Testicular Cancer

 

Testicular cancer accounts for about 1% of all cancers in men worldwide. Though it accounts for a very small percentage of all cancer cases in men, it is the most common cancer among younger men. With early diagnosis and effective treatment, the overall five-year survival rate is 97%. 

About testicular cancer

Testicular cancer begins when healthy cells in a testicle undergo mutation (change) and grow out of control, forming a mass called a tumor. Testicles are two small egg-shaped glands located below the penis and are held inside a sac of loose skin called the scrotum. They produce the male hormone testosterone, and sperms, the male cells needed for reproduction.

The testicles are made up of many types of cells which on mutation can develop into one or more types of cancer. Around 95% of testicular cancers are germ cell (produce sperms) testicular cancers. Two main subtypes of germ cell testicular cancers are:

  • Seminoma: They are non-aggressive cancers and tend to grow and spread more slowly than non-seminomas.
  • Non-seminoma: They are aggressive cancers and tend to grow rapidly and spread outside the testicles.

Signs and Symptoms

Signs and symptoms of testicular cancer often appear at an early stage. An enlarged testicle or a small lump is the first sign of testicular cancer. Other important symptoms are:

  • Dull ache in the lower abdomen or the groin
  • Sudden swelling in the scrotum
  • Pain or discomfort in a testicle or in the scrotum
  • Back pain
  • Enlargement or tenderness of the breasts

As the cancer advances to different body parts, one may experience:

  • Low back pain
  • Shortness of breath, chest pain, or a cough 
  • Belly pain
  • Headaches or confusion

Risk factors

Testicular cancer is more likely to occur in people with the following risk factors:

  • An undescended testicle (cryptorchidism )
  • Abnormal development of the testicles
  • A personal history of testicular cancer
  • Having certain genetic conditions, such as Down syndrome or Klinefelter syndrome
  • Having a family history of testicular cancer
  • Being white
  • Been diagnosed as HIV positive

Diagnosis

When a person experiences any signs and symptoms of testicular cancer, the doctor may initially, review the medical history and conduct a detailed physical examination.  If any suspicious lumps or mass are detected during the physical examination, the following tests are recommended for a detailed diagnosis.

  • Blood tests/tumor markers: Blood tests help to detect proteins known as tumor markers; elevated levels of alpha-fetoprotein, human chorionic gonadotrophin, and lactate dehydrogenase in blood can be considered a strong indication of testicular cancer.
  • Ultrasound: The sound waves are used to create detailed images of the internal organs. It helps to identify whether the testicular tumor is more likely to be benign (non-cancerous) or malignant (cancerous).
  • Imaging test: Tests such as computerized tomography (CT) scan, magnetic resonance imaging (MRI), bone scan, chest X-ray is performed to detect the extent of cancer spread.

Stages of testicular cancer

Testicular cancer staging is based on the American Joint Committee on Cancer (AJCC) TNM system. It provides detailed information about:

  • Tumour (T): Whether the primary tumour has grown through the testicles
  • Node (N): Whether the cancer has spread to the surrounding lymph nodes
  • Metastasis (M): Whether the cancer has spread to distant parts of the body
  • Serum (S): Whether the blood levels of tumor markers are higher than normal

Testicular cancers can have the following stages:

Stage 0: Cancer cells are located within the seminiferous tubules inside the testicles.

Stage I:  Cancer cells have grown beyond the seminiferous tubules, but are still within the testicle, and haven’t grown into nearby blood vessels or lymph nodes.

Stage II: Cancer cells may or may not have grown outside the testicles and have spread to one or more nearby lymph nodes. But it hasn’t spread to distant parts of the body.

Stage III: Cancer cells may or may not have grown outside the testicle or nearby lymph nodes. It has spread to distant parts of the body like lungs, bones.

Treatment

If you are diagnosed with testicular cancer, the healthcare team would decide the treatment based on the overall health, the type of testicular cancer, and the stage at which the cancer is diagnosed. The cancer care team would also discuss about the possible side effects, risk and benefits of each treatment.

The treatment options for testicular cancer are:

  1. Surgery: Surgery is the main treatment for nearly all types and stages of testicular cancer. It involves the removal of the testicle through an incision made in the groin.

Inguinal orchiectomy involves removal of the entire testicle, the procedure is called orchiectomy. The testicle is then examined under a microscope to determine the type of cancer and its stage. If the cancer is aggressive and more likely to metastasize, a retroperitoneal lymph node dissection (RPLND) may be performed.

Retroperitoneal Lymph Node Dissection (RPLND) is the surgical procedure to remove the lymph nodes of the retroperitoneum (space in behind peritoneal membrane that lines the abdominal cavity). This is a complex and long operation; however, a laparoscopic approach may be considered to reduce the post-surgery complications.

The common side effects of surgery are reactions to anesthesia, excess bleeding, blood clots, infections, and erectile dysfunction.

  1. Chemotherapy: Chemotherapy involves the use of potent anti-cancer drugs to destroy the cancer cells. These drugs enter the blood stream and travel throughout the body to destroy the cancer cells. For testicular cancers, chemotherapy is used in the following roles:
  • As a standard treatment for advanced cancers (Stage I and II)
  • As adjuvant therapy (after surgery) to prevent the recurrence of cancer

Chemotherapy is administered in several cycles followed by a rest period to allow the body time to recover. The patients may receive single or combination of drugs for better results. Chemotherapy cycles may begin soon after the orchiectomy is performed.

Possible side effects of chemotherapy include nausea and vomiting, loss of appetite, hair loss, mouth sores, diarrhea or constipation, increased chance of infections and fatigue.

  1. Radiation therapy: Radiation therapy involves the use of high energy radiations (such as gamma rays or x-rays) to slow down the growth of cancer cells or to destroy it.  It usually begins after the orchiectomy procedure.

Radiation therapy is used in the following cases:

  • In stage I cancer as an adjuvant therapy to prevent the recurrence of cancer
  • In stage II and III as a main treatment to manage the symptoms

For testicular cancers, high energy beams are delivered at the site of tumor through an external source (external beam radiation therapy). It is an outpatient procedure that is usually given over several weeks.

Common side effects of radiation therapy may include fatigue, nausea, and diarrhea. Some men may also experience redness, blistering, and peeling at the delivery site.

Preventive measures

There are no preventive measures for testicular cancer as there are no known lifestyle risk factors.  Routine screening for men with cryptorchidism, family history and other non-modifiable risk factors can help in early diagnosis. 

Outlook

Testicular cancers usually have an excellent prognosis. The prognosis depends on the stage at the time of diagnosis, type of cancer and the overall health of the patient. Men with stage I and II cancers are likely to be cured with surgery and radiation therapy. Even men with the most advanced case have a fair average five-year survival rates.

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