TESTICULAR CANCER

Testicular cancer are classified by the type of cells the cancer begins in. The most common type of testicular cancer is “germ cell testicular cancer“. Germ cells are a type of cell that the body uses to create sperm.

There are two main subtypes of germ cell testicular cancer. They are:

• seminomas – which have become more common in the last 20 years and now account for 50-55% of testicular cancers. Seminoma tumors occur in all age groups, but if an older man develops testicular cancer, it is more likely to be seminoma. Seminomas, in general, aren’t as aggressive as nonseminomas.
• non-seminomas – which account for most of the rest and include teratomas, embryonal carcinomas, choriocarcinomas and yolk sac tumours. Nonseminoma tumors tend to develop earlier in life and grow and spread rapidly. Several different types of nonseminoma tumors exist, including choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumor.

Both types tend to respond well to chemotherapy.

Less common types of testicular cancer include:

• Leydig cell tumours – which account for around 1-3% of cases
• Sertoli cell tumours – which account for around 1% of cases
• lymphoma – which accounts for around 4% of cases

Symptoms

The most common symptom is a painless lump or swelling in one of the testicles. It can be the size of a pea or it may be much larger.

Other symptoms can include:

• a dull ache in the scrotum
• a feeling of heaviness in the scrotum

See your GP if you notice any changes.

DIAGNOSIS

Some men discover testicular cancer themselves, either unintentionally or while doing a testicular self-examination to check for lumps. In other cases, your doctor may detect a lump during a routine physical exam.

To diagnose that you have testicular cancer, your doctor may recommend:

• Ultrasound. A testicular ultrasound test uses sound waves to create an image of the scrotum and testicles. During an ultrasound, you lie on your back with your legs spread then your doctor applies a clear gel to your scrotum. A hand-held probe is moved over your scrotum to make the ultrasound image. An ultrasound test can help your doctor determine the nature of any testicular lumps, such as if the lumps are solid or fluid-filled. Ultrasound also tells your doctor whether lumps are inside or outside of the testicle.
• Blood tests. Your doctor may order tests to determine the levels of tumor markers in your blood. Tumor markers are substances that occur normally in your blood, but the levels of these substances may be elevated in certain situations, including testicular cancer. A high level of a tumor marker in your blood doesn’t mean you have cancer, but it may help your doctor in determining your diagnosis.
• Surgery to remove a testicle (radical inguinal orchiectomy). If it’s determined that the lump on your testicle may be cancerous, surgery to remove the testicle may be recommended. Your removed testicle will be analyzed to determine if the lump is cancerous and, if so, what type of cancer.

Staging the cancer

The next step after your doctor confirms your diagnosis is knowing the extent (stage) of the cancer. To determine whether cancer has spread outside of your testicle, you may undergo:

• Computerized tomography (CT) scan. CT scans take a series of X-ray images of your abdomen, chest and pelvis. Your doctor uses CT scans to look for signs that cancer has spread.
• Blood tests. Blood tests to look for elevated tumor markers can help your doctor understand whether cancer likely remains in your body after your testicle is removed.

After these tests, your testicular cancer is assigned a stage. The stage helps determine what treatments are best for you. The stages of testicular cancer are:

• Stage I. Cancer is limited to the testicle.
• Stage II. Cancer has spread to the lymph nodes in the abdomen.
• Stage III. Cancer has spread to other parts of the body. Testicular cancer most commonly spreads to the lungs and liver.

TREATMENT

The options for treating your testicular cancer depend on several factors such as the type and stage of cancer, your overall health, and your own preferences.

Surgery

Operations used to treat testicular cancer include:

• Surgery to remove your testicle (radical inguinal orchiectomy) is the primary treatment for nearly all stages and types of testicular cancer.
• Surgery to remove nearby lymph nodes (retroperitoneal lymph node dissection) is performed through an incision in your abdomen. In some cases, the surgeon harm to the nerves which can cause difficulty with ejaculation, but won’t prevent you from having an erection.

In cases of early-stage testicular cancer, surgery may be the only treatment needed.

Radiation therapy

Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells.  Radiation therapy is a treatment option that’s sometimes used in people who have the seminoma type of testicular cancer. It may be recommended after surgery to remove your testicle.

Side effects may include fatigue, as well as skin redness and irritation in your abdominal and groin areas. Radiation therapy is also likely to cause infertility. Talk to your doctor about your options for preserving your sperm before beginning radiation therapy.

Chemotherapy

Chemotherapy treatment uses drugs to kill cancer cells. Chemotherapy drugs travel throughout your body to kill cancer cells that may have migrated from the original tumor.

Chemotherapy may be your only treatment, or it may be recommended before or after lymph node removal surgery.

Side effects of chemotherapy depend on the drugs being used. Common side effects include fatigue, nausea, hair loss and an increased risk of infection. There are medications and treatments available that reduce some of the side effects of chemotherapy.

Chemotherapy is also likely to cause infertility, which can be permanent. Talk to your doctor about your options for preserving your sperm before beginning chemotherapy.