Testicular Cancer

What is testicular cancer? 

The testes comprise primitive cells that mature to become cells that make spermatozoa or sperm that are important in sexual reproduction. There are also supporting cells that make enzymes and other fluid that enable the sperm to function properly. These primitive cells may become cancerous. These tumours are called testicular germ cell cancers.

How common is testicular cancer?

What is the age of onset for testicular cancer?

What are the symptoms of testicular cancer? 

Typically, patients present to their doctor with a painless lump in one or both testes. Occasionally, there may be a heavy or aching sensation in the testes. In advanced cancer, other symptoms may be present, for example, if cancer has spread to the lungs, there may be shortness of breath.

When shoudl you see a doctor?

If you notice a lump, swelling, or changes in the size or shape of a testicle, experience persistent pain or discomfort, feel heaviness, or observe fluid buildup in the scrotum, seek medical advice. Additionally, symptoms such as back or abdominal pain, or a general feeling of unwellness, should also prompt a visit to the doctor. 

Early detection and treatment of testicular cancer significantly improves outcomes, so it is important not to ignore any worrying symptoms.

How is testicular cancer prevented?

There is no sure way to prevent testicular cancer, but some steps may help with early detection or lowering the risk:

1. Regular self-examinations: Men are advised to carry out monthly testicular self-exams to spot any unusual lumps or changes in size. Early detection can lead to better treatment outcomes.
2. Awareness of risk factors: While prevention is not always possible, being aware of risk factors like a family history of the disease, undescended testicles or previous testicular cancer can encourage more frequent check-ups and alertness.
3. Healthy lifestyle: Keeping a healthy lifestyle with regular exercise, a balanced diet and avoiding exposure to harmful substances may help lower overall cancer risk.

It is important to consult with a healthcare professional if you have any concerns about your testicular health.

What causes testicular cancer?

The exact cause of testicular cancer is unknown. However, it occurs when healthy cells in the testicles develop changes in their DNA, leading to uncontrollable abnormal growth and the formation of a tumour which may be cancer (malignant). 

What are the risk factors for testicular cancer?

Males who have a history of undescended testes (testes that did not descend to lie in the scrotum during development) have a much higher chance of developing testicular cancer. Other risk factors include history of testicular cancer in the other testis and family history of testicular cancer.

How is testicular cancer diagnosed?

Ultrasonography of the testes will locate and delineate the size of the testicular lump.

Blood tests are taken for tumour markers comprising of alpha-fetoprotein (AFP) and beta-human chorionic gonadotrophin (HCG), and lactate dehydrogenase (LDH). CT scan of the chest, abdomen, pelvis and occasionally, the brain, is also performed to find out the extent of cancer.

Testicular cancers may be seminomas or non-seminomatous germ cell tumours, depending on what cell type is found at examination of the cancer under the microscope. An orchidectomy (removal of the testis) or biopsy is done to obtain the diagnosis.

How is testicular cancer treated?

Orchidectomy is performed to remove the affected testis if the cancer is localised. If there is advanced cancer, this may be done after chemotherapy in order to shrink the tumour first. Following surgery for early testicular cancer, chemotherapy or radiotherapy may be required to reduce the risk of recurrence. 

Chemotherapy is used if there is advanced cancer involving other organs such as the lungs or liver¹. Side effects of chemotherapy which are injected into veins include temporary nausea and vomiting, mouth ulcers, hair loss, loss of appetite and tiredness.

Clinical examinations, scans and pathology reports all help the medical team decide what is the stage of the germ cell tumour. The appropriate course of treatment may then be recommended. The treatment strategy will vary from person to person. 

Prognosis of testicular cancer is generally very good. It depends on the extent of the disease, the state of health of the individual as well as response to treatment. With appropriate treatment, cure rates of up to 80% have been reported even for patients with advanced testicular germ cell tumour. Patients with early-stage testicular cancer have reported cure rates of more than 95% with appropriate treatment. Close monitoring of blood markers together with radiological assessment is essential to detect early recurrence of cancer.

1. Could a painless lump in my testis be a sign of testicular cancer and should I see a doctor?

   Testicular cancer is usually not painful. If there is a lump, seek early medical attention. Although it may not be cancerous, it is better to have it checked.
   



2. I only have one testis. Should I be concerned about cancer, especially if it did not descend before birth?

   Normally, two testes are formed in the embryo, which descend before birth to lie in the scrotum. Occasionally one or both testes do not descend. There is a higher chance of cancer developing in undescended testes; therefore it is advisable to seek early medical attention. Surgery may be required to bring the testis back into the scrotum.
   



3. Will cancer treatment for testicular cancer affect my ability to have children in the future and how can that be mitigated?
   

   Yes, fertility will be affected by chemotherapy and as such your physician will likely refer you to a reproductive clinic for cryopreservation of your sperm to be used at a later stage post treatment should the need arise. 
   

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