Treatment for testicular cancer: Established and new methods

Testicular cancer is a rare form of cancer. However, in Germany and Switzerland, it is the most common malignant tumor in men between the ages of 25 and 45. As the cancer is usually detected early, the chances of successful treatment are very good. Below, our experts provide a comprehensive overview of current and emerging treatment for testicular cancer. We also provide information on the different types of testicular cancer, the stages of the disease, risk factors, and symptoms.

What is testicular cancer?

When a malignant tumor develops in the testicles, it is called testicular cancer, testicular carcinoma, or testicular tumor. The testicles (testis/testes) are the male gonads. These organs are about the size of a plum and are located in the scrotum below the penis. The majority of their mass consists of germ cells (spermatogonia), which continuously produce sperm. Supporting cells, also known as Sertoli cells, provide metabolic and structural support for the germ cells. The connective tissue of the testicles also contains Leydig cells, which produce the male sex hormone testosterone.

The vast majority of testicular tumors (92 percent) originate in the germ cells; therefore, they are also called germ cell tumors or germinal tumors. More than half of these tumors are seminomas, and one-third are non-seminomas. Other types of testicular cancer that develop from the supporting or connective tissue (Seritoli cell tumors or Leydig cell tumors) are very rare.

Seminoma

Seminoma originate exclusively from the germ cell tissue that produces sperm cells. The prognosis for this type of cancer is very good, as only about 20 percent of seminomas tend to form secondary tumors (metastases).

Non-seminoma

Non-seminoma (non-seminomatous germ cell tumors) are mixed tumors that contain other tissue types in addition to germ cell tissue. Some non-seminomas are particularly aggressive and can metastasize early.

Risk factors

Undescended testicles (cryptorchidism) are a confirmed risk factor for testicular cancer.

This common congenital malformation results in one or both testicles not being located in the scrotum. In cases of undescended testicles, the testicle may be located slightly above the scrotum (prescrotal), in the groin, in the inguinal canal, or, less frequently, in the abdomen or thigh. The increased risk of testicular cancer is independent of whether the undescended testicle has been corrected or the precise location of the testicle outside the scrotum.

Other risk factors for a testicular carcinoma are:

Congenital malformation of the urethral opening (hypospadias), e.g. due to a shortened urethra, a curvature of the penile shaft or a so-called "foreskin apron".
Misprogrammed germ cells during embryonic development, known as "testicular intraepithelial neoplasia" (TIN cells). These are initially inactive after birth, but develop into cancer cells due to the hormonal surge of puberty and external influences. The reasons for the development of TIN cells are not yet fully understood – genetic predisposition and hormonal influences during pregnancy likely play a crucial role.
Family history, g., if the father or brother has already had testicular cancer.
Previous diagnosis of testicular cancer or a precancerous condition. This increases the risk of a tumor developing in the healthy testicle as well.
Infertility or temporary fertility disorders as well as gonadal dysfunction.
Rare genetic disorders of sex development.
Other possible risk factors being discussed among researchers include a birth weight below 2,500 g or above 4,500 g, as well as tall stature.

Lifestyle and environmental factors most likely do not increase the risk of testicular cancer compared to other types of cancer such as lung or skin cancer. The frequency of sexual activity, wearing tight clothing, or participating in certain sports have also not been conclusively identified as risk factors for testicular cancer.

Testicular cancer symptoms and diagnosis

In its early stages, a testicular tumor rarely causes symptoms such as pain. However, there are some signs that can indicate testicular cancer very early in the course of the disease. In most cases, changes occur on one side of the testicle. Common symptoms include:

Palpable, usually painless enlargement, swelling or hardening in the testicle
Feeling of heaviness in the testicles
Pulling or tightening sensation in the testicles or groin
Pain in the testicular area
Infertility
Possibly an accumulation of watery fluid around the testicle (hydrocele)
Changes that appear like inflammation, but do not subside even with antibiotic treatment, for example
Swelling of one or both breast glands (rare)
Back pain due to enlarged lymph nodes in the back of the abdomen (in advanced stages of the disease)

Every man should regularly – ideally once a month – examine both testicles individually to detect any changes early. Sometimes tumors can be felt during self-examination. Unlike colorectal cancer, there are no statutory or standardized screening programs for testicular cancer. However, in Germany, men aged 45 and over can have a free physical examination once a year by their doctor for early detection. It's important to note that not every palpable change is a malignant testicular tumor. There are also benign changes or inflammations that do not require treatment or are easily treated. Nevertheless, anyone who notices changes should have them checked by a specialist as soon as possible.

