2023-11-21 22:00:00
Testicular cancer, although rare with 2,800 cases annually, must be known to the general public to be better detected. Regular self-examination of the testicles allows cancer to be detected very early, with a cure rate of 99%. Dr. Thibaut Murez, urological surgeon at Montpellier University Hospital, reviews the subject.
Testicular cancer represents 1 to 2% of male cancers. However, this rare cancer is most common in young men up to the age of 40. It generally occurs between the ages of 18 and 45.
“The vast majority of men who develop testicular cancer have no risk factors,” explains Dr. Thibaut Murez. Family factors are rare. Some men have a higher risk due to cases of testicular cancer in their family. father or grandfather, a personal history, cryptorchidism, incomplete descent of a testicle into the bursae during fetal life, or testicular dysgenesis, abnormal development of the testicles.”
Seminomas, and others…
It exists two main categories of testicular cancersthe vast majority of germ cell tumors*: seminomas, and other types of tumors (so-called non-seminomatous cancers) which can cause more serious clinical manifestations.
Advanced forms do not necessarily manifest themselves by the presence of a palpable mass, but rather by symptoms such as shortness of breath, blood in the sputum (hemoptysis), or pain linked to abdominal compression by a lymph node. .
“These situations lead men to resort to emergency services,” adds Thibaut Murez, “but with a hope of recovery of more than 50%.”
Overall survival of around 99%
Cure is common for testicular cancer, with overall survival approaching 99% when the cancer is discovered early.
When it is localized to the testicles, i.e. 73% of cases when they are discovered, doctors carry out the removal of the testicle, also called orchiectomy, if necessary supplemented by chemotherapy in order to prevent relapses. This surgery usually has no major consequences on fertility or sexuality, because the remaining testicle produces sufficient testosterone and sperm.
It is possible to cure more than 70% of serious testicular cancers
On the other hand, if the cancer is not discovered in time, it metastasizes, that is to say it spreads to the abdominal and supraclavicular lymph nodes, in the hollow, above the clavicle, and to other organs such as the lung, liver and brain…
Fortunately, the majority of metastatic tumors are classified as having a “good prognosis” where the cure rate exceeds 95% thanks to chemotherapy, supplemented if necessary by surgery. Metastatic forms with an “intermediate” prognosis are also more than 80% cured, but treatments can eliminate any possibility of natural fertility.
In the most severe metastatic cases, chemotherapy is administered first, with removal of the testicle reserved for the final phase of treatment. Radiotherapy is an alternative in specific tumors.
If in doubt during a self-palpation test of the testicles (swelling, small mass, etc.), do not hesitate to speak to your doctor. A simple ultrasound will detect the presence of testicular cancer.
Reconstruction of the testicle systematically proposed
Today, reconstruction surgery after removal of the testicle is systematically offered, covered by Health Insurance. Some urological surgeons prefer to perform the reconstruction in two stages, i.e. one operation for removal and another for reconstruction, for fear of potential infections, while others opt for simultaneous reconstruction of the ablation when requested by the patient.
The choice of testicular prostheses is limited in terms of shape, consistency and size. Healing plays a crucial role in the aesthetic result. Inappropriate healing can lead to an unsatisfactory appearance. Despite these risks, approximately two thirds of patients who opt for reconstruction say they are satisfied.
For years, specialists have been asking health authorities for certified reference centers. Several studies carried out in Europe have shown that the chances of cure differ by 20% depending on the place of care, especially in advanced cancers.
Countries have already imposed this centralization of testicular cancers in a few reference hospitals such as Denmark or the United Kingdom.
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