Testicular Seminoma - Causes, Symptoms, Diagnosis, and Treatment

What Is a Testicular Seminoma?

Seminoma is a type of testicular cancer commonly seen in males. Cancer occurs when the body cells show uncontrolled cell division. When cancer originates from the testes, it is known as testicular cancer. The human body contains germ cells responsible for forming sperm and testicles in males and ovaries and egg cells in females. When these germ cells proliferate rapidly, they give rise to a tumor known as testicular seminoma. When the cells remain confined to the testicles, they are benign. On the contrary, when the cells spread to the nearby organs, the tumors turn malignant. Seminomas usually turn malignant and affect other organs like the brain, chest, and abdomen. The condition must be diagnosed and treated at the earliest to avoid complications.

What Are the Causes of Testicular Seminoma?

The exact cause of the testicular seminoma is still under research. However, scientists believe that environmental factors and disturbances in endocrine activity impact germ cells. First, the germ cells from the sperm and the eggs fertilized to form the embryo. Later on, the germ cells mature into sperm-producing cells in the testicles. The problem arises when these cells fail to mature, undergo changes and multiply rapidly. As a result, a seminoma or a non-seminoma is formed, resulting in a condition known as testicular cancer. The risk factors for testicular seminoma are listed below:

1. Patients suffering from cryptorchidism or undescended testicles are at a higher risk of developing a testicular seminoma than those with normal testicles.

2. Males suffering from infertility (inability to become a father) are more likely to develop testicular cancer because of the absence of sperm in their semen.

3. Patients suffering from chromosomal disorders like Down syndrome might develop testicular cancer later due to genetic defects.

4. Studies have reported that low birth weight babies are at a higher risk of developing testicular cancer.

What Are the Different Types of Seminomas?

Seminomas are a type of testicular cancer that comes under the germ cell tumors category. There are two different germ cell tumors, mainly seminoma, and non-seminoma. Seminomas are slow-growing types of testicular cancer, whereas non-seminomas grow aggressively. The different types of testicular seminomas are listed in the table below:

What Are the Signs and Symptoms of Seminoma?

Patients are usually asymptomatic in the initial stages of testicular cancer. However, the following symptoms are usually seen with the progression of the disease:

1. Painless lump or mass in the testicles.

2. The patient might feel a heaviness of the scrotum.

3. Pain in the abdomen and groin.

4. Presence of fluid in the scrotum.

5. Growth of the breast due to the secretion of the female hormone by the tumor.

6. Lower back pain is commonly seen if the tumor spreads to the nearby lymph nodes.

What Are the Stages of Testicular Seminoma?

Testicular cancer has been divided into three stages depending upon the severity. The stages of testicular cancer or seminoma are listed below:

• Stage 1: Cancer is confined to the testicles.

• Stage 2: Cancer has spread to the abdominal lymph nodes.

• Stage 3: Cancer has spread to the surrounding organs like the liver, brain, and lungs.

How Is a Testicular Seminoma Diagnosed?

The diagnosis of testicular seminoma is a multi-step process and involves a medical history, physical examination, laboratory tests, and imaging tests. The diagnostic methods are described below:

• Medical History - A medical history provides an idea about the patient's general health. The doctor might ask questions related to the condition's symptoms, drug history, family history, and past treatments.

• Physical Examination - The doctor examines the patient to check the physical signs of testicular seminoma. The doctor palpates each testicle for swelling and tenderness. Patients suffering from testicular seminoma usually present with a mass or swelling in the scrotum. The abdomen, groin, and surrounding lymph nodes are also examined.

• Blood Test - The doctor recommends the patient undergo a blood test to check the protein levels. These proteins are known as tumor markers, and their levels are usually raised in cancer. The tumor markers mainly include the following:

  • Beta-Human Chorionic Gonadotropin (B-HCG): About 30 % of people suffering from testicular seminoma show elevated beta-human chorionic gonadotropin levels (B-HCG). It indicates that cancer has spread to the surrounding organs.

  • Alpha-Fetoprotein (AFP): Alpha-fetoprotein indicates non-seminomatous disease or mixed tumor.

  • Lactate Dehydrogenase: About 40 to 60 % of people show increased lactate dehydrogenase levels in testicular seminoma.

• Imaging Tests - The following imaging tests are usually recommended -

  • Ultrasound: It is one of the most effective imaging tests for diagnosing testicular seminoma and other associated testicular lesions.

  • Computed Tomography (CT) Scans: It produces three-dimensional (3D) images of the body organs using computer technology and X-rays. The X-ray images provided by the procedure check cancer spread in the abdomen, pelvis, and lungs.

• Biopsy - Biopsy is a procedure in which a tissue sample is obtained from the patient’s testis to check the size and shape of the cells under a microscope.

How Are Testicular Seminomas Managed?

The treatment of testicular seminoma depends upon the grade. However, the treatment mainly includes surgery, chemotherapy, and radiotherapy. The treatment options have been described below:

• Surgery - The surgical removal of the testis is the primary treatment of seminoma. The following surgery is usually done:

  • Radical Orchiectomy: It is a procedure in which the affected testis is surgically removed. The doctor makes an incision in the groin to remove the testis and the spermatic cord. The patient is kept on follow-ups, and an oncologist monitors his condition.

  • Retroperitoneal Lymph Node Dissection: They are removed if cancer has spread to the abdominal lymph nodes. This procedure is also known as retroperitoneal lymph node dissection.

• Radiation Therapy - Radiation therapy is useful for patients with stage two testicular seminoma. After the surgery, radiotherapy helps kill the remaining cancer cells. It is also beneficial for patients with stage 3 seminoma, where cancer has spread beyond the lymph nodes.

• Chemotherapy - Chemotherapy is a procedure in which drugs are administered in high doses to kill cancer cells or slow down their growth. The most commonly used chemotherapeutic agents are Carboplatin, Bleomycin, Etoposide, and Cisplatin.

Conclusion:

Testicular seminoma is a cancer of the germ cells of the testis. It is a highly curable type of cancer, and 95 to 98 % of the patients survive after treatment. The treatment aims to remove the affected testicle. Sometimes, the patients are worried about their testosterone levels after removing their testicles. They feel depressed and think they might not be able to become a father again, which is not the case. Removal of a testis does not have a significant effect on testosterone levels. If the patient is concerned about the cosmetic implications of losing a testis, he can undergo reconstructive surgery in which the testicles can be replaced. Consult the doctor soon to learn more about testicular seminoma and the treatment options.