All to Know About Testicular Cancer

Testicular cancer, or cancer of the testes, occurs in the male sex hormones where sperm are produced.

Testosterone controls the development of the reproductive organs and other male physical characteristics. Testicular cancer is one of the most common forms of cancer in young men. Treatment of this cancer is mostly successful in 95 percent of men.

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Symptoms of Testicular Cancer

Symptoms of testicular cancer do not normally appear until a later stage. Men who notice anything unusual about their testicles should see a doctor immediately. Some symptoms may include:

  • pain in a testicle or scrotum
  • a painless lump or swelling in a testicle
  • a dull ache in the lower back, groin, or abdomen
  • discomfort in a testicle or scrotum
  • a sensation of heaviness in the scrotum
  • a sudden accumulation of fluid in the scrotum
  • Unexplained fatigue or malaise.

At times, these symptoms may not necessarily be caused by cancer. However, men shouldn’t ignore a lump or swelling in the testicle. It is important to see a doctor to rule out cancer. Even though testicular cancer can spread to the lymph nodes, it hardly ever travels to other organs. If the cancer does spread, a person may experience:

  • Difficulties in breathing
  • Swallowing difficulties
  • Coughing
  • Swelling in the chest

Early signs

To improve the chances of treatment and survival, it is important to catch testicular cancer early. The earliest signs that occur are a painless lump and swelling. The testicle may also seem to be larger than usual.

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However, this type of cancer may not cause noticeable symptoms until a later stage. Self-examination is essential to catch testicular cancer at an early stage.

Causes

Although scientists are not sure what the specific causes of testicular cancer are, there are some factors which may raise a man’s risk of developing the disease. These risk factors include:

  • Cryptorchidism (undescended testicle):If a testicle has not moved down when a male is born, there is a greater risk that he will develop testicular cancer later on.
  • Congenital abnormalities:Males born with abnormalities of the testicles, kidneys or penis.
  • Inguinal hernia:Males born with hernia in the groin.
  • Having had testicular cancer:If a male has had testicular cancer, he is more likely to develop it in the other testicle, compared with a man who has never had testicular cancer.
  • Family history: A male who has a close relative with testicular cancer is more likely to develop it himself compared with other men.
  • Abnormal testicular development:Conditions, such as Klinefelter’s syndrome, where the testicles do not develop normally, may increase a person’s risk of testicular cancer.
  • Mumps orchitis: This is an uncommon complication of mumps in which one or both testicles become inflamed.
  • Ancestry: Testicular cancer is more common among Caucasian males, compared with men of African or Asian descent. The highest rates are found in Scandinavia, Germany, and New Zealand.

Having a vasectomy does not increase a man’s risk of developing testicular cancer.

Treatment

The sooner a patient is diagnosed and treated, the better his prognosis is. Treatment for testicular cancer may involve surgery, chemotherapym radiotherapy or a combination.

Surgery

Orchiectomy

Orchiectomy is usually the first line of treatment where the testicle is surgically removed to prevent the tumor from spreading. If the patient is diagnosed and treated in stage 1, surgery may be the only treatment needed.

An orchiectomy is a straightforward operation. The patient receives a general anesthetic. A small incision is made in the groin, and the testicle is removed through the opening. The patient remains in hospital for a few days.

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If the man still has one testicle after the operation, it would not affect his chances of reproducing.

Fertility

If after the operation, the patient has no testicles, he will be infertile and will not be able to produce sperm.

Males who wish to have children one day are advised to bank their sperm before the operation – some sperm is kept in a sperm-bank before the testicle or testicles are removed.

Other testicular cancer treatments, including radiotherapy and chemotherapy, can also affect a cancer patient’s long-term fertility.

Lymph node surgery

If the cancer has reached the lymph nodes, they will need to be removed through surgery. This usually involves the lymph nodes in the abdomen and chest. Sometimes lymph node surgery can result in infertility.

Radiation therapy

Males with seminoma testicular cancer will require radiotherapy and surgery to destroy cancer cells. Radiotherapy involves the use of beams of high-energy X-rays or particles (radiation) to destroy cancer cells. Radiotherapy works by damaging the DNA inside the tumor cells, destroying their ability to reproduce. The radiotherapy is used to prevent cancer recurrence.

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Patients whose cancer has spread to their lymph nodes will need radiation therapy. Radiation therapy may cause the following temporary side effects:

  • muscle stiffness
  • muscle stiffness
  • loss of appetite
  • tiredness
  • rashes
  • joint stiffness
  • muscle stiffness

Chemotherapy

Chemotherapy is the use of chemicals (medication) to destroy cancer cells. Cytotoxic medication prevents cancer cells from dividing and growing.

Chemotherapy is usually given to patients with advanced testicular cancer – cancer that has spread to other parts of the body. Treatment is administered either orally (tablets by mouth) or injection. As chemotherapy attacks healthy cells as well as cancerous ones, the patient may experience the following temporary side effects:

Most people immediately link chemotherapy with uncomfortable side effects. However, side-effect management has improved considerably over the last 20 years.

Diagnosis

There are several ways to diagnose testicular cancer.

Blood tests

These measure levels of tumor markers, such as alpha-fetoprotein (AFP), human chorionic gonadotrophin (HCG), and lactate dehydrogenase (LDH). However, it is possible that blood tests come back normal, even though cancer is present.

Testicular ultrasound

An ultrasound of the scrotum can reveal the presence and also the size of a tumor.

Testicular biopsy

A small sample of tissue is taken from the targeted area in the testicle and examined under a microscope to determine whether the lump is malignant (cancerous) or benign (non-cancerous).

Testicular cancer types

When the doctor has determined the type of testicular cancer the patient has, they can then devise a treatment plan and make a prognosis. There are two main types of testicular cancer:

  • Seminoma testicular cancer: These contain only seminoma cells. All age groups can get this type of cancer.
  • Non-seminoma testicular cancer: These may contain many different cancer cells. Non-seminoma tumors tend to affect younger patients and will spread more rapidly than seminoma ones.

Most testicular cancers start in the germ cells – the cells in the testicles that produce immature sperm. We don’t know what causes those cells to become abnormal and cancerous. Sometimes, both types of cancers may be present. If this is the case, the doctor will use non-seminoma treatment.

Staging the cancer

After carrying out all the relevant tests, the doctor will then be able to stage the cancer. This helps determine what treatment to use.

  • Stage I: The cancer is only in the testis and has not spread.
  • Stage II:The cancer has reached the lymph nodes in the abdomen.
  • Stage III:The cancer has spread further, to other parts of the body. This could include the lungs, liver, brain, and bones.

Self-exam

The best time to check yourself is when the scrotal skin is relaxed; usually after a warm shower or bath.

  • Hold the scrotum gently in the palms of both hands. Stand in front of the mirror and look for any swelling on the skin of the scrotum.
  • Start by feeling the size and weight of the testicles.
  • With fingers and thumbs press around and be receptive to any lumps or unusual swellings. Some men have one testicle that hangs lower than the other. Some people have one testicle which is bigger than the other. This is normal.
  • Each check, try to detect any significant increase in the size or weight of the testicles.
  • Feel each testicle individually. Place the index and middle fingers under the testicle while your thumbs are on the top. Gently roll the testicle between the thumbs and the fingers – it should be smooth, oval-shaped, and somewhat firm. There should be no lumps or swellings. The top and back of each testicle should have a tube-like section where sperm is stored, known as the epididymis, which may be slightly tender. It is normal for it to feel tender.

 

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