What is testicular cancer?

The testicles (or testes) are part of the male reproductive system. Testicular cancer can start in one or both testicles. This type of cancer can be treated and is very often cured.  The testicles are made up of several kinds of cells and each may develop into one or more types of cancer.

There are three main types of testicular tumours:

  • Germ cell tumours are the most common type of testicular tumours that start in the cells that make sperm.
  • Stromal tumours start in the cells that make hormones and the cells that support the cells that make sperm.
  • Secondary testicular tumours are from cancer that has spread to the testicles from other parts of the body.

Thus, based on the type of cell the cancer started from, influences how the cancer is treated and the chance of survival of the patient.

What are the risk factors for testicular cancer?

While we do not know the exact cause of most cases of testicular cancer, we do know some of the risk factors linked to testicular cancer. These risk factors may include:

  • Undescended testicle: One of the main risk factors for testicular cancer is a problem called cryptorchidism, or undescended testicle(s).
  • Family history: A family history of testicular cancer increases the risk. If a man has the disease, there is a higher risk that his brothers or sons may also get it. But very few cases of testicular cancer are actually found in families.
  • HIV infection: There is some evidence that men infected with HIV (human immunodeficiency virus) have an increased risk of testicular cancer. This may be especially true for men who have AIDS. No other infections have been shown to increase testicular cancer risk.
  • Cancer of the other testicle: Men who have been cured of cancer in one testicle have an increased risk of getting cancer in the other testicle.
  • Age: About half of testicular cancers occur in men between the ages of 20 and 34. But this cancer can affect males of any age, including infants and older men.

What are the signs and symptoms of testicular cancer?

In most cases of testicular cancer, the man has a lump on a testicle or notices that the testicle is swollen or larger. Most of the time there is no pain. Men with testicular cancer may also notice a feeling of heaviness or aching in the lower belly or scrotum.

Even when the cancer has spread to other organs, few men have any symptoms. Lower back pain is a symptom of later-stage testicular cancer. Signs that the cancer has spread to the lungs can include:

  • Shortness of breath
  • Chest pain
  • Cough
  • Spitting up blood

A number of problems other than cancer, such as an injury to the testicle, infection, or inflammation, can cause symptoms like those of testicular cancer. If you have any of the signs or symptoms above, see a doctor right away. Remember, the sooner cancer is found the sooner you can start treatment. And the earlier you get treatment, the better it is likely to work.

How is testicular cancer diagnosed?

Tests and procedures used to diagnose testicular cancer include:

  • Medical history and physical exam: If you have signs or symptoms that suggest testicular cancer, your doctor will want to take a complete medical history to check for risk factors and symptoms. Then the doctor will do a physical exam. During the exam, the doctor will feel the testicles for any swelling, tenderness, or lumps. The doctor will also feel your belly for swollen lymph nodes which could be a sign that the cancer has spread.
  • Ultrasound: This test uses sound waves to make pictures of internal organs. An ultrasound can help doctors tell whether a lump (or mass) is solid or filled with fluid. If the lump is solid, then it is more likely to be cancer.
  • Blood tests: Certain blood tests can help diagnose testicular cancer. Many cancers make proteins (called tumour markers) that can be found in the blood. The levels of these tumour markers might be used to tell the doctor how much cancer is present, how well treatment is working, and whether the cancer has come back.

In many cases, to confirm the diagnosis of testicular cancer, a procedure (most often surgery) is done to remove the tumour or to get a sample of the tumour.  If testicular cancer is found, doctors use imaging tests (such as x-ray, CT or MRI to see how advanced it is.  The cancer is then staged, an important indicator of the type of treatment and the outlook for the recovery.

What are my treatment options?

After the cancer is found and staged, your doctor will talk to you about treatment choices. In choosing a treatment plan, things to take into account include the type and stage of the cancer as well as your overall physical health.  The three main methods of treatment for testicular cancer are surgery, radiation therapy, and chemotherapy.

  • Surgery: Surgery is most often the first treatment for testicular cancer.  Since a tumour in the testicle is likely to be a cancer, biopsies are rarely done for testicular cancer.
  • Radiation Therapy: In testicular cancer, radiation is mainly used to kill cancer cells that have spread to lymph nodes.
  • Chemotherapy: Chemotherapy is the use of drugs to kill cancer cells. The drugs can be taken in pill form or through a needle into a vein or muscle. Once the drugs enter the bloodstream, they spread throughout the body. Chemo is a good way to destroy any cancer cells that break off from the main tumour and travel in the bloodstream to lymph nodes or distant organs. It is often used to cure testicular cancer when it has spread outside the testicle or to decrease the risk of cancer coming back after the testicle is removed.

” Courtesy of the Aga Khan Hospital”