It is the most diagnosed cancer in the middle age male population and it is associated with a favorable evolution, with a very low mortality rate. It is testicular cancer. What forms of treatment are available for this neoplasm? We talk about this issue with Dr. Giovanni Lughezzani, urologist at Humanitas.
Less than one diagnosis per hundred patients per year
The tumor originates from the tissue cells of one or both of the testicles, organs responsible for the production of sperm and some male hormones. Although it is rare in the age group up to 49 years, testicular cancer is still the most frequent neoplasm in men. Its proportion in relation to the total oncological diagnoses is 12%, as recalled by Aiom, the Italian Association of Medical Oncology.
The incidence peak is reached between 20 and 30 years of age, while after 50 years the testicular cancer gives way to another neoplasm that always affects the urogenital apparatus, or prostate cancer. According to the association’s estimates for 2017 there are about 2500 diagnoses expected, 1% of all cancers diagnosed in men.
The mortality associated with testicular cancer is very low, with less than one death from testicular cancer (0.1% to be exact). In the first five years after diagnosis, therefore, the survival rate is very high and exceeds 90%.
Treatments for testicular cancer
Early diagnosis, with the tumor in its early stages, is associated with healing rates approaching 100%. It is precisely in order to increase the chances of early diagnosis that urologists and andrologists recall the importance of testicular self-palpation, a gesture that should be made regularly to detect the presence of swelling and irregularities in the testicle. In most cases, in fact, the subject affected by this neoplasm reports to the doctor the detection of a nodule or the increase in the size of the testicle, usually in the absence of other symptoms such as pain, but with a feeling of heaviness of the organ itself.
In general, testicular tumors are divided into germinal and non-germinal with the former representing almost all of this neoplasm. Germinal tumors affect cells that produce spermatozoa and are divided into seminal- or non-seminal testicular neoplasms.
Treatments for testicular cancer include both surgery and radio- or chemotherapy depending on the histological type and stage of diagnosis of the neoplasm.
“Surgery on the testicle is always fundamental to obtain a correct characterization of testicular neoplasms – confirmed the specialist, specifying in which cases the operation involves the removal of the testicle. In most cases, inguinal orchiectomy is the treatment of choice, although in extremely selected cases (such as bilateral or small neoplasms) conservative surgery, which involves the removal of only the tumor, may play a role. Radiotherapy on retroperitoneal lymph node stations is sometimes used in the case of seminomatous testicular neoplasms, although it is an approach that is less and less used because of possible long-term side effects, such as the onset of secondary tumors.
“Chemotherapy can be used both in seminomatous and non-seminomatous cancers and it can be administered as a precaution, for example in patients without evidence of disease at the lymph node level, or as treatment in the presence of lymph node metastases or metastases to other organs at a distance. Both surgical and radio/chemo-therapeutic treatment may be associated with fertility problems. Consequently, patients who are candidates for these therapies must be duly informed about these risks and, if necessary, undergo cryopreservation of their semen before starting their own therapeutic process”, concluded Dr. Lughezzani.
