Testicular tumors

Testicular tumors are broadly categorized into germ cell tumors (the most common) and non-germ cell tumors. Germ cell tumors account for over 90% of cases. Below is an overview of the key types:

Germ Cell Tumors

These tumors originate from cells that later develop into sperm.

Seminomas

  • Most common testicular tumor (around 50% of germ cell tumors).
  • Typically slow-growing.
  • Most common in men aged 30 to 40 years.

Non-Seminomas

  • More aggressive and tend to metastasize earlier.
  • Subtypes:
    • Embryonal carcinoma: Aggressive, occurs in younger men (20–30 years).
    • Yolk sac tumor: Common in children under 3 years; rare in adults.
    • Choriocarcinoma: Rare, highly aggressive, with early metastasis (especially via the bloodstream).
    • Teratoma: Can be mature (benign) or immature (malignant).

Mixed Germ Cell Tumors

  • Contain a mix of different subtypes (e.g., seminoma and embryonal carcinoma).
  • More common than pure forms.

Non-Germ Cell Tumors

These tumors arise from testicular structures unrelated to germ cell formation.

Gonadal Stromal Tumors

  • Develop from connective and supportive tissues in the testis.
  • Subtypes:
    • Leydig cell tumor: Usually benign; may cause hormonal imbalances (e.g., gynecomastia).
    • Sertoli cell tumor: Often benign and rarely hormonally active.

Lymphomas

  • Most common in older men.
  • Secondary involvement of the testis by malignant lymphomas (e.g., non-Hodgkin lymphoma).

Rare Tumors

  • Granulosa cell tumor: Rare, typically benign.
  • Fibromas and other mesenchymal tumors.
  1. Secondary Tumors
  • Metastases from other cancers (e.g., prostate, lung, or stomach carcinoma) in the testis.
  • Rare compared to primary testicular tumors.

Diagnosis and Treatment

  • Diagnosis:
    • Ultrasound, tumor markers (e.g., AFP, β-HCG, LDH), and histological examination following orchiectomy.
  • Treatment:
    • Depends on tumor type and stage: surgery, chemotherapy, or radiation therapy.

Testosterone Therapy After Treatment

In cases where hormone production from the remaining testis is insufficient, or both testes are removed (bilateral orchiectomy), testosterone replacement therapy (TRT) may be considered.

Precautions

  1. Active Disease:
    • TRT is generally avoided during active tumor treatment, as testosterone might potentially stimulate growth in hormone-dependent tumors (though this is rare in germ cell tumors).
  2. Metastases or Recurrence:
    • TRT should only begin after complete remission.
  3. Hormone-Producing Tumors:
    • In tumors like Leydig cell tumors that naturally produce hormones, TRT should be approached with caution to avoid exacerbating hormone excess.

Conditions for Testosterone Therapy

  • Confirmed Hypogonadism: Verified through blood tests showing low testosterone.
  • Complete Remission: No active tumor or recurrence.
  • Regular Monitoring: Ongoing follow-ups to ensure the tumor does not return.

If these conditions are met, TRT can significantly improve quality of life by enhancing libido, muscle mass, and energy level