Testicular Cancer

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Overview

Testicular cancer occurs when the cells present in the testicles or testes start dividing uncontrollably. It is one of the rare cancers, and it can be seen occurring among men aged between 15 and 45 years.

The risk of testicular cancer is relatively high among those who have undescended testis or cryptorchidism, which is a condition, wherein one or both sides of the scrotum are empty and testicles are located in the groin or abdomen. Having a family history of testicular cancer is also a risk factor for this disease.

Testicular cancers are relatively easier to treat, especially if detected in the early stages.

Types

Based on the rate at which they grow, testicular cancers are classified into seminomas and nonseminomas. Both these cancers arise from germ cells, which are responsible for sperm production.

1. Seminoma: Seminoma is the more common testicular cancer type. It is relatively slow-growing and shows a good response to radiation therapy and chemotherapy.
2. Nonseminoma: Nonseminoma is a type of testicular cancer that is fast-growing and shows poor response to chemotherapy and radiation. Based on the type of cell that they are made up of, nonseminomas are further classified into choriocarcinoma, embryonal carcinoma, teratoma, yolk sac tumour, etc.

A stomal tumour is a rare condition, wherein non-cancerous tumours are formed in the testicles; Leydig cell tumours and Sertoli cell tumours are the two types of stromal tumours. Stromal tumours are more common during childhood.

Symptoms

Following are the main symptoms associated with testicular cancer:

Sudden accumulation of fluid in the scrotum and swelling
Scrotum starts feeling heavy
Presence of a lump in the testicles
Dull pain in the lower abdomen or groin
Pain in the testicles
Testicles may start shrinking

Courses

The exact causes that can lead to testicular cancers are unknown. However, there are a few risk factors that have been identified for testicular cancer:

Age: Testicular cancers are more common among men aged between 15 and 45 years.
Abnormal Testicle Development: Those who have an abnormally-developed testicle, which could be caused due to health conditions, such as Klinefelter syndrome, Down syndrome, etc., have a higher risk of developing testicular cancer.
Undescended Testicle or Cryptorchidism: If one or both testes are present in the groin or abdomen instead of the scrotum, it is termed cryptorchidism; this condition increases the risk of testicular cancer.
Family History of Testicular Cancer: Having a family history of testicular cancer increases one’s chances of developing this disease.
History of Testicular Cancer: Those who have been diagnosed with testicular cancer in the past are also at a higher risk of getting this disease.
Infertility: In a few cases, infertility is also found to increase testicular cancer risk.
Exposure to Harmful Chemicals: Those who are exposed to hazardous chemicals, such as pesticides, industrial solvents, chemical fertilisers, engine fuels and exhausts and welding fumes on a regular basis are also at an increased risk of getting testicular cancer.
Tobacco Usage: Those who use tobacco products have a higher chance of getting testicular cancer.
HIV Infection: HIV infection is found to increase the chances of getting seminomas in a few cases.

Diagnosis

There are multiple diagnostic tests available for the detection and diagnosis of testicular cancer.

a. Medical History Assessment and Physical Exam: When an individual presents himself with the symptoms of testicular cancer, his medical history is assessed by the doctor before everything. Previous and current illnesses, previous medical treatments, allergies, etc., are discussed. This is important in order to understand the cause of the symptoms. Also, the doctor physically examines the testicles for swelling, lumps or hardenings and tenderness, as these could be the signs of testicular cancer.

b. Ultrasound Scan: An ultrasound scan is one of the first tests recommended by the doctor if testicular cancer is suspected. If there is swelling in a testicle, this test can help in finding out the size and nature of the lump or swelling, which could be a cyst or a solid mass. The solid mass is usually indicative of testicular cancer.

c. Test for Tumour Markers: The doctor may suggest blood tests in order to check for the specific tumour markers. In the case of testicular cancers, blood tests are carried out to look out for the presence of tumour markers – alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) and lactate dehydrogenase (LDH). High levels of these hormones indicate testicular cancer. Nevertheless, there are chances of one having testicular cancer despite his tumour marker levels being normal. Hence, additional tests are required for a conclusive diagnosis.

d. Advanced Imaging Tests: For a more accurate diagnosis, advanced imaging tests, namely PET CT scan or MRI scan will be suggested by the doctor. These tests can provide additional information, such as the size of the tumour, its stage, the extent of local and distant spread, etc.

Throughout the treatment, imaging tests may be recommended frequently in order to determine the patient’s response to the treatment.

e. Orchiectomy: This procedure removes the testicle that is affected by cancer for further analysis of the disease. In a few cases, this could also be the first line of treatment for testicular cancers.

