Testicular cancer

Approximately 95% of testicular cancers are germ cell tumors, which originate in the cells responsible for sperm production. These tumors are divided into two main categories: seminomatous tumors and non-seminomatous tumors, each with distinct clinical behavior, progression, and sensitivity to treatment.

Non-germ cell tumors (approximately 5%) include seminoma tumors (Leydig or Sertoli tumors) and tumors of the testicular appendages, which are much rarer.

Seminomas

Seminomatous tumors account for approximately 50% of cases. They mainly affect young adults and are often diagnosed at a localized stage. They generally progress more slowly and respond favorably to treatment, particularly chemotherapy or, in some cases, radiotherapy. This type of tumor is also associated with a better overall prognosis.

Non-seminomatous

Non-seminomatous tumors account for 40 to 45% of germ cell tumors. They are more aggressive, growing more rapidly and tending to metastasize early. They include several histological subtypes: embryonal carcinoma, choriocarcinoma, postpubertal teratoma, vitelline tumor, and rare trophoblastic tumors.

Some tumors combine several subtypes and are therefore referred to as mixed germ cell tumors. There are also rare germ cell tumors that do not derive from an in situ state, such as spermatocytic tumors, typically found in older men.

Non-germ cell tumors

Finally, non-germ cell tumors account for less than 5% of cases and include sex cord-stromal tumors (such as Leydig or Sertoli cell tumors) and testicular adnexal tumors. Although rare, they require specialized care.

Most often, testicular cancer manifests as a palpable, painless mass in a single testicle. This abnormality, which can be felt on palpation or seen, may be accompanied by a feeling of heaviness in the scrotum, sudden swelling, or dull pain in the lower abdomen or groin.
In a minority of cases, the patient reports acute pain associated with intratumoral hemorrhage or tumor tissue infarction. Other signs may include an increase in breast size (gynecomastia) or back or chest pain when there is metastatic spread

In most cases, the exact cause of testicular cancer remains unknown. The disease begins with a change in the genetic material of a germ cell, which escapes the natural mechanisms of cell regulation. These cells then multiply in an uncontrolled manner, forming a tumor mass that, over time, can invade neighboring tissues or spread to other parts of the body.
The vast majority of testicular cancers originate from germ cells, which are responsible for producing sperm. Scientists still do not know the precise reasons for this genetic alteration, although several risk factors are now well documented

Several factors increase the risk of developing testicular cancer, but do not guarantee its occurrence.
A history of cryptorchidism, i.e., undescended testicles at birth, is one of the most well-established factors. This risk is multiplied by 4 to 8, and is even higher if corrective surgery (orchidopexy) is performed late.
Male infertility or spermatogenesis disorders are also associated with an increased risk, although the exact link is not fully understood. Other factors include a personal history of testicular cancer (12 times higher risk of contralateral cancer), family history (father or brother affected), and certain genetic abnormalities.
Prenatal exposure to certain synthetic hormones or endocrine-disrupting pesticides has also been linked to an increased risk, as have testicular development disorders

The diagnosis of testicular cancer is based primarily on a thorough clinical examination. Any palpable mass or change in testicular volume should prompt immediate consultation. The initial evaluation includes a testicular ultrasound, which can differentiate between intra- and extratesticular masses and confirm the solid nature of the suspicious lesion.
At the same time, blood tumor markers are systematically measured: beta-hCG, alpha-fetoprotein (AFP), and lactate dehydrogenase (LDH). These markers are both diagnostic and prognostic, and enable subsequent monitoring of the disease.
When cancer is suspected, the standard surgical procedure is radical inguinal orchiectomy. This involves removing the affected testicle with the spermatic cord, without penetrating the scrotum, thereby preventing the spread of the tumor. This sample allows for histological confirmation and guides the therapeutic strategy.
Finally, a staging assessment is performed to evaluate the presence of metastases. It generally includes a chest, abdominal, and pelvic CT scan and additional biological tests.

Treatment is primarily based on surgery: orchiectomy. This therapeutic procedure is systematic, regardless of the stage of the disease, and is the starting point for any strategy.

Depending on the histological type (seminoma or non-seminoma) and the stage of spread, several complementary options may be proposed:

• Active surveillance is possible in certain localized forms, particularly stage I seminomas.
• Chemotherapy is indicated in the presence of risk factors or metastases.
• Radiotherapy is sometimes used, mainly for early-stage seminomas.
• Finally, additional surgery may be considered in cases of residual masses or specific non-seminomatous forms.

The choice of treatment is based on a multidisciplinary assessment that takes into account the type of tumor, the stage, the patient's general health, and their wishes, particularly with regard to fertility.

When treated quickly, testicular cancer has one of the highest cure rates in oncology. The 5-year survival rate is around 95-99% for localized forms and remains above 80% even in cases of metastatic disease.
However, some patients may experience a relapse, often within the first two years after treatment. Metastases may appear in the retroperitoneal lymph nodes, lungs, or even the liver or brain.
Although effective, treatments carry long-term side effects: kidney or hearing toxicity, infertility, hormonal disorders, secondary cancer, chronic fatigue, and increased cardiovascular risks after chemotherapy.
It is therefore essential to ensure rigorous and prolonged medical follow-up, including regular oncological check-ups, psychological support, and fertility assessment, particularly in young men.

To date, there is no proven prevention strategy to prevent the onset of testicular cancer. Most of the identified risk factors, such as cryptorchidism or family history, cannot be modified or avoided.
Nevertheless, it may be beneficial to know what your testicles normally look like so that you can detect any early changes. Personal vigilance is therefore still advisable, in addition to careful medical monitoring for people at increased risk.

It is recommended that you consult a doctor immediately if you experience any persistent symptoms, particularly a palpable lump, testicular pain, a feeling of heaviness in the scrotum, or a change in the consistency or size of a testicle.
Prompt treatment not only allows a diagnosis of cancer to be confirmed or ruled out, but also optimizes the chances of recovery when the disease is confirmed.

Hôpital de La Tour offers integrated, rapid, and coordinated treatment for testicular cancer, from diagnosis to post-treatment monitoring. The hospital has all the medical and surgical expertise required to treat testicular cancer, as well as the latest imaging technologies for initial assessment and follow-up

Is testicular cancer painful?

In most cases, the tumor is painless. Pain only occurs in certain advanced forms or when intratumoral hemorrhage occurs.

Can you have children after testicular cancer?

Yes, in many cases. The other testicle, if healthy, can ensure hormone and reproductive production. However, some treatments can affect fertility. It is often recommended to freeze sperm before treatment.

Is this cancer hereditary?

A family history increases the risk, but the vast majority of cases occur without a known family history.

What are the early signs to watch out for?

A lump in the testicle, a feeling of heaviness, unusual scrotal pain, or a change in the size of a testicle.

Is a single ultrasound sufficient for diagnosis?

Ultrasound is the initial test of choice, but the definitive diagnosis is based on histological analysis after orchidectomy.