Malignant tumor( cancer) of the testicle - Causes, symptoms and treatment. MF.

Testicular tumors( seminoma) are common among malignant tumors of male genital organs, especially among young people, more often from 25 to 35 years. These tumors are characterized by rapid growth, high aggressiveness and early metastasis.

More than half of the treated patients testicular cancer is detected at the advanced stage, including in the presence of distant metastases. The late treatment of patients is usually associated with a lack of awareness of the population about such tumors, as well as psychological causes: fear of illness and intimacy of problems associated with the genital area.

The problem of neglect of the process is often due to the insufficient vigilance of the doctors of the polyclinic network regarding the tumors of the male genital organs. Young people suffering from testicle diseases are most often suspected of banal inflammatory or congenital processes: orchitis, hydrocele and others. The thought of the oncological nature of the disease does not always arise.

Causes of testicular cancer

The causes of malignant testicular tumors, for the most part, are congenital. Most often, tumors develop with cryptorchidism-congenital unmasking of the testicle in the scrotum, while the organ may be in the inguinal canal or in the abdominal cavity. Cryptorchidism requires surgical treatment. In some cases, when the testicle is in the inguinal canal and its normal function, dynamic observation is possible. As for adults, removal of an undescended testicle is recommended in all cases to prevent its tumor lesion.

In addition, diseases such as atrophy and testicular hypotrophy( decrease in size), tumors of the opposite testicle, trauma, inflammation( including as a result of mumps), may be predisposing factors. The risk factor may be the presence of tumor testicular lesions in blood relatives( genetic predisposition) and infertility.

Symptoms of testicular tumors

In the initial stages of patients, the presence of a dense or dense painless testicular tumor is of concern. In some cases, patients may be bothered by persistent pain in the scrotum, without having any visual changes.

As the tumor grows, the affected testicle increases in size, an asymmetry of the scrotum appears;The egg and its appendage merge into a single dense conglomerate, the boundary between them is not determined.

Over time, the tumor can spread to the spermatic cord, which leads to its thickening and compaction. The tumor can develop against a background of fluid accumulation in the testicles, revealing the signs of hydrocele by the results of ultrasound does not exclude the diagnosis of neoplasm.

In some cases, a careful examination of the patient can detect metastatically altered lymph nodes: inguinal, supraclavicular, sometimes retroperitoneal, if the tumor reaches a large size, they are defined as a dense nodal formation in the lower abdomen.

In addition to the above symptoms, the development of malignant testicular tumors is characterized by the appearance of common symptoms: weakness, weight loss and appetite, body temperature rises to low digits.

Symptoms of testicular tumors

Classification of testicular tumors:

Tumor size:

T1-tumor is limited to the testicle but does not grow into its membranes;
T2-tumor is limited to the testicle and grows into its tissue membranes;
T3 - the tumor extends to the spermatic cord;
T4-tumor passes to the scrotum.

1st stage: T1-4;
Stage 2: any tumor size in the presence of metastases in regional lymph nodes ranging in size from 2 to 5 cm;
Stage 3: any tumor size in the presence of distant metastases.

Test for testicular tumors

The ultrasound examination is most informative: examination of the scrotum, pelvic organs and retroperitoneal lymph nodes. Testicular tumors can be one or several knots of a dense consistency ranging in size from 2-3 cm to 10 cm or more. Investigation of small pelvis and retroperitoneal lymph nodes allows to reveal their metastatic lesion.

Performing an ultrasound test is considered mandatory in all cases if a young man has either signs of a retroperitoneal tumor, or metastases in his internal organs, or an elevated level of chorionic gonadotropin and / or alpha-fetoprotein.

In some cases, magnetic resonance imaging or computed tomography of the abdominal cavity, small pelvis and scrotum can be used.

The most important role in the diagnosis of testicular tumors is played by a serological study of blood on tumor markers - special proteins that are produced by tumor cells, circulate with blood flow and are absent in a healthy person.

The most important of them, specific for the testicular tumor complex: alpha-fetoprotein( AFP), chorionic gonadotropin( hCG) and lactate dehydrogenase( LDH).An increase in the level of AFP and hCG is observed in 90% of patients with malignant testicular tumors. The norm for AFP is 15 ng / ml.in some cases, but it should be remembered that an increase in the level of oncomarker data, possibly in case of a tumor lesion of the gastrointestinal tract.

In most patients at the time of diagnosis, or already have metastases to the lymph nodes of the retroperitoneal space, lymph nodes of the mediastinum, visceral metastases, most often to the lungs, or they will let themselves know about themselves soon after the operation.

Relapses after treatment can occur in the coming months, and a few years after the treatment of the disease, usually relapses occur within up to two years after the operation. The most common metastases are the retroperitoneal lymph nodes, up to 95% of the cases.

Treatment of testicular tumors

The first stage of treatment at any stage of the tumor is surgery: orhofunkilectomy - removal of the affected testicle with the spermatic cord.
After surgery, with the condition and absence of distant manifestations of the disease, recovery occurs in 80% of patients. Such patients are shown dynamic observation( a complete examination every 3 months).In some cases, the operation is complemented by subsequent antitumor chemotherapy, this technique allows you to increase the number of people who have recovered to 90-100%.

In some cases, with large tumor sizes, radiotherapy is used in the postoperative period. During treatment a small dose of irradiation( 20 Gy) is applied to the zone of retroperitoneal lymph nodes. Relapses of the disease in the operation area, small pelvis and retroperitoneal lymph nodes after the use of radiation treatment are extremely rare. But, one should know that the use of radiation therapy, although slightly, but potentially increases the risk of infertility.

With a large prevalence of the tumor and the presence of distant metastases, treatment is initiated with chemotherapy, the purpose of which is to reduce the tumor in size, to facilitate subsequent surgeon manipulations.

At 2 -3 stages of the disease, that is, in the presence of metastases in the inguinal or retroperitoneal lymph nodes, a two-stage method of treatment is used: the first stage is the operation( orhofunkilectomy) followed by radiation treatment or chemotherapy. If there are residual metastases in the inguinal or retroperitoneal lymph nodes after treatment, their removal is performed.

In the presence of distant metastases, if there are not many tumors and it is possible to delete them - the operation is performed, in all other cases only chemotherapy is used.

Prognosis of the disease.

At the initial stage of the tumor and its small size, the prognosis is favorable( provided only surgical treatment): more than 80% of patients recover. In the presence of metastases in the nearby lymph nodes( retroperitoneal and inguinal), taking into account complex treatment( surgery + radiation or chemotherapy), the survival rate is 90-95%.In more advanced stages of the disease, survival is much worse and does not exceed 40-50%.

Doctor oncologist Barinova N.Yu.