What Is a Testicular Neoplasm?

Testicular tumors are the most common malignant tumors in young men and are divided into primary and secondary types. The vast majority are primary and are divided into two major categories: germ cell tumors and non-germ cell tumors. Germ cell tumors occur in the reproductive epithelium of the seminiferous tubules. Among them, seminoma is the most common, with a slower growth rate and generally a better prognosis. It is relatively rare, but has a high degree of malignancy. Lymphatic and hematogenous metastases occur earlier, and the prognosis is poor. Non-germ cell tumors occur in testicular mesenchymal cells and are derived from fibrous tissue, smooth muscle, blood vessels, and lymphoid tissues. Secondary testicular tumors are rare.

Basic Information

English name

testicular neoplasms

Visiting department

Urology, Oncology

Multiple groups

Young men

Common locations

testis

Common causes

Cryptorchidism

Common symptoms

Painless testicular enlargement

Causes of testicular tumors

The cause of testicular tumors is unknown. Among them, congenital factors include cryptorchidism or undescended testicles, family inheritance, Klinefelter syndrome, testicular feminization syndrome, and endocrine disorders caused by excessive estrogen secretion. Acquired factors include testicular injury, occupation and environment, malnutrition, and elevated local temperature. In recent years, foreign studies have found that race, the degree of weight gain and estrogen levels of the mother during pregnancy, the weight of the patient at birth, age, social status, lifestyle, education, and serum cholesterol levels are all related to the incidence of testicular tumors. Genetic studies have shown that testicular tumors are related to ectopic short arm chromosome 12, and changes in p53 gene are related to the occurrence of testicular tumors.

Clinical manifestations of testicular tumors

Testicular enlargement

The testicles of most patients are enlarged to varying degrees. Sometimes the testicles are completely replaced by tumors, the texture is hard, and the normal elasticity disappears. The early surface is smooth, and the late surface can be nodular, can adhere to the scrotum, or even rupture, the scrotal skin can be dark red, and the surface often has blood vessels curled. If there are more tumors in the cryptorchidism than in the abdomen, groin, etc., and the scrotum on the ipsilateral side is empty, some patients with testicular tumors also have hydrocele.

Pain

The vast majority of patients feel the testicles disappear without pain. Therefore, tumors are generally considered to be painless scrotal masses. It is worth noting that sharp painful testicular tumors can also be seen in the clinic, but it is often considered to be inflammation. The pain is caused by tumor bleeding or central necrosis, or pain caused by testicular tumors invading tissues outside the testicle.

3. Metastatic symptoms

Testicular tumors are mainly lymph node metastases, which are common in the iliac crest, common iliac crest, paraabdominal aorta, and mediastinal lymph nodes. The metastases can be large, the abdomen can be touched, and the patient complains of back pain. Patients with testicular villous cancer may have hypertrophy of the breast and pigmentation of the nipple and areola.

Testicular tumor examination

Laboratory inspection

In the late stage of the disease, anemia, rapid erythrocyte sedimentation, abnormal liver function, increased jaundice index, and impaired renal function may occur. Testicular tumor markers: The use of new radioimmunoassay technology to detect trace hormones in the blood is a breakthrough in laboratory diagnosis of tumors. For diagnosis of testicular tumors, 90% of patients with high sensitivity and specificity for alpha-fetoprotein and chorionic gonadotropin have increased one or two markers.

2.CT and MRI examination

Abdominal CT can show the three-dimensional size of the tumor and its relationship with adjacent tissues. The accuracy of identifying testicular masses as cystic or solid is 90% to 100%, and it can distinguish liquefaction of tumor center necrosis and cysts. MRI has a good contrast to soft tissues, can show the structure of blood vessels, and reduces the error of clinical staging by 22%. Urine gonadotropin and urine latex tests, if positive, are decisive for diagnosis.

Testicular tumor treatment

Radiotherapy

After testicular resection of seminoma, the radiotherapy was performed, and 25 to 35 Gy (2500 to 3500 rad) were irradiated to the aorta and ipsilateral iliac and inguinal lymph nodes for 3 weeks. 90% to 95% of stage I patients can survive for 5 years. If the clinical findings of retroperitoneal disease is stage II, the mediastinum and supraclavicular area is also irradiated with 20-35 Gy (2000-3500 rad) for 2 to 4 weeks, and the 5-year survival rate can reach 80% or more.

2. chemotherapy

(1) Patients with stage II or III who are unsuitable for surgery or unwilling to undergo surgery; local tumors are limited to the testis, but there is cancer invasion in the tissue after the retroperitoneal lymph nodes have been cleared; Maintenance and rescue treatment.

(2) Contraindications to heart, liver, kidney and other important organ dysfunction; people with serious complications such as infection and fever; those who are elderly or have cachexia; those who have severe bone marrow suppression.

3. Interventional Radiotherapy

Testicular tumors are prone to metastases to the lymphatic and blood tracts. Interventional radiology arterial regional perfusion chemotherapy and lymphatic perfusion chemotherapy have important effects on improving the prognosis, especially in advanced patients.

4. Immunotherapy

The causes of malignant tumors are factors that reduce the immunity of the organism. Surgical treatment, chemotherapy, and radiation therapy suppress the immune system to a certain extent. Therefore, in the comprehensive treatment of malignant testicular tumors, immunotherapy can still be used as an adjunct. The therapy plays a role.

5. Surgical treatment

Orchiectomy is suitable for any type of testicular tumor, and it is emphasized that radical inguinal approach should be used.

Testicular resection alone often does not achieve a complete surgical resection effect, and it needs to be performed in conjunction with post-membrane lymph node removal to achieve the goal of radical cure.