What to know about testicular cancer
Testosterone controls the development of the reproductive organs and other male physical characteristics.
Although testicular cancer is uncommon compared with other cancers (0.7 percent of all cancers), it is the most common cancer in males aged between 15 and 35 years in North America and Europe. Every year, 8,000 males in the United States are diagnosed with testicular cancer, and 390 men die each year in the from the disease.
- Testicular cancer is one of the most common forms of cancer in young men.
- Common diagnoses include examination, blood tests, and ultrasounds.
- Treatment is successful in 95 percent of men with testicular cancer.
Symptoms of testicular cancer do not normally appear until a later stage.
In most cases, the individual finds the cancer himself. Sometimes, it is discovered by doctors during a routine physical exam.
Anyone who notices anything unusual about their testicles should see a doctor, especially if they detect any of the following:
- a painless lump or swelling in a testicle
- pain in a testicle or scrotum
- discomfort in a testicle or scrotum
- a sensation of heaviness in the scrotum
- a dull ache in the lower back, groin, or abdomen
- a sudden accumulation of fluid in the scrotum
- unexplained tiredness or malaise.
It is worth noting that these symptoms may not necessarily be caused by cancer. In fact, less than 4 percent of lumps in the testicles are found to be cancerous. Individuals should not ignore a lump or swelling in the testicle, though. It is important to see a doctor. They can then determine the cause.
Even though testicular cancer can spread to the lymph nodes, it hardly ever travels to other organs. If the cancer does spread, a person may experience:
- breathing difficulties
- swallowing difficulties
- swelling in the chest
It is important to catch testicular cancer early to improve the chances for successful treatment.
The earliest signs that occur are a painless lump and swelling. The testicle may also seem to be larger than usual.
However, this type of cancer may not cause noticeable symptoms until a later stage. That is why self-examination is so important - it is often the only way to catch testicular cancer at an early stage.
Although scientists are not sure what the specific causes of testicular cancer are, there are some factors which may raise a man's risk of developing the disease. These risk factors include:
- Cryptorchidism (undescended testicle): If a testicle has not moved down when a male is born, there is a greater risk that he will develop testicular cancer later on.
- Congenital abnormalities: Males born with abnormalities of the penis, kidneys, or testicles.
- Inguinal hernia: Males born with a hernia in the groin.
- Having had testicular cancer: If a male has had testicular cancer, he is more likely to develop it in the other testicle, compared with a man who has never had testicular cancer.
- Family history: A male who has a close relative with testicular cancer is more likely to develop it himself compared with other men.
- Abnormal testicular development: Conditions, such as Klinefelter's syndrome, where the testicles do not develop normally, may increase a person's risk of testicular cancer.
- Mumps orchitis: This is an uncommon complication of mumps in which one or both testicles become inflamed.
- Ancestry: Testicular cancer is more common among Caucasian males, compared with men of African or Asian descent. The highest rates are found in Scandinavia, Germany, and New Zealand.
Having a vasectomy does not increase a man's risk of developing testicular cancer.
Around 95 percent of all men with testicular cancer make a full recovery after receiving treatment. The sooner a patient is diagnosed and treated, the better his prognosis is.
Orchiectomy is usually the first line of treatment. The testicle is surgically removed to prevent the tumor from spreading. If the patient is diagnosed and treated in stage 1, surgery may be the only treatment needed.
An orchiectomy is a straightforward operation. The patient receives a general anesthetic. A small incision is made in the groin, and the testicle is removed through the incision. The patient remains in hospital for a few days.
If the man still has one testicle after the operation, his sex life and chances of reproducing should not be affected.Fertility
If after the operation, the patient has no testicles, he will be infertile. He will not be able to produce sperm.
Males who wish to have children one day should consider banking their sperm before the operation - some sperm is kept in a sperm-bank before the testicle or testicles are removed.
Other testicular cancer therapies, including radiotherapy and chemotherapy, can also affect a cancer patient's long-term fertility.
