A testicular tumor was discovered in BVB star Sebastien Haller. This is the most common malignant tumor among young men. Why testicular cancer occurs so early, there’s no prevention, what symptoms to look out for, and who’s most at risk. FOCUS online spoke to an expert.
When it comes to cancer, most people think that the risk only increases with age. Testicular cancer is very different. Here, the age of onset is 28 to 35 years, so it hits men who are about to build their lives, make a career, start a family.
Testicular cancer is actually the most common cancer in the 30-year-old age group. Around 4,000 new cases are currently registered in Germany every year, and they are increasing, especially in northern European countries.
The number of cancer cases is increasing in general, which can be explained by the increasing life expectancy. But in the case of testicular cancer, as a young man’s cancer, this justification is out of the question. “To explain the current increase in testicular cancer, we have to go back 30 years, because this form of cancer takes that long to develop,” notes Mark Schrader, chief physician of urology at the Helios Klinikum Berlin-Buch and head of the testicular cancer center. Because even before birth, while still in the uterus, it is determined whether this boy will later develop testicular cancer or not.
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But it is difficult today to find out in retrospect what triggered this fatal change, notes Mark Schrader. Scientists like him suspect that dietary estrogens could play a role in changing the primordial germ cells in the embryo. The same could have happened due to medication, such as some birth control pills.
Another hypothesis: the drinking water could have been heavily contaminated with female hormones from medicines. Excess estrogen is therefore associated with a later risk of testicular cancer.
“The risk of getting testicular cancer is therefore anchored before birth,” the expert clarifies. From the time of birth, the clock starts ticking, so to speak, until testicular cancer develops after about 30 years.
So when men get sick, it’s not because they’ve smoked too much or cycled too much. It is therefore not possible for men to prevent testicular cancer.
Men whose father already had testicular cancer are particularly at risk. “Your risk is increased sevenfold,” warns Mark Schrader. If the brother is affected, it increases 15-fold. The family burden must therefore be clarified in any case: Is the father ill? Is the brother affected?
In addition to this genetic component of testicular cancer, undescended testicles are also an indirect indicator. If the testicles do not descend into the scrotum after birth, but remain in the groin, the risk of testicular cancer is up to 20 times higher.
“This applies to all men, regardless of whether the undescended testicles corrected themselves after the birth or whether the doctor had to treat it,” reports the expert.
Undescended testicles are the most common anomaly of the urogenital tract, affecting around two percent of boys born term, but almost one in three of premature babies.
It would be ideal if parents would inform their affected son during puberty, along the lines of ‘you had undescended testicles, please be alert because of signs of testicular cancer’.
These are:
“Anytime anything is different compared to the second testicle, it can be a sign of a testicular tumor,” warns Mark Schrader and advises going to the doctor immediately, preferably a urologist.
Ultrasound can be used to detect cancer in an uncomplicated and painless manner. A blood test also identifies the tumor markers typical of testicular cancer. If the suspicion of testicular cancer is confirmed, MRI or CT can clarify whether the tumor has already formed metastases, for example in the abdomen, lungs, bones or brain.
The first treatment option is the removal of the diseased testicle, as stipulated in the new guidelines. The tumor is now examined in detail and a decision is made as to whether further treatment is required.
“It is particularly positive here that testicular cancer has been able to be cured very well for more than 35 years, even if metastases are already present,” emphasizes the professor. Chemotherapy with a combination of cisplatin, etoposide and bleomycin ensures a cure rate of over 95 percent.
In order to avoid the burden of side effects, however, the therapy should be tailored precisely to the patient, because in the past there was often a risk of overtreatment. If you want to be on the safe side, you should ask your doctor to consult an expert from the national second opinion network for testicular tumors, the expert advises. Every third patient with testicular cancer tumor (a total of 1400 testicular tumor inquiries in 2018) used this opportunity in the last year.
It is well known that chemotherapy is highly effective, but often also associated with significant side effects. This can dramatically decrease the number of sperm. Urologists therefore advise patients to freeze the ejaculate before chemotherapy. Cryosperma or cryopreservation of the sperm can then be used later to fulfill the desire to have children. The sperm are frozen at almost minus 200 degrees and can be preserved in this way for up to 30 years.
In the past, patients had to pay for it themselves. “Since 2019, the statutory health insurance companies have been covering the costs of cryopreservation of ejaculate,” says Mark Schrader of this positive change.
On the other hand, the fact that one of the two testicles is usually removed in the case of testicular cancer does not affect fertility because the other testicle continues to produce hormones and sperm. Voice pitch, sex and the ability to have an orgasm are not affected. And if – as in very rare cases – both testicles have to be removed and therefore hardly any testosterone is produced, the masculinity hormone can be taken as a drug, as hormone replacement therapy.
Incidentally, the missing testicle can be replaced with a small silicone pad that is implanted in the empty part of the scrotum. The testicular prosthesis is a cosmetic correction, but does not replace the function of the testicles.
But even if there are many new, positive developments in testicular cancer and the therapy is very successful: All of this only works if the cancer is discovered early and the earlier the better. Men should therefore always examine their testicles themselves. Urologists recommend this testicle check with palpation to all boys over the age of 14. How important it is is shown by the fact that testicular cancer is discovered by the affected man himself in around 80 percent of cases, and even at an early stage.
