What men need to know about testicular cancer
Testicular cancer is a malignancy that affects the testes, which are the sex glands in men that are responsible for secreting the male sex hormone testosterone and for producing sperm cells that fertilize female eggs to kick start a pregnancy.
Prevalence of testicular cancer
In the United States, there are around 240,000 men afflicted by cancer of the testes, but this is by no means as common as other cancers. It mostly affects men in their 20s to their mid-30s. The chances of surviving testicular cancer are as high as 95 percent, with the prognosis getting even better with early detection.
Anatomy of the male reproductive system
The testes are a pair of rounded glands that are encased within folds of tissue called the scrotum, hanging loosely beneath the penis in men. They are the male counterpart of the paired female ovaries. Sperms are motile male sex cells that go on to fertilize eggs.
Germ cells produce sperms in tiny tubular structures. The matured sperms are emptied into the epididymis, a duct of larger coiled tubes through which sperm pass to the vas deferens and transport the sperm to the urethral opening. The seminal vesicles and the prostate gland exude secretions that add bulk and volume to the sperms forming the semen that is ejaculated.
The tissue affected by testicular cancer
Testicular cancer almost always starts in the germ cells which are specialized cells lining millions of small tubular structures within the testes. These germ cells, which normally mature into independent and motile sperm cells, sometimes fail to do their primary job. They start replicating copies of themselves with alarming speed creating discordant lumps of cancerous tumors.
The symptoms of testicular cancer
The signs and symptoms of testicular cancer include changes in the shape and feel of the testicular surface following the discovery of a hard lump in the testes when touched and a feeling of heaviness in the scrotum. Pain in the testes is not always a deciding factor, but some testicular discomfort will be evident that may or may not be accompanied by intermittent pain in the groin. One or both testes may swell or shrink noticeably, sometimes with fluid invading the scrotal sac.
Why it occurs and the risk factors that provoke testicular cancer
What causes testicular cancer and why it affects white male Caucasians more than men of African and Asian descent or other ethnic groups still remains a mystery, but doctors have identified some of the risk factors that increase the likelihood of developing cancer of the testes.
- Age factor: Men within the age group of 20 to 35 years old are more prone to testicular cancer than older men. The risk in teenagers and adults above 55 years developing cancer is almost the same – seven percent for both populations.
- Family history: The risk is higher if cancer runs in the family. If you have a father, brother, or a grandparent affected by testicular cancer, you might get it too.
- Genital defects: Anatomical defects increase the risk. For example, if you have a condition when a testicle is missing from the scrotum such as cryptorchidism, your risk is higher. Testicles that stay undescended since birth show lower chances of producing sperm and are observed to be more susceptible to tumors. Whereas only three out of 100,000 men are likely to develop testicular cancer, the statistics narrow down to one incidence of testicular cancer for every 2,000 cases of undescended testes.
- HIV: A compromised immune system predisposes men to testicular cancer.
- Klinefelter syndrome: Men born with an extra X chromosome possessing smaller testes are generally incapable of fathering children and more susceptible to testicular cancer.
Detection and diagnosis of testicular cancer
Probing the medical history
The urologist will make specific queries regarding the personal medical background of the patient and whether the male generations of the family have historically exhibited symptoms of testicular cancer. Preliminary inquiries on lifestyle, diet, and chronic ailments, if any, will be helpful in ruling out or isolating the risk factors that predispose the individual to this form of cancer.
The physical examination
The penis and the testes will be physically examined to assess their size and shape, and for any structural abnormality indicative of a deeper malaise. The surface of the testes will be felt through the scrotal covering to test for unusual hardening, swelling, shrinkage or fluid buildup.
How sonography reveals inner details of reproductive organs
Eco imaging of internal organs is possible through sonography using sound waves. This is one of the minimally intrusive ways of diagnosing tumors, and other structural abnormalities indicative of growing cancers. Among other things, ultrasound reveals:
- Bacterial or viral infections of the prostate or epididymitis that trigger testicular inflammation
- Swelling of the epididymis caused by large cysts or fluid filled sacs
- A twisted spermatic chord suffocating the testes by reducing its blood supply
- A tumor that may be growing within the testes
- Fluid accumulating in the scrotal sac as in hydrocele
Blood testing for tumor markers
Alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (beta-hCG) and lactate dehydrogenase (LDH) are complex proteins that are found in excessive quantities in blood serum when tumor cells are hyperactive in the body. As high levels of such proteins in the blood usually point to germ cell tumors in the testes, we refer to them as tumor markers.
Though ultrasonography reveals different forms of cancer, sometimes the findings, including blood tests, are inconclusive. In such a situation, a biopsy or physically extracted sample of testicular tissue may be performed to confirm cancer. The pathological study reveals malignancy and is helpful in staging cancer. The downside of a biopsy is that it may cause cancer to unwittingly spread to other organs.
Treatment of testicular cancer
Once cancer is confirmed, one or more of the following treatment options can be leveraged:
- Surgery: This is usually performed by the surgical oncologist. In inguinal orchiectomy, the testicles are removed through a small incision in the groin. This enables the surgeon to microscopically view malignant cells to determine the progress of the disease. In stage one, cancer is confined to the tubular vessels, epididymis and membranous covering of the testes. In stage two, the cancer spreads to the lymphatic nodes in the abdomen. In stage three, cancer spreads to lymphatic nodes in the lungs and is poised to grow in other organs.
- Chemotherapy: A combination of chemicals is administered by a medical oncologist either orally or intravenously to kill cancer cells, especially clumps that have broken off from the main mass and are spreading elsewhere in the body.
- Radiation therapy: Controlled by a radiation oncologist, an intense beam of radiation is focused on a lymph node to kill cancerous cells and prevent them from spreading. This is usually done after the testes are surgically removed to prevent cancer from spreading elsewhere.
Because of the short-term discomfort and long-term damage that may result due to chemotherapy and radiation therapy, the condition of the patient is monitored closely to avoid or mitigate side effects as much as possible.
Life after testicular surgery
The post-surgery scenario will be characterized by hormonal imbalances that produce symptoms like loss of libido, sterility, weight gain, osteoporosis, muscle atrophy and gynecomastia. Testosterone replacement treatment is an effective long-term rehabilitative measure, and the surgical placement of artificial testes in the scrotal sac offers a cosmetic solution to preserve the body image.