Testicular Cancer

Testicular cancer is a relatively rare form of cancer and accounts for only 1 percent of cancers in men; however it is the most common cancer in men between the ages of 15 and 40. Nevertheless, testicular cancer is one of the most treatable forms of cancer, with cure rates approaching 100% if detected early.

The testes or testicles are part of the male reproductive system and produce sperm cells, as well as the male sex hormone testosterone. The testes are suspended in a multi-layered sac called the scrotum that hangs below the groin and the penis. Behind each gland is the epididymis (which later becomes the vas), a tube that transports the sperm to the urethra for ejaculation through the penis.

The most common sign of testicular cancer is a painless swelling or lump in one testis. About a third of the time, a man may experience a dull ache or a feeling of heaviness in the lower stomach, scrotum or groin area.

Testicular cancers are sometimes referred to as Germ Cell Tumours (GCT's). Testicular cancer takes several forms but is grouped into two main categories: Seminoma and Non-Seminoma (everything else including mixed tumours with seminoma as one of the cancers). Seminomas tend to be slower-growing and occur in the fourth decade of life, while non-seminomas occur more often in younger men. Non-seminomas are generally more aggressive than seminomas.

Testicular Self Examination (TSE)

Men are advised to perform testicular self-examinations. All men should be familiar with the size and feeling of their testicles, so they can detect any type of change. A TSE is best done after a warm bath or shower when the skin of the scrotum is relaxed. Each testis is carefully examined by rolling it between the fingers and thumbs of both hands to check for any lumps. Examination by a medical professional is critical if any abnormalities are felt, particularly if these change over time. Since the symptoms commonly associated with testicular cancer can also be caused by infections or illnesses other than cancer, further tests may be required to diagnose the underlying problem.

Tests

As with other urological cancers there may be a number of treatment options available to individual patients. These are most likely to include Surgery, Chemotherapy or Radiation Therapy. The best course of treatment for each individual case depends on a number of factors including the type of testicular cancer, its stage and grade as well as general health.

A series of tests may need to be conducted in order to plan the best treatment available. This work up may include a physical examination, imaging studies such as scrotal ultrasound and CT of the chest and abdomen, and blood tests to determine proteins that are specific markers of testicular cancer. Staging will be based on these results and the examination of the removed testicle by a pathologist.

Staging is an assessment of the extent of disease. Staging gauges the size and location of any tumours by using information gathered from imaging studies such as CT scans etc., as well as information from pathological and physical examinations. Stage can help determine prognosis (how a patient may do over time) and determine what therapy is indicated.

Basically, in Stage 1 the tumour is confined to the testes. In Stage 2 the tumour may have spread to lymph nodes but is restricted to the abdomen. Finally, in Stage 3 the tumour has spread to organs or beyond the lymph nodes in the abdomen to other parts of the body.

A blood sample is taken and examined to check for ‘Tumour Markers' that some cancers of the testis produce. These markers mirror the activity of the tumour and can be useful to follow the response of the cancer to treatment.
A CT scan may be taken to check the lymph nodes in the abdomen and the other organs in your body to ascertain whether the cancer may have spread or not.

Treatments

If a suspicious mass is found and other conditions are ruled out surgery is undertaken for most testicular cancers. Initially radical orchidectomy is performed, both for treatment purposes and to complete staging and grading assessment.

Orchidectomy involves the surgical removal of the testicle. This procedure is performed in hospital under general anaesthetic. An incision is made into the groin, where the blood vessels leading to the testicle are divided before the testicle is removed. The operation is often performed as day surgery and takes less than an hour to complete.
Side effects
Most side effects from this surgery tend to be temporary. Typically pain and discomfort around the operation site are the most common side effects, but this pain can be managed with painkillers, and should subside over time. Bleeding and infection are possible but uncommon side effects of orchidectomy.
If you have had an orchidectomy, a prosthetic testicle can be made and inserted into the scrotum at a later date for cosmetic reasons if you wish. Sexuality and fertility should not be affected by the removal of one testicle presuming that the other is present and normal. A single testicle will usually be able to make sufficient testosterone without requiring replacement therapy.
Removing both testicles leads to infertility. Hormone therapy may be needed to replace the lack of testosterone production which has many effects around the body. These include preserving muscle mass and bone density, preventing fat formation as well as helping to maintain mood and energy levels. Taking hormones will help relieve symptoms of reduced testosterone levels. Sexual activity can continue as erections and ejaculation will still be possible – although no sperm will be produced.
Depending on the results of the staging and grading assessment, further treatment may involve:
- Active surveillance — intensive interval follow-up with examination, blood tests and imaging (Usually with CT scans and chest x-rays)
- Chemotherapy — combinations of drugs given to kill any remaining cancer cells. This treatment is given and monitored by a medical oncologist who has specialized in this area
- Radiation treatment — focused energy waves made by a linear accelerator machine that kill cells by breaking the DNA in a way that prevents it from dividing. This treatment is given by a Radiation Oncologist who has specialized in the area and may be an option for Seminoma cancer treatment in some circumstances
- RPLND — surgical removal of the lymph nodes in the abdomen. Occasionally performed for men without evidence of disease spread as a preventative but usually performed following incomplete chemotherapy treatment
Sometimes an operation to remove the lymph nodes in the abdomen is performed as well as Orchidectomy. This is usually done if the cancer is thought to have spread into the other parts of the body, usually at a later date following further treatment.
Side effects
Lymphadenectomy can have both temporary (including bleeding, infection, blood clots and organ injury) and longer term side effects, (including inability to ejaculate and infertility).