Uro-Oncology - Testicular Cancer

What is testis cancer?

Testis cancer, or testicular cancer, is a type of cancer that occurs in the testicles of men. The testicles are located in the scrotum, underneath the penis, and are responsible for the production of the male sex hormone and sperm.

It is estimated that about 8000 to 10000 men suffer from testis cancer every year in the United States. It may sound frightening, but with early detection, the chances of beating testis cancer are actually really high.

What are the symptoms of testis cancer?

Some symptoms of testis cancer to look out for include:

Pain in the testicle
Lump or swelling of the testicle
Changes in firmness or shape of the testicles when you feel it.
Dull ache in groin or lower abdomen
Swelling or heaviness in the scrotum
Breast enlargement or tenderness
Back pain

The first symptom of testicular cancer is usually a lump or swelling of the testicles. Most of the time, lumps or swelling caused by testicular cancers are painless.

When to visit a doctor

You should visit a doctor if you have any of the above symptoms. Early detection leads to early treatment and can greatly increase the chances of cure.

Is a testis cancer lump hard or soft?

The lump often forms within the testicle and feels hard. It may also feel firmer and more swollen than usual. The shape of the testicle can also change.

What are the stages of testis cancer?

Stages of testis cancer are determined based on 4 main factors:

How far the testicular tumour has involved the surrounding structures
Whether the lymph nodes in the body are involved.
How far the cancer has spread to other parts of the body
Whether the blood tumour markers are raised.

The different stages of testis cancer are summarised in the table below:

Stage I

Stage IA

Cancer is only found in testis
Tumour markers are normal

Stage IB

Cancer may have grown outside of the testis into nearby structures but has not spread to lymph nodes or other organs
Tumour markers are normal

Stage IS

Cancer might have spread to outside of testes
At least one tumour marker level is elevated

Stage II

Stage IIA

Cancer has spread to no more than 5 nearby lymph nodes, which are less than 2cm in size

Stage IIB

Cancer has either:
1) Spread to at least one lymph node larger than 2cm but no more than 5cm
2) Spread to more than 5 nearby lymph nodes which are all less than 5cm in size
3) Spread through outside covering of the lymph node

Stage IIC

Cancer has spread to at least one nearby lymph node which is larger than 5cm

Stage III

Stage IIIA

Cancer has spread to distant lymph nodes (e.g. near the collarbone), or to the lungs
Tumour marker level is normal or slightly raised

Stage IIIB

Cancer has spread to nearby lymph nodes and tumour marker levels are moderately high
OR
Cancer has spread to lungs or distant lymph nodes and tumour marker levels are moderately high

Stage IIIC

Same as stage IIIB but with high tumour marker levels
OR
Cancer has spread to another body organ other than lungs (e.g. liver or brain). Tumour markers can be of any level.

Can testis cancer spread?

Testicular cancer usually spreads to the lungs, lymph nodes of the chest, pelvis and the base of the neck.

How is testis cancer caused?

There is currently no known cause for testis cancer. However, there are certain factors that can increase someone’s risk of developing testis cancer. These factors include:

Undescended testicles (cryptorchidism): Boys who have testicles that do not descend into the scrotum have a higher risk of testis cancer.
Family history: Having a close relative with testis cancer or an undescended testicle increases your chance of testis cancer.
Abnormal testicular development: Conditions that cause the testicles to develop abnormally may result in an increased risk of testis cancer.
Age: Although testis cancer can occur at any age, it usually affects men between the ages of 15 and 35 years old.

How is testis cancer diagnosed?

Testis cancer can be diagnosed through a series of tests such as:

Physical examination: Your doctor will examine your testis. They may also shine a torch at your testis to see if light passes through. Testicular lumps are hard, which prevents light from passing through.
Scrotal ultrasound: Your doctor will pass high-frequency sound waves to produce an image of your scrotum and testes in order to determine the position and size of abnormality in your scrotum, if any.
Blood tests: A blood sample can be drawn and analysed for tumour markers (beta-human chorionic gonadotropin, alpha-fetoprotein, and lactate dehydrogenase) specific to testicular cancer. Such tumour marker levels may be elevated.
Biopsy: A small sample of tissue from the testes may rarely be taken for further examinations in very selected cases.

How to prepare for your first consultation

There is nothing special that you will need to prepare before going for your first consultation. Your doctor may ask about your family history to help him in his diagnosis.

Is there a blood test to diagnose testis cancer?

Testicular cancer is diagnosed with histological diagnosis – tissues placed under the microscope for examination. Although there are blood tests to predict the risk and severity of testicular cancer, these blood tests are not considered diagnostic of testicular cancer. Not all patients with testicular cancer will produce elevated levels of tumour markers.

How is testis cancer treated?

There are different treatments available that your doctor may recommend, either singly or in combination, depending on your condition.

● Chemotherapy

Chemotherapy involves the use of drugs to treat cancer by destroying the cancer cells. It is usually used when the cancer has spread outside of the testes or to help consolidate treatment after surgery.

● Radical orchiectomy

The standard treatment for the removal of testis cancer is a radical inguinal orchiectomy. This surgery involves the removal of the entire testicle and spermatic cord, and chances of making a full recovery are high. Chemotherapy is often required after surgery. The involved lymph nodes may also be required to be removed.

A testicular prosthesis may be offered as an option and is a personal decision.

● Radiation therapy

Radiation therapy uses high doses of X-rays to kill cancer cells. This is typically used for certain types of testicular cancer after surgery to the nearby lymph nodes to reduce the recurrence of cancer.

Is testis cancer curable?

Yes, testis cancer is curable. Early detection is key in the treatment of testis cancer. Testis cancer is treated successfully in more than 95% of cases.

What’s the difference between a simple orchiectomy and a radical orchiectomy?

A radical orchiectomy involves the removal of the testicle and spermatic cord through an incision made in the groin. On the other hand, a simple orchiectomy involves removing the testicle through the scrotum. A simple orchiectomy is not the ideal surgery to treat testicular cancers.

Can I still have kids with one testicle?

Yes, you can. Generally, one testicle can provide enough testosterone and sperm for pregnancy. However, with chemotherapy or radiotherapy, the sperm may be affected. Sperm banking can be considered in these circumstances. Having one testicle does not affect your ability to get an erection.

Summary

Early detection of testis cancer entails early treatment and good outcomes. If you experience a painless lump or swelling in your testicles, please visit your urologist for a comprehensive diagnosis and a personalised treatment plan.

Uro-Oncology - Testicular Cancer