testicular cancer | Testicular Cancer

Testicular Cancer

Testicular cancer occurs when a normal cell of the testicle undergoes a transformation, making it cancerous. The multiplication of this cancerous cell in an anarchic way leads to the formation of a tumor.

Testicular cancer actually groups several types of cancers according to the original testicular cell nature. In 95%, testicular cancer develops from germ cells involved in sperm production.

There are 2 major types of germ tumors: Seminomas and non-seminoma carcinoma cancers.

Testicular cancer
Frequency of illness
Testicular cancer is rare with about 2 200 new cases in 2011, in France. Testicular cancer represents 1 to 1.5% of all cancers in humans. More than 85% of cases are diagnosed between 15 and 49 years of age. The number of testicular cancer deaths is estimated at 87 in 2010 in France. It is therefore a cancer of very good prognosis including for metastatic stages. Survival at 5 years oscillates between 98 and 99% for purely local forms and above 70% for metastatic forms.

Risk factors for testicular cancer
Having one or more risk factors does not necessarily lead to the onset of cancer. They increase the likelihood of developing this cancer compared to an unexposed person. However, a cancer can develop without any risk factor being present.

To know! A risk factor is an element that can promote the development of cancer

The cryptorchidism
During fetal development, the testicles are housed in the abdomen and gradually descend into the fellowships. Sometimes, without knowing why, one of the testicles remains lodged in the abdomen: this phenomenon is called cryptorchidism. It is a common infant malformation that affects 3 to 4% of newborn boys and 33% of premature babies. It is estimated that a man with a history of cryptorchidism has a risk of testicular cancer multiplied by 5 to 10.

Testicular cancer contralateral
Testicular cancer usually affects a single testicle. A person who has had a previous testicular cancer is more exposed to developing one on the other testicle, says Contralateral. The risk of recurrence in the second testicle is estimated to be 2-3% during the 15 to 25 years after the diagnosis of the first cancer

Other risk factors
Other risk factors are currently being studied without a strong scientific link being established. It would appear that occupational exposure to chemical substances such as benzene or hydrocarbons may be responsible for an increase in the risk of developing testicular cancer. In addition, other work tends to show that exposure to certain pesticides, endocrine disrupters and cannabis is conducive to the onset of testicular cancer.

Symptoms
Testicular symptoms: Most of the time, testicular cancer is suspected by the patient himself after the discovery of a palpable mass on the testicle. It is most often hard and painless to touch. Moreover, this mass does not regress spontaneously in the course of time. If this training is important, it may be the cause of an increase in the volume of scholarships.
The other signs are rarer: among them, one can cite the gynecomastia which corresponds to the rapid development of the breasts in humans. This phenomenon is caused by the secretion of a hormone, hCG, which is normally produced in women during pregnancy. In the case of gynecomastia, the hormone is produced by the tumor. However, this symptom is not exclusive to testicular cancer; It can also be induced by drug causes or in a normal way in adolescence.
Surveillance and screening
Since testicular testing is not systematic in the doctor, the patient must be attentive to certain signs detectable by self-palpation.  Young men are advised from 14 years of age to perform it once a month and especially in patients with a history of cryptorchidism.

In practice, it is recommended to make it at the exit of the shower, because the heat of the water leads to relax the stockings, facilitating the palpation.
It is recommended to examine each testicle one after the other by rolling it between the thumb and the four fingers. The thumb being placed above and the four fingers underneath.

It is normal to feel at the top of each testicle a small elongated formation which is the epididymis (channel containing the sperm). If self-palpation reveals a small hard, often painless mass that was absent during the previous examination, it is advisable to consult a physician.

Diagnosis
It is based on a clinical examination revealing different symptoms seen above coupled with a set of paraclinical checkups (biology, imaging, biopsy). It is important to note that all of these assessments are intended to confirm or not the presence of cancer and to characterize the tumor in order to propose a treatment optimized for the patient.

In most cases, the diagnostic approach in testicular cancer begins after discovery at palpation or self-palpation of a mass on one of the testicles. The result of the diagnosis includes an ultrasound, biological research of tumor markers, and examination of the cells after ablation of the testicle.

