Tumors in the scrotal sac most commonly present as a painless "nodule". These nodules can originate from various tissues, such as the testicle itself, its fibrous covering, the epididymis or the spermatic cord. Most often these nodules are benign, but a small percentage may be malignant. For this reason, every swelling or new nodule should be evaluated by a physician or urologist, especially when it developed relatively rapidly.
Malignant tumors of the scrotum originate mainly in the testis. In the early stages of the disease they usually do not cause any discomfort, therefore patients often consult a physician late. Although there is only a painless local swelling distant metastases in different organs may already be present. Rare clinical symptoms are swelling of the mammary gland, diffuse abdominal pain or shortness of breath, when the tumor has metastasized to the abdominal lymph nodes and lungs. Then unspecific symptoms such as fatigue, loss of performance capacity, appetite and weight may appear. The clinical findings of malignant testicular, epididymus or vas deferens tumors hardly differ from one another.
Factors favouring the development of testicular neoplasms are developmental disturbances and testicular maldescent (cryptorchism). In case of cryptorchism, especially when it is not diagnosed and corrected at an early age, the risk of developing a testicular cancer is 20-30 times higher as when the testis has descended normally.
Testicular tumors account for approximately 1% of all malignant tumors in the male. On the other hand they are the most frequent tumor type in men 20 to 35 years of age and the incidence has been increasing over the last 20 years. Every year 2-4 patients per 100'000 men are afflicted by this disease. After the age of 60 testicular neoplasms are rare. There is a large variety of testicular neoplasms of different cellular origin.
With 85 to 90 percent of the testicular neoplasms the germ cell tumors are predominant. They comprise a heterogeneous group of malignant tumors (seminoma, embryonal cell carcinoma, teratoma, choriocarcinoma, yolksac tumor, polyembryona), all of which stem from the germ cells, that is sperm and their precursors. The other testicular neoplasms are so called stromal tumors (Leydig cell tumor, Sertoli cell tumor, granulosa cell tumor, gonadoblastom, androblastom that arise from the testicular connective tissue cells. These stromal tumors are mostly benign. Only 10 to 20 percent of them are malignant and may metastasize to other organs. Rarely one may find metastasis in the testis of malignant tumors of other organs.
Prognosis of testicular tumors depends on the type and differentiation of the tumor, the extension, and on the presence of metastases. In order to evaluate the first two of this factors, the suspect testicle must first be surgically laid free and removed if the suspicion of malignancy is verified. Depending upon the tumor type, extension or radiological evidence of metastases, further treatment with chemotherapy, radiotherapy or rarely surgery is determined. In general, one may say that over 90% of neoplasms of the testis can be cured. Benign tumors of the testis can be operated with organ conservation and rarely need further treatment.
Another group of tumors in the scrotum are the so-called paratesticular tumors. Paratesticular means that the tumors are in the scrotum but not in the testicle.