Diagnosis

If one or more of the described symptoms occur, those affected should consult a doctor – preferably a urologist. During a detailed medical history, the specialist will record the current symptoms, the patient's medical history, and clarify any existing risk factors. This is followed by a thorough physical examination, during which the testicles are carefully palpated for hardening and lumps. The lymph nodes are also palpated.

Subsequently, an ultrasound examination (sonography) and laboratory tests are usually performed. The ultrasound provides an image of the affected testicle. Any tumors that may be present can be visualized this way. Blood is also drawn to determine the patient's general health and to measure so-called "tumor markers." Tumor markers are substances that are produced in increased amounts by tumor cells and can be detected in the blood. The detection of these tumor markers can provide information about the presence of cancer and the type of tumor (seminoma, non-seminoma.

If testicular cancer is suspected, a chest X-ray and a computed tomography (CT) scan of the lungs and abdomen are usually performed to determine the exact extent of the tumor. A histological examination (biopsy) may also be necessary.

Once the results from all examinations are available, the doctors will decide on the testicular cancer treatment and the possible combination of therapy methods together with the patients.

Established options for testicular cancer treatment

Regardless of the stage of the cancer, testicular cancer is usually treated surgically. During this operation, the affected testicle is removed. Further testicular cancer therapy depends on the stage and classification of the tumor, as well as its histology (seminoma, non-seminoma, or other type of testicular carcinoma).

Stage 0: Non-invasive germ cell neoplasm without elevated tumor markers, lymph node involvement, or metastases.
Stage I:Tumors without metastases and lymph node involvement, which:
- IA: are limited to the testicles and epididymis; tumor markers are within the normal range.
- IB: have already affected blood vessels and lymphatic vessels, spermatic cords or the scrotum; tumor markers are within the normal range.
- IS:have spread as in stages IA and IB, but with slightly, moderately, or significantly elevated tumor markers.
Stage II: Tumors without metastases, as in stage I, but which have affected the lymph nodes to varying degrees (IIA, IIB, IIC). Tumor markers are within the normal range or slightly elevated.
Stage III: Tumors such as those in stages I and II that have also formed metastases, e.g. in the lymph nodes in the neck or lungs (IIIA), in the lungs (IIIB) or in other organs (IIIC).

Surgery (Orchiectomy)

If testicular cancer is still suspected after the initial examinations, the testicle is surgically exposed. This involves making an incision in the groin. Usually, examining the tissue reveals whether the tumor is malignant. If there is any doubt, a tissue sample can be examined in pathology during the operation. If the tumor is benign, it is usually sufficient to remove it from the testicular tissue. In stage I testicular cancer, the affected testicle, including the epididymis and spermatic cord, is completely removed (orchiectomy). In later stages and with certain types of cancer, it may be advisable to also remove the lymph nodes in the back of the abdomen.

Active monitoring

If testicular cancer is detected in stage I, surgery is often sufficient for complete treatment. Whether further treatment steps are necessary depends on the biopsy results, tumor markers in the blood, and the results of imaging procedures (CT, MRI). The patient's wishes are also taken into account – the Cancer League offers decision-making support. With active surveillance, no chemotherapy or radiation therapy is administered after the removal of the testicle. Instead, the treating physicians establish a monitoring strategy. This typically involves close monitoring using the diagnostic procedures mentioned above to quickly detect any potential relapse (recurrence).

Chemotherapy

If cancer cells have already spread through the bloodstream or lymphatic system, chemotherapy is recommended. Special medications (chemotherapeutic agents) are used to destroy cancer cells in the body. Chemotherapy is usually administered after surgery (adjuvant). In some cases, it is given before surgery (neoadjuvant). Because chemotherapeutic agents act non-specifically on rapidly growing cells throughout the body, some undesirable side effects can occur.

Radiation therapy

Radiation therapy (radiotherapy) can be performed after surgery to destroy any remaining tumor tissue. High-dose X-rays are used for the radiation treatment. The therapy is administered locally in the back of the abdomen and is only used for semiomas from stage II onward. The radiation treatment is given five days a week for two weeks. If the bowel is within the radiation field, bowel discomfort may occur.

In stage I, testicular cancer treatment is the same regardless of the histology (seminoma or non-seminoma). In stages IIA/IIB and IIC/IIIC, there are differences in how testicular cancer is treated.