The Ultrasound
Testicular cancer ultrasound It is a technique for visualizing organs using ultrasound.
In the case of testicular cancer, one speaks of scrotal ultrasound, i.e. the probe of the apparatus is applied on the fellowships to observe the testicles.

This technique allows a very good detection of testicular cancer and to estimate its size.

Analysis of testicular cancer markers
It is carried out if there is a strong suspicion of testicular cancer after the ultrasound. It is a blood sample, which after analysis allows to dose 3 biomarkers: AFP, Total HCG and LDH. These markers are substances in the blood that can be traced to the diagnosis and severity of the disease and the response to treatment. However, a patient may very well have high markers without having cancer and conversely. It is the link between the different means of investigation that allows the doctor to make a clear diagnosis.

The Anatomopathologic exam
It is the microscopic observation of the cells recovered after the testicular ablation. This method makes it possible to confirm in a certain way the diagnosis, but also to specify the characteristics of testicular cancer. Germ tumors can be discerned and the exact origin of the "sick cell" in order to establish a suitable treatment.

The scanner and MRI
They are used only for the examination of suspicious lymph nodes and the search for metastases. It is a diagnostic step that is called an extension balance, because it arrives in a second time after the discovery of cancer at the level of the testicles. This assessment is performed only when doctors suspect a spread or extension of cancer to other places than the testicle.

Therapeutic management of testicular cancer
Fertility preservation
Before the beginning of any treatment, the freezing of semen is systematically proposed, in order to prevent any consequences of the treatment on fertility. Two to three samples are made at CECOS (Centre for the study and conservation of eggs and human semen). These samples are analyzed in order to evaluate the quality of the semen for future use. Finally, it is important to note that the overall treatment of testicular cancer has little risk of causing significant fertility disorders, so that only 20% of patients end up using their sperm donations.
As with almost all cancers, management has three main axes: surgery, chemotherapy, radiation therapy. These three types of treatments have the specificity of having to be used either for systemic (whole body) or locoregional (a particular part or organ).

Preservation Fertility sperm

The surgery
This is the initial treatment for all types of testicular tumors.

Orchidectomy is a surgical procedure that corresponds to the removal of the testicle in which the cancer developed. This action is considered both diagnostic and therapeutic because it allows both to remove the tumor and also to obtain an indispensable sample for the analysis of "diseased cells" in order to orient the management. In addition, the installation of a silicone prosthesis is possible, directly during the operation or in a second time.

Radiation therapy
Radiotherapy is a locoregional treatment using high-energy ionizing radiation to destroy cancer cells. This therapeutic method allows to precisely target an area to be treated to irradiate the tumor while preserving as much as possible the surrounding healthy tissues. In the case of testicular cancer, it is indicated for localized or advanced seminomatous germ tumors (seminomas) after the testicular ablation. The radiation beam is directed to the remaining testicle or surrounding lymph nodes to limit the risk of propagation and to avoid the risk of recurrence.

Chemotherapy

Chemotherapy

Chemotherapy includes all the drug therapies that act on cancer cells that aim either to destroy them or to limit their multiplication. It is the only therapeutic axis to act on the whole body. In testicular cancer, chemotherapy can be undertaken after orchidectomy (removal of the testicle) in order to limit the risk of recurrence or spread of cancer. Depending on the stage and the nature of the cancer cells involved, the medical team chooses a combination of anti-cancer drugs to best combat the type of cancer the patient suffers.

The most common association in the treatment of testicular cancer chemotherapy is the BEP protocol: bleomycin, etoposide and cisplatin.

Sexuality after testicular cancer

Testicular cancer is cured in a large majority of cases, leaving it up to the acceptance of oneself and his body. This is a difficult stage that must be just as well understood as the disease itself.

The cancer does not leave any sequelae, but the orchidectomy touches on the physical integrity of young men. Ablation has no physical impact on sexuality or fertility.

Yet this operation is often associated with a degraded self-image and a loss of self-confidence. It is here, in these moments of fragility, that the spouse can play a fundamental role in accepting the consequences of the disease.

In addition, questions related to sexuality and procreation must be approached freely with the medical team. The person must understand the exact and actual consequences of the treatment on his or her life, so do not leave it in a system of inaccurate belief potentially source of psychological suffering.

Thus, it is important to note that most of the men operated have no erection disorder and will most likely never use in vitro fertilization to procreate.