Lymph node surgery
If the cancer has reached the lymph nodes, they will need to be surgically removed. This usually involves the lymph nodes in the abdomen and chest. Sometimes lymph node surgery can result in infertility.
Radiotherapy involves the use of beams of high-energy X-rays or particles (radiation) to destroy cancer cells. Radiotherapy works by damaging the DNA inside the tumor cells, destroying their ability to reproduce.
Patients with seminoma testicular cancer will typically require radiotherapy as well as surgery. The radiotherapy is used to prevent cancer recurrence.
Patients whose cancer has spread to their lymph nodes will need radiation therapy. Radiation therapy may cause the following temporary side effects:
- muscle stiffness
- joint stiffness
- loss of appetite
Chemotherapy is the use of chemicals (medication) to destroy cancer cells. Cytotoxic medication prevents cancer cells from dividing and growing.
Chemotherapy is usually given to patients with advanced testicular cancer - cancer that has spread to other parts of the body. Treatment is administered either orally (tablets by mouth) or injection. As chemotherapy attacks healthy cells as well as cancerous ones, the patient may experience the following temporary side effects:
- hair loss
- mouth sores
Most people immediately link chemotherapy with uncomfortable side effects. However, side-effect management has improved considerably over the last 20 years.
There are several ways to diagnose testicular cancer.
These measure levels of tumor markers, such as alpha-fetoprotein (AFP), human chorionic gonadotrophin (HCG), and lactate dehydrogenase (LDH). However, it is possible that blood tests come back normal, even though cancer is present.
An ultrasound of the scrotum can reveal the presence and also the size of a tumor.
A small sample of tissue is taken from the targeted area in the testicle and examined under a microscope to determine whether the lump is malignant (cancerous) or benign (non-cancerous).
Testicular cancer types
Seminoma testicular cancer cells pictured.
When the doctor has determined the type of testicular cancer the patient has, they can then devise a treatment plan and make a prognosis. There are two main types of testicular cancer:
- Seminoma testicular cancer: These contain only seminoma cells. All age groups can get this type of cancer.
- Non-seminoma testicular cancer: These may contain many different cancer cells. Non-seminoma tumors tend to affect younger patients and will spread more rapidly than seminoma ones.
Most testicular cancers start in the germ cells - the cells in the testicles that produce immature sperm. We don't know what causes those cells to become abnormal and cancerous. Sometimes, both types of cancers may be present. If this is the case, the doctor will use non-seminoma treatment.
Staging the cancer
After carrying out all the relevant tests, the doctor will then be able to stage the cancer. This helps determine what treatment to use.
- Stage I: The cancer is only in the testis and has not spread.
- Stage II: The cancer has reached the lymph nodes in the abdomen.
- Stage III: The cancer has spread further, to other parts of the body. This could include the lungs, liver, brain, and bones.
The best time to check yourself is when the scrotal skin is relaxed; usually after a warm shower or bath.
- Gently hold the scrotum in the palms of both hands. Stand in front of the mirror and look for any swelling on the skin of the scrotum.
- Feel the size and weight of the testicles first.
- With fingers and thumbs press around and be receptive to any lumps or unusual swellings. Some men have one testicle that hangs lower than the other. Some people have one testicle which is bigger than the other. This is normal.
- Each check, try to detect any significant increase in the size or weight of the testicles.
- Feel each testicle individually. Place the index and middle fingers under the testicle while your thumbs are on the top. Gently roll the testicle between the thumbs and the fingers - it should be smooth, oval-shaped, and somewhat firm. There should be no lumps or swellings. The top and back of each testicle should have a tube-like section where sperm is stored, known as the epididymis, which may be slightly tender. It is normal for it to feel tender.
Preventing most cases testicular cancer is not possible, as the causes are largely unknown. Many men who develop testicular cancer do not have any known risk factors.
However, it is possible to make sure the cancer does not advance before treatment.