Testicular cancer develops when abnormal, or malignant cells form in one or, rarely, both testicles. The testicles are two oval-shaped organs contained in the scrotum, a pouch of skin hanging underneath the penis. These are the organs responsible for the production of sperm and the hormone testosterone. While it may be quite disheartening to find out that one has testicular cancer, the good news is that the treatment rates for this particular form of cancer are quite high.
Types of Testicular Cancer
About 90% of all testicular cancers develop in the germ cells, which are the cells that produce sperm. These cancers usually take the form of a lump or tumour in the testicles. The two main types of germ cell tumours are:
Seminoma: This is a slow-growing type of cancer usually seen in men in their 40s or 50s.
Non-seminoma: These tumours are very aggressive and usually affect younger men, from their late teens into their early 30s. There are four types of non-seminoma tumours: embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and teratoma. Sometimes, a tumour may contain both seminoma and non-seminoma cells.
Testicular Cancer Incidence
While the disease is uncommon-only about 1 in 250 people with testicles will develop testicular cancer during their lifetime is the most common cancer for people assigned male at birth between ages 15 and 35.
Recognizing Symptoms of Testicular Cancer
A painless lump in the testicle is the most common symptom of testicular cancer. Other symptoms may include:
Swelling or fluid build-up in the scrotum
A feeling of heaviness in the scrotum Crushing pain, or dull ache, in the groin or lower abdomen Tenderness or pain in the scrotum or testicle A shrunk or smaller-than-normal testicle
These symptoms do not always point to cancer, but they could also result from other conditions. If any of these symptoms occur, however, seeking immediate medical consultation is necessary to get a proper diagnosis and treatment as early as possible.
What Causes Testicular Cancer?
Although experts are not yet certain of the exact causes, they do know that testicular cancer develops when there is an abnormal growth of the germ cells and these begin to accumulate, leading to the development of a tumour. There are certain risk factors, not actually causes, but these increase the possibility of testicular cancer.
Risk Factors for Testicular Cancer
Following are some of the possible risk factors for testicular cancer:
Age: The age range at highest risk for testicular cancer is between 15 and 35 years old. Undescended testicle: If the testicles don't move down into the scrotum during development before birth, there is an increased risk. This risk remains, even if the testicles are moved surgically to their normal position.
Ethnicity: In the United States and Europe, testicular cancer is most common in non-Hispanic white people.
Family History: A person's biological family history of testicular cancer increases his risk. Other genetic or inherited conditions, like Klinefelter syndrome, can be the risk factors.
Infertility: There is some evidence of linking factors associated with infertility to testicular cancer. Further research is needed to help clarify the association between infertility and testicular cancer.
How is Testicular Cancer Diagnosed?
Testicular cancer is most often diagnosed with a self-exam or during a routine examination by a physician. Diagnosis generally consists of the following important tests and procedures:
Physical examination: A physician will perform an appropriate physical examination searching for lumps in the testicles and lymph nodes for signs of cancer.
Ultrasound: An ultrasound may be performed to take images of the soft tissues to help confirm that abnormalities are carcinomas.
Inguinal Orchiectomy and Biopsy: The testicle from which the cancerous indications show may be surgically removed to check for malignant cells.
Other tests include blood tests that detect tumour markers, including AFP, HCG, and LDH. Other imaging studies may be done to determine if the tumour has spread to other parts of the body, including CT scans, X-rays, and MRIs.
Staging of Testicular Cancer
Staging of testicular cancer is crucial in giving a way forward for treatment. Staging reveals the extent of the spread of cancer and tumour size.
- Stage 0: There are abnormal cells present but remain confined to the confines of the testicle.
- Stage I: Cancer is confined within the confines of the testis, maybe blood vessels close, or lymph nodes.
- Stage II: The tumor has spread to the lymph nodes in the back of the abdomen, but not beyond.
- Stage III: The tumour has spread to other organs or lymph nodes beyond the abdomen.
Treatment Options for Testicular Cancer
Treatment options in the management of testicular cancer are highly individualized, considering the overall health of the patient, extent of disease presentation, and type of tumour.
Surgery
Treatment usually involves the removal of the affected testicle, a procedure called radical inguinal orchiectomy. It is an effective treatment for both seminoma and non-seminoma tumours. Lymph nodes may also be removed in some cases.
Orchiectomy, Radical Inguinal: The testicle is removed through an incision in the groin and the blood vessels that supply it are tied off to prevent cancer spread.
RPLND: This is the surgical removal of lymph nodes in the abdomen to help with staging and treatment. It is more common with non-seminoma cancers.
Radiation Therapy
Radiation therapy uses high-energy X-rays to kill cancer cells. It may be given after surgery to decrease the chance of the cancer returning. Radiation treatment is usually reserved for the treatment of seminomas.
Chemotherapy
Chemotherapy refers to the use of potent drugs that destroy the cancer cells. Chemotherapy is a common treatment modality, especially when the cancer has spread for both seminomas and nonseminomas. It is given pre-operatively before surgery to shrink the tumors or post-operatively after surgery to kill remaining cancerous cells.
Prevention of Testicular Cancer
Although no method is known to prevent testicular cancer, a person can conduct routine testicular self-exams to find variations in their early stages. A monthly self-exam can be recommended through health providers.
How to Perform a Testicular Self-Exam
Performing a testicular self-exam is relatively simple and only takes a few minutes. The best time to do this exam is after a warm bath or shower because the warmth relaxes the scrotal skin, making it easier to notice anything that might feel abnormal.
Examine each testicle with both hands.
Gently roll the testicle between your thumb and fingers to feel for lumps, bumps, or changes in size.
Note the epididymis is a cord-like structure at the top and back of the testicle; this should not be confused with a lump. If you find any lumps, nodules or changes in the size of your testicles, report these changes to your healthcare provider immediately.
Prognosis and Outlook for Testicular Cancer
The prognosis for individuals diagnosed with testicular cancer is usually very good. Over 95 per cent of the cases can be cured. Even patients in whom testicular cancer has spread extensively may enjoy an excellent chance for cure, with the average cure rate for patients with unfavourable risk factors currently standing at about 50 per cent.
Cure and Survival Rates
This is considered a highly curable disease, and outcomes can be further improved when the disease is diagnosed at an early stage. The cure rate of testicular cancer can go up to 98% if it is diagnosed and treated at an early stage.
Long-Term Effects and Living With Testicular Cancer
Living with testicular cancer frequently leads to questions about fertility and sexual health. Generally, having only one testicle is not a problem since the remaining one will produce adequate amounts of testosterone to maintain normal sexual desire and fertility. Occasionally, treatments like chemotherapy and lymph node removal can affect fertility or the ability to ejaculate.
It's important to speak with your doctor about any options for preserving fertility - like sperm banking - before starting treatment.
