Treatment of testicular tumors
Andrology – EURODOCTOR.RU – 2007
Unlike other genital organs, testicular tumors – a rather common disease, with an average of about 2% of cancers in men. Almost 99% of tumors – malignant.
The maximum frequency of malignant tumors coincides with the culmination of a period of sexual activity (20 – 40 years), but also occurs in children and the elderly.
In the development of malignant tumors of the testes noted two factors. One of them – cryptorchidism. Almost 25% of patients with testicular tumors observed this pathology.
The second factor that contributes to the formation of malignant tumors – testicular atrophy and hormonal changes in a man associated with it.
As noted by most researchers in the abnormally developed testis cancer develops in 15 – 20 times more often than normal.
In children, the tumor can cause overproduction of androgens, resulting signs of premature puberty. Testicular tumors in children is very rare.
Classification of testicular tumors
Tumors of the testis is divided into two groups:
- Germinal – arise from epithelial tissue of the testis: seminoma, embryonal carcinoma, chorionepithelioma, teratoblastoma and others – they account for 95% of all tumors
- Negerminativnye – arising from the so-called stroma of the testis: leydigoma, sertolioma, sarcoma.
Seminoma – is the most common tumor of the testis (40 – 50%). It is a tight knot lobed.
Testicular tumor is too early to give metastases, which are predominantly spread through the lymphatic vessels and develop in the lymph nodes: first in the nearby (inguinal, paraortalnyh), and then in the more distant (mediastinal, supraclavicular region).
The manifestations of testicular tumors
Testicular tumor is initially does not appear. Patients usually find themselves in one of the eggs seal the egg is growing rapidly, it becomes stressful and sometimes painful. Testicular tumor itself causes no pain, they occur after the transfer of tumor in the spermatic cord. Later, the egg becomes very dense, it is deformed. Then, in the shells of eggs accumulated fluid, which further increases the corresponding half of the scrotum. If the testicle is not descended into the scrotum (or was deleted by surgery), the tumor can be felt in the inguinal canal, where it is tight and painful. If the tumor has arisen in the testis in the form of abdominal cryptorchidism (when the egg is in the abdominal cavity), it attains a large size, sometimes even take half of the abdomen.
Up until the tumor has not moved beyond the testicle, the patient is not the temperature of the reaction and the effects of intoxication. Sometimes there may be a reduction in potency, rarely observed gynecomastia (breast enlargement in men). In certain tumors may occur early puberty.
Approximately 3% of patients develop tumors in both testicles at once, usually the same, but maybe her appearance, and several years later.
Testicular tumors, as well as all other tumors are classified according to the International Classification of TNM.
Diagnosis of testicular tumors
First, the diagnosis of testicular cancer is viewed from the scrotum. It may already be the first to provide information about the tumor. If the patient does not cryptorchidism, but the observed asymmetry of the scrotum, then be feeling. This technique also gives very valuable information for the physician. When testicular tumors between the shells often accumulate fluid. If necessary, the doctor removes it by aspiration and provides a feeling of the testicle.
A very important role in the diagnosis of testicular tumors is ultrasound. It allows you to see the internal structure of testicular tumors, accurately determine its size.
Radiographic methods help to establish only the presence of metastases. Usually performed excretory urography – a method of investigation of the kidneys and urinary tract through the introduction of radiopaque substance into the blood and a series of x-rays.
The most reliable method for diagnosing tumors of the testis is considered to be a needle biopsy with cytological examination.
Treatment of testicular tumors
Treatment of malignant testicular tumors is mainly surgical. It is the surgical removal of the affected testicle – gemikastratsii. In most cases, mature seminoma of the operation is sufficient. In other cases it is necessary to remove all of the spermatic cord. If the existence of metastases in the lymph nodes of the retroperitoneal space, the operation is conducted lymphadenectomy.
Simple or Advanced gemikastratsiya – the first stage in the treatment of testicular tumors. after radiation therapy is needed. This treatment gives positive results with seminomas and such tumors, which include elements of seminoma. Sometimes, especially if the tumor is large, the irradiation is done prior to surgery. This often reduces the size of the tumor so that it becomes possible to uninstall it.
Radiation therapy used to treat metastatic disease, especially in the form of radiation conglomerate lymph nodes, even in cases where it is impossible to remove.
It is widely used for the treatment of malignant testicular tumors, particularly in seminoma, and chemotherapy.
Andrology and Urology Clinic of Professor GEPELYA – GERMANY
Andrology and urology at the Medical Center Imedical – ISRAEL
Clinic Andrology and genital surgery in MOSCOW
Examination and treatment in GERMANY – Institute "DIAGNOSTIX"
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