Testicular tumors

Testicular tumors are the most common malignant tumor entities in young men.

In western industrialized countries, the annual number of new cases is between 3 and 10 per 100,000 inhabitants. A distinction is made between the far more common germ cell tumors (90-95%) and tumors originating from connective and supporting tissue. Among germ cell tumors, a distinction is made between seminoma and non-seminoma. Thanks to modern treatment options, the risk of dying from testicular tumors is very low. The detection of testicular tumors at an early stage is decisive for the prognosis.

The first symptoms of a testicular tumor are usually a painless increase in the size of the testicle or palpable, nodular indurations in the area of the testicle, which are often noticed by the patient themselves or their partner.
The first step in the diagnosis is a thorough medical history, including a family history, and a detailed physical examination. Other diagnostic tools available are testicular sonography and a laboratory analysis of testicular tumor markers (AFP, ß-HCG and LDH).

After diagnosis and, if necessary, surgical treatment, a staging examination is performed using CT or MRI of the lungs, abdomen and pelvis to identify possible metastasis. In addition, CT or MRI examinations of the skull or a skeletal scintigraphy should be performed if there are indications of symptoms in these organs.

Risk factors for developing a testicular tumor are

• maldescensus testis (undescended testicles)
• White skin color
• Testicular tumor on the opposite side
• familial disposition

Surgical therapy:

Part of the treatment of testicular tumors is the removal of the affected testicle via an incision above the inguinal ligament. This is done not only to remove the testicle and reduce the tumor mass, but also to confirm the diagnosis and histopathologically differentiate the various tumor entities. At the patient's request, a testicular prosthesis can then be implanted for aesthetic reasons.

Germ cell tumors are the most common tumor disease in men between the ages of 20-45 and are treated differently depending on their stage. The cure rate is around 90% if the concept is applied correctly. Surgery, radiotherapy and chemotherapy are used in therapy.

Histopathologically, a distinction is made between seminomas, non-seminomas and teratomas. After surgical removal of the affected testicle and by means of cross-sectional imaging, 3 clinical tumor stages are defined:

In clinical stage I, the tumor is confined to the testicle.

Stage II describes the spread to the abdomen and is subdivided into stage IIA with lymph nodes up to 2 cm, stage IIB with lymph nodes between 2-5 cm and stage IIC with lymph nodes larger than 5 cm.

Stage III describes the spread of the tumor above the diaphragm. All patients with a tumor stage > IIB require chemotherapy. An additional risk grouping enables the ideal choice of intensity with few side effects but optimal chances of recovery.

Chemotherapy for patients with pure seminoma: One cycle of chemotherapy with carboplatin can be recommended for high-risk patients with pure seminoma in stage I. In stage IIA/B and from stage IIB, patients are treated with 3 or 4 cycles of combination therapy with cisplatin (P), etoposide (E) and bleomycin (B) (so-called PEB chemotherapy) every 21 days.

Chemotherapy for patients with non-seminoma: High-risk patients in clinical stage I can receive 2 cycles of PEB every 21 days as a standard option. The standard therapy for patients with clinical stage > II is according to the risk stratification including testicular tumor markers: 3 cycles (low-risk) or 4 cycles (intermediate or high-risk) of PEB chemotherapy.

Before starting PEB combination chemotherapy, audiometry (hearing measurement), an ECG and a lung function test should be performed. Patients undergoing PEB chemotherapy require close laboratory monitoring due to the toxicity of the medication. Discontinuation or dose adjustment or replacement with another substance should take place if side effects occur. This form of therapy should be carried out in centers with the highest level of expertise in tumor therapy.