes that are not visible even on CT, an increased level of markers will allow the doctor to understand that there are cancer cells left in the body and it is necessary to continue treatment.

Stage of testicular cancer

Stage I	no evidence of tumor outside the testicle
Stage IIA	testicular tumor metastases to retroperitoneal lymph nodes less than 2 cm in greatest dimension
IIB stage	testicular tumor metastases to retroperitoneal lymph nodes more than 2 cm and less than 5 cm
I IC stage	testicular tumor metastases to retroperitoneal lymph nodes more than 5 cm
Stage III	testicular tumor metastases to the retroperitoneal lymph nodes or their absence metastases to the lymph nodes above the diaphragm and/or lungs and/or liver, bones, brain

Testicular cancer treatment

Treatment of stage I testicular cancer (no tumor outside the testicle)

Listed below are the types of treatments and the order in which they are used for different stages of different types of testicular cancer. Due to the significant variety and multi-stage nature of treatment, it is difficult even for a specialist to understand. Therefore, if you wish, you can go straight to information about individual treatment methods used for testicular cancer.

Seminoma stage I:

1. observation
2. radiation therapy to the area of ​​the retroperitoneal lymph nodes
3. chemotherapy with carboplatin (one course)

Stage I nonseminoma

1. observation (only in patients with no adverse signs when examining the tumor under a microscope)
2. chemotherapy (2 courses according to the BEP regimen (bleomycin, etoposide, cisplatin))

Treatment of testicular cancer with metastases

Seminoma stage IIA-B (metastases to retroperitoneal lymph nodes less than 5 cm)

1. radiation therapy to the area of ​​the retroperitoneal lymph nodes

Seminoma stage IIC-III

1. chemotherapy (3 courses according to the BEP regimen)

The space-occupying formations remaining after the end of treatment in pure seminoma are observed.

After completing the course of induction chemotherapy, you may be recommended to perform a positron emission computed tomography (PET-CT), based on the data obtained from this study, a conclusion can be made about the need to remove the retroperitoneal lymph nodes. In this case, the operation is not performed.

Stage IIA nonseminoma (negative markers, metastases to retroperitoneal lymph nodes less than 2 cm)

1. removal of lymph nodes from the retroperitoneal space followed by chemotherapy (2 courses according to the VER regimen), except for patients in whom examination of the removed nodes under a microscope revealed a so-called pure teratoma - a tumor insensitive to chemotherapy
2. 3 courses according to the VER scheme and subsequent removal of lymph nodes from the retroperitoneal space, if they have not completely disappeared. Surgery is performed only if tumor markers are negative.

Nonseminoma stage IIB or more

1. 3 courses according to the BEP regimen, followed by removal of lymph nodes from the retroperitoneal space in case of incomplete disappearance of metastases. Surgery is performed only if tumor markers are negative. If tumor cells that are not killed by chemotherapy are found in the removed tumor nodes, then 2 more courses of chemotherapy are given after surgery.

Observation . Patients with stage I testicular cancer after orchidectomy can be closely monitored without any additional treatment.

However, in the so-called stage I (no signs of a tumor outside the testicle), some patients may have microscopic tumor metastases, which in most cases are located in the retroperitoneal lymph nodes.

Therefore, such patients can be treated prophylactically.

Radiation therapy . Seminoma is highly sensitive to radiation therapy. Before irradiation, a CT scan is performed, on the basis of which the irradiation fields are determined. They include the area of ​​retroperitoneal lymph nodes, located in the form of a chain along the aorta and inferior vena cava. Radiation is a painless procedure and takes a few minutes a day.

Radiation therapy is carried out 5 days a week for a month. Radiation may cause abdominal pain, nausea, vomiting, and diarrhea (radiation gastritis, enteritis, colitis). If the intensity of these side effects is high, a break in radiation treatment is taken until they subside. Radiation therapy does not make the patient radioactive and dangerous to others.

    

Chemotherapy . Testicular cancer is very sensitive to modern chemotherapy. Chemotherapy involves the administration of drugs that have an adverse effect on all rapidly multiplying cells, primarily tumor cells.

The correct choice of treatment regimen (drugs, doses and frequency of administration) is the key to success. Therefore, treatment of testicular cancer must be carried out only in a specialized hospital. Chemotherapy causes a number of side effects, the type of which depends on the drugs used.

The most serious complications are hematological - associated with a decrease in the number of various blood elements. A decrease in the number of leukocytes leads to a decrease in the body’s resistance to infection, platelets – to increased bleeding.

Therefore, regular monitoring of blood tests during chemotherapy is extremely important. The most common nonhematologic complications of chemotherapy include nausea and vomiting. The use of modern antiemetic drugs in the vast majority of cases makes it possible to eliminate these phenomena.

Other complications are discussed with a chemotherapy specialist. Any changes in your health during chemotherapy should be reported to your doctor. If severe complications develop, the doses of chemotherapy drugs are reduced or chemotherapy is interrupted/cancelled.        

Retroperitoneal lymphadenectomy (removal of retroperitoneal lymph nodes) is a abdominal operation during which all fatty tissue with lymph nodes is removed from the retroperitoneal space. The most serious disadvantage of this operation is the development of retrograde (into the bladder) ejaculation and infertility.

The key to good surgical results is extensive experience in performing retroperitoneal lymphadenectomies after chemotherapy.

Observation

Regular examination (AFP, hCG, LDH, as well as ultrasound or CT of the abdominal cavity and retroperitoneum and radiography or CT of the chest) for several years is vital for patients with testicular cancer.

The frequency of visits depends on the histological structure of the tumor, the stage of the disease and the type of treatment performed.

The control examination is aimed at early detection of relapses of the disease, as well as tumors of the second testicle, which may appear after the end of treatment in some patients.  

In the urological department of the National Medical Research Center of Oncology named after. N.N. Blokhin has extensive experience in treating patients with testicular tumors. The use of modern diagnostic and treatment standards in combination with the possibility of involving doctors of related specialties (chemotherapists and radiologists) allows us to achieve the best results in each specific case.

Source: https://www.ronc.ru/grown/treatment/diseases/rak-yaichek/