In stage IIA/IIB, the affected testicle is surgically removed in the case of a seminoma. This is usually followed by chemotherapy or local radiation therapy of the affected lymph nodes. In the case of non-seminomas, the affected testicle is removed, and in addition, the affected lymph nodes are removed and/or chemotherapy is administered.

In stage IIC/IIIC, chemotherapy is administered after surgery in both cases. For seminomas, chemotherapy is given before surgery (neoadjuvant) if tumor markers are elevated or if bone/brain metastases are present.

Clinical trials are currently underway investigating the use of a combination of radiation therapy and chemotherapy for testicular cancer treatment in stages IIA and IIB.

The removal of a testicle generally has no effect on sexuality or virility. Thanks to nerve-sparing techniques, the surgery usually also has no impact on ejaculation. Nevertheless, a decrease in sperm production in the healthy testicle is frequently observed after an orchiectomy. Chemotherapy, radiation therapy, and the removal of lymph nodes can also impair ejaculation and sperm production. Therefore, if you wish to have children, it may be advisable to store sperm samples in a sperm bank and later undergo artificial insemination.

New treatment approaches for testicular cancer

The chances of a cure are very good in the early stages of the disease: Up to 98% of patients with testicular cancer can be successfully treated with testicular cancer therapy. Even in advanced cases, the cure rate is up to 70%, however, the treatment is significantly more intensive and the burden of side effects is greater. To further improve treatment success for those affected and reduce the occurrence of undesirable side effects, personalized therapies for testicular cancer are increasingly being developed. These groundbreaking new treatment methods are tailored to the individual cancer of the patient and target the cancer cells more precisely. The therapy is based on the specific genetic, molecular, and cellular characteristics of the tumor. These are already well understood. These advanced approaches open up new avenues in cancer therapy that complement and further develop traditional methods.

Cancer blood tests are used to examine specific tumor characteristics. The test results, along with the results of other examinations, form the basis for individualized testicular cancer treatment. This allows doctors to determine the best combination of treatment methods for their patients.

A cancer test is therefore the first step toward targeted and personalized testicular cancer treatment. Cancer tests can also be used for diagnosis or to monitor treatment success.

The following of our tests can be used for cancer diagnosis, for identifying specific biomarkers, and for personalizing testicular cancer therapy:

Oncotrace

establishes baseline values for CTC count, phenotype markers, and stemness markers in the bloodstream. These parameters provide a…

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Oncocount

detects the presence of CTCs and quantifies their concentration in the bloodstream. A higher number of CTCs might…

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Metastat

investigates the proteins that are related to the distant spread of cancer and the potential metastatic properties of…

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Onconomics

provides highly detailed and accurate information about how effective specific anti-cancer drugs and targeted therapies are in treating…

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Onconomics Plus

provides information about the effect of specific anti-cancer drugs, targeted therapies and natural treatments on the cancer…

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Onconomics Extracts

is a unique and highly detailed test that provides information on how effective natural substances and plant…

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Onconomics Extracts +

Onconomics Extracts+ provides highly detailed and accurate information about how effective specific natural substances and plant extracts are. Furthermore,…

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ChemoSNiP

analyzes how each body reacts to a chemotherapy agent. It helps clinicians make superior decisions on which medication(s)…

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Immune-Frame

provides insights into the current state of a patient’s immune system. It is used to guide treatment and…

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ArrayCGH RGCC

helps identify chromosomal abnormalities and genetic disorders.

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CAMBISeq

is used to predict cancer treatment response. The test analyzes 500+ genes, which are used as biomarkers to…

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Onco-D-Clare

Early detection can make all the difference. Onco-D-Clare can help identify cancer risk even before symptoms appear.

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InVyomma Plus

focuses on gut microbiome profiling, including analysis of short-chain fatty acids, and their association with cancer.

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The researchers at RGCC International work daily to address unmet medical needs and contribute to more targeted cancer therapies. With our tests and innovative approaches, we aim to support physicians and patients so that the treatment of testicular cancer and other types of cancer can be made even more effective.

Would you like to have an early cancer diagnosis, disease analysis, or therapy monitoring performed using a blood test? Then please get in touch with us! Our state-of-the-art tests and innovative approaches are available exclusively to physicians in the RGCC network. In addition to testicular cancer care, our methods can also be used for other types of cancer, such as bladder cancer, prostate cancer, and thyroid cancer. Do you have any questions? Contact the highly specialized team at our help desk. We are happy to assist you.