Biopsies are not recommended for the diagnosis of testicular cancers as they may increase the risk of the cancer spreading and cause alterations in the lymphatic drainage pattern.

Treatment

The treatment plans for testicular cancers are made based upon considering multiple factors, such as the stage of the disease, size of the tumour, the patient’s age and his overall health condition. Following are the commonly recommended treatment options for testicular cancers:

a. Surgery: Surgery is the main line of treatment for testicular cancers. Depending on the stage of the disease, the doctor may recommend the following surgical procedures for the successful management of the disease:

Radical Inguinal Orchiectomy: This surgery removes the cancer-affected testicle. Radical inguinal orchiectomy is the primary treatment recommended for the majority of testicular cancer cases, irrespective of the stage of the disease. During the procedure, the surgeon makes an incision in the groin and removes the entire testicle from this incision. For early-stage testicular cancers, this might be the only treatment required.
Active Surveillance: In the case of early-stage testicular cancers that are treated with orchiectomy alone, active surveillance may be suggested. The doctor recommends frequent tests to check for the signs of cancer. More comprehensive treatment plans may be recommended if there are signs of cancer coming back.
Retroperitoneal Lymph Node Dissection: This procedure removes the lymph nodes located close to cancer. It is recommended if the cancer is likely to spread or has already spread to the nearby lymph nodes. During this procedure, an incision is made in the abdomen, and the lymph nodes are carefully removed.

b. Radiation Therapy: Early stage testicular cancers, especially seminomas, show a good response to radiation therapy. During radiation therapy, strong radiation beams, which could be X-rays or proton beams, are delivered to the tumour to destroy it. In many cases, radiation therapy may be recommended after the surgery in order to reduce the risk of a relapse.

c. Chemotherapy: As a systemic therapy, chemotherapy uses strong anticancer drugs to destroy cancer cells throughout the body. Chemotherapy may be recommended in combination with other treatment options in order to enhance the efficacy of the overall treatment given for testicular cancer management. Chemotherapy cycles administered after testicular cancer surgery play a significant role in reducing the chances of relapses.

Frequently Asked Questions

1. Are testicular cancers treatable?

Yes, testicular cancers are treatable. In most cases, they can be treated with positive clinical outcomes and excellent survival rates.

However, the stage at which the disease is diagnosed plays a pivotal role in the disease prognosis. The treatments are less complicated and more successful when testicular cancers are in the early stages. That said, it is important to know that today, the field of cancer medicine has evolved remarkably, and advanced-stage testicular cancers can also be treated with decent clinical outcomes.

2. Is testicular cancer fast-growing?

This depends on the type of testicular cancer that has been diagnosed. Seminomas are relatively slow-growing and are more responsive to the treatment. On the other hand, nonseminomas are fast-growing.

Be it slow-growing or fast-growing, patients are advised to receive timely treatment in order to avoid various disease-related complications.

3. Are all testicle lumps cancerous?

No, not all lumps formed in the testicles are cancerous. In most cases, these lumps are benign and non-cancerous. Nevertheless, if a lump is found, it has to be examined by the doctor in order to be sure that it is not cancer.

4. Can testicular cancer treatments cause infertility?

In most cases, testicular cancers are treated with orchiectomy or the removal of testicles and this procedure affects the patient’s ability to produce sperms. Therefore, yes, testicular cancer treatments can cause infertility. However, in a few cases, fertility loss is temporary, and patients can father children after the treatment.

Patients who are looking forward to having children after the treatment can consider preserving sperm in a sperm bank before starting the treatment.

5. Do testicular cancers come back?

In a few cases, testicular cancers can come back after a few years. However, these recurrences can be treated successfully.

The follow-up regimen recommended by the doctor after the treatment plays a pivotal role in reducing the risk of relapses and in their early detection. Therefore, patients must never ignore their follow-up care or miss their follow-up appointments.

6. How can I prevent testicular cancer?

Just like every other cancer, there is no way you can prevent testicular cancer completely. However, there are a few measures that can bring down your risk of developing testicular cancer:

Avoid Exposure to Harmful Chemicals: Prolonged exposure to certain chemicals like pesticides, chemical fertilisers, engine fuels, etc., can increase one’s lung cancer risk.Therefore, you must avoid exposing yourself to these chemicals for long duration.
Quit Tobacco: If you use tobacco, consider quitting it as it can increase your testicular cancer risk.
Regular Screening: If you have a history of testicle-related problems or a family history of testicular cancer, consider talking to your doctor for regular screening.

Apart from these, you can also examine your testicles regularly for abnormal signs such as swelling, pain, tenderness and the presence of a lump. If any of these are found, you should immediately consult a doctor.