Testicular Cancer

1 What is Testicular Cancer?

Cancer that begins in testes is called testicular cancer. Testes are part of a male reproductive system that lies inside the scrotum, a bag underneath the penis.

Testes produce male sex hormones and sperm. Testicular cancer is a rare type of cancer but it is, unfortunately, the most common cancer in American males between 15 and 35 years.

The good news is, testicular cancer has a fair chance of remission even when cancer has spread beyond the testicle.

Treatments include a single or combination of various therapies, which depend on upon the type and stage of cancer.

Treatments are most successful when the disease is detected at an earlier stage, for which regular testicular self-examination is recommended.

2 Symptoms

The common signs and symptoms of testicular cancer are:

  • An enlarged mass in any of the testicles
  • Scrotum may feel heavy
  • Slight pain in the abdomen or groin
  • A sudden collection of fluid in the scrotum
  • Pain or discomfort in a testicle or the scrotum
  • Back pain

Cancer usually affects only one testicle.

Any pain, swelling or lumps in your testicles or groin area should be suspected for testicular cancer.

Visit your doctor if the symptoms last longer than two weeks.

3 Causes

The exact cause of testicular cancer has not be discovered yet.

However like other cancers, this type is also thought to be caused due to genetic abnormalities in the cells of the testes.

These abnormalities result in uncontrolled multiplication of the cells and lead to the formation of mass in the testicle.

Germs cells, the cells in the testicles that produce immature sperm, are where most of testicular cancer originate.

4 Making a Diagnosis

Making a diagnosis of testicular cancer is done by performing several tests.

Schedule an appointment with your doctor if you find any abnormal mass on a testicle.

After you visit the doctor, s/he may refer you to a specialist in the urinary tract and male reproductive disorders (urologist) or a cancer specialist (oncologist).

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

Here is what you can do:

  • List out all the symptoms.
  • Write down your key medical information.
  • You may take a friend or family member with you.
  • Write down the names of all your medications, vitamins or supplements.
  • Make a list of the questions to ask your doctor. 

Some typical questions can be:

  • Do my symptoms indicate testicular cancer? If yes, what type?
  • Are there any additional tests needed?
  • What are the treatment options and side effects of each treatment option?
  • What is my chance of having a cure?
  • Do I need to see a specialist?
  • What will be the cost of treatment, and will my insurance cover it?
  • Can I become a father in future?
  • What can I plan to manage possible infertility?
  • What your does doctor want to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

  • When did you first notice the symptoms?
  • How severe are they?
  • Are your symptoms continuous or occasional?
  • Do you notice if any factor improves or worsens your symptoms?

The mode of detection varies among men. Some men may accidently discover it on their own while in others, a routine physical exam may be required to detect it.

Your doctor may recommend following tests to ensure if the lump is testicular cancer:

Ultrasound: It involves imaging your scrotum and testicles by using sound waves. During the test, you have to lie on your back and spread your legs.

A gel is then applied on your scrotum followed by rubbing a hand-held probe over your scrotum to make the ultrasound image.

After thorough observation of the ultrasound images, your doctor can determine the location and nature of any testicular lumps.

Blood tests: Blood tests are performed to know if certain substances indicative of cancer are present in your blood.

These substances, called tumor markers are raised in your blood if you have certain conditions including testicular cancer.

A high level of a tumor marker in your blood doesn't necessarily indicate cancer, rather it helps to diagnose the exact cause behind this.

Radical inguinal orchiectomy is a surgical procedure to remove a testicle. It helps to confirm cancer in your testes and is also a standard treatment for testicular cancer.

The type of testicular cancer guides the treatment and prognosis. Generally, two types of testicular cancer are common:

  • Seminoma: Seminoma tumors are usually less aggressive forms that may occur in all age groups but more commonly in old age.
  • Nonseminoma: Nonseminoma tumors are more aggressive forms that develop at a young age and spread rapidly. Some types of nonseminoma tumors are choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumor.

Once the diagnosis is confirmed, the cancer is staged. Staging helps to select a treatment that’s appropriate for you.

Following tests can detect if your cancer has spread outside of your testicle:

Computerized tomography (CT) scan: CT scan uses numerous X-ray images to produce a cross-sectional image of your abdomen, chest, and pelvis.

Blood tests: Blood tests help to detect if cancer still persists in your body after removal of a testicle. These tests measure tumor markers in your blood. These tests help to stage your cancer.

The stages of testicular cancer are:

  • Stage I: Cancer has not spread and is restricted to the testicle only.
  • Stage II: Cancer has spread to the lymph nodes in the abdomen.
  • Stage III: Cancer has spread to other parts of the body like lungs and liver.

5 Treatment

The treatments options for testicular cancer are selected on the basis of the type and stage of cancer, overall health status, and preferences.

  • Surgery: The surgical options include:
    • Surgery to remove your testicle (Radical inguinal orchiectomy) This is the standard treatment for almost all cases of testicular cancer. The testicle is removed through an incision in your groin. You may opt for a prosthetic, saline-filled testicle.
    • Surgery to remove nearby lymph nodes (retroperitoneal lymph node dissection). This involves surgical removal of lymph nodes near the affected testicle. It is done through an incision in your abdomen. During the process, some nerves that surround the lymph nodes may be damaged, which may cause difficulty with ejaculation, but erection is preserved.

Surgery is the only treatment for early-stage testicular cancer. After surgery, follow-up visits are necessary to detect if cancer has returned.

Follow-up appointments are scheduled typically every few months for the first few years and then less frequently after that.

  • Radiation therapy: It uses ionizing radiations like X-rays to destroy cancