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Le cancer du testicule : facteurs de risque génétiques et environnementaux

Testicular cancer: genetic and environmental risk factors

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Résumé

L'incidence du cancer du testicule (CT), qui est inégale d'une région à l'autre, progresse dans la plupart des pays y compris la France. L'origine la plus probable du CT est la non différenciation de cellules germinales souches pendant la vie fœtale. Ces cellules, maintenues dans un état immature, pourraient proliférer pour former une tumeur après la puberté. La fréquence de son association avec une cryptorchidie ou une infertilité a conduit à formuler l'hypothèse que le CT pouvait être un des constituants du syndrome de dysgénésie testiculaire. Le rôle des facteurs génétiques est suggéré par la fréquence de cas familiaux de CT mais aucun gène clairement responsable du cancer n'a été identifié jusqu'à présent. Parmi les nombreux gènes étudiés, ce sont ceux contrôlant la voie KITLG/KIT, qui participe à la régulation de la prolifération et de la fonction des cellules germinales primordiales, qui semblent jouer le rôle principal. Les études faites sur des populations migrantes et les jumeaux suggèrent par ailleurs que des facteurs environnementaux pourraient jouer un rôle essentiel dans la genèse du CT. Des dérégulations hormonales pendant la vie fœtale ou la puberté pourraient notamment favoriser le développement de CT. Cependant, l'exposition à des substances exogènes agissant comme des perturbateurs endocriniens est encore à démontrer.

Abstract

The incidence of testicular cancer (TC) has a distinct geographic distribution but is increasing in most countries, including France. The most likely origin of TC is a lack of normal germ cell differentiation in the foetal testis. The maintained immature germ cells could proliferate after puberty to induce testicular tumor. Because of its frequent association with cryptorchidism and infertility, TC could be part of the testicular dysgenesis syndrome. The role of genetic factors is suggested by the frequency of familial TC cases, but no responsible gene has been clearly identified until now. Among the various studied genes, those regulating the KITLG/KIT pathway involved in primordial germ cell proliferation seem to play an important role. Studies made in immigrants and twins suggest the influence of environmental factors on the origin of TC. Hormonal deregulation occurring during prenatal life or puberty could facilitate the development of TC. However, the role of exogenous substances acting as endocrine disruptors has not been demonstrated yet.

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Correspondence to P. Jouannet.

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Mots clés

  • Cancer du testicule
  • Épidémiologie
  • Dysgénésie testiculaire
  • Perturbateurs endocriniens

Keywords

  • Testicular cancer
  • Epidemiology
  • Testicular dysgenesis
  • Endocrine disruptors