Testicular cancer
Any palpable mass in the testicle should be taken seriously, as it could be a sign of a serious condition — testicular cancer. Reassuring oneself with assumptions that it's "anything but a tumor" is not advisable. Unfortunately, testicular cancer most commonly affects men between the ages of 20 and 40 — an age group that often tends to underestimate or ignore symptoms.
▪️ What should you do if you or your loved one is diagnosed with a testicular tumor?
▪️ What exactly is testicular cancer?
▪️ How do doctors diagnose and determine the stage of testicular cancer?
▪️ Is treatment for testicular cancer limited to surgery — just removal of the testicle — or are there other effective methods?
▪️ How effective are chemotherapy and radiation therapy in treating testicular cancer?
▪️ What are the advantages of the Dilanyan Clinical Center in treating testicular cancer?
— The answer to this question is clear: see a doctor immediately. Any lump a patient feels could be a sign of a serious condition—testicular cancer. One should not comfort themselves with thoughts like “it must be anything but a tumor.” Unfortunately, testicular cancer mainly affects men between the ages of 20 and 40, and at that age, people tend to underestimate symptoms. As a result, we often see cases of testicular cancer with severe metastasis, and later are forced to resort to aggressive chemotherapy and radiation treatment.
— What is testicular cancer, and who should be “worried” about this disease?
— Essentially, testicular cancer, like any other tumor, is a cluster of cells that at some point began to multiply uncontrollably and spread through the lymphatic vessels—this process is called metastasis. Due to their unchecked growth, cancer cells replace normal cells and release toxic substances that poison the body.
First and foremost, men who had a childhood condition called cryptorchidism—undescended testicle—need to be examined. Studies show that even if the testicle was surgically lowered, this condition increases the risk of developing testicular cancer by four times.
Men whose close relatives—fathers, brothers, or other immediate family members—had testicular cancer should also be monitored by a doctor annually. But the rule for every man should be this: any changes in the scrotum — go see a doctor immediately. In some cases, testicular cancer can “hide” behind symptoms of testicular inflammation, hydrocele, epididymal cyst, or even unexplained pain.
— The very first examination is palpation. At the Dilanyan Clinical Center, we also perform ultrasound and color Doppler mapping. Among laboratory tests, it is important to highlight the blood test for specific tumor markers — beta-hCG, AFP, and LDH. Unfortunately, these markers are elevated in only about half of testicular cancer cases, so the leading diagnostic method remains ultrasound of the scrotal organs.
Important to know!
— Obviously, if a patient has testicular cancer, the organ needs to be removed. But is surgery the only important treatment for testicular cancer, or do you also use chemotherapy and radiation therapy?
— You know, I wouldn’t be so categorical. There are quite a few cases when what looks like testicular cancer turns out to be epidermoid cysts, angiomas, in other words, benign tumors.
A recent case: a 16-year-old boy was diagnosed with “testicular cancer” based on ultrasound. Many centers recommended immediate orchifuniculectomy — removal of the testicle along with the spermatic cord. However, since we were not confident it was cancer, we performed enucleation of the tumor and an urgent histological examination right during the surgery. It turned out the boy had only an epidermoid cyst, and we preserved his testicle. This is our advantage — at the slightest suspicion of a benign process, we perform urgent histology, following the recommendations of the European Association of Urology.
Of course, in confirmed cases of testicular cancer, we remove the organ by performing what is called a high or radical orchifuniculectomy — removal of the testicle along with the spermatic cord. I can proudly say we are one of the few clinics offering radical lymphadenectomy — laparoscopic removal of retroperitoneal lymph nodes. Lymph node removal is required in cases of metastasis of testicular cancer and is performed together with chemotherapy and radiation therapy.
— How effective are chemotherapy and radiation therapy for testicular cancer? In other words, what is the prognosis for a patient with testicular cancer?
— Testicular cancer responds quite successfully to treatment; however, it has been shown that the treatment outcome is better when carried out in a specialized department where a surgeon-urologist, oncologist-chemotherapist, and oncologist-radiologist work together. In the vast majority of cases, this collaboration enables the patient to be cured of the tumor.
— This advantage certainly exists at the Dilanyan Clinical Center.
— I would like to emphasize once again that for every patient, we conduct a multidisciplinary consultation involving several specialists. We do not follow the principle of “operate first, then send the patient to an oncology dispensary,” as we consider that a harmful practice. It’s worth noting that if a patient wishes to have a silicone prosthesis implanted after orchiectomy (removal of the testicle), we accommodate this by performing the prosthesis implantation in a single stage, without the need for a second surgery.
A cohesive surgical team combined with a well-equipped operating room and, I dare say, an excellent histology department have allowed us, over the years, to avoid unnecessary removal of testicles. Moreover, in some cases, we performed resections of overtly malignant tumors, understanding the patient’s desire to preserve fertility.
In one case of bilateral testicular cancer, when it seemed necessary to remove both testicles, we successfully performed tumor resections, after which the patient’s wife became pregnant. Of course, chemotherapy and radiation therapy were required, but still, we did not leave the patient infertile.
All of this can be summed up in one phrase that reflects our philosophy: at every stage—from diagnosis, surgical and therapeutic treatment, to psychological rehabilitation—we stand by the patient’s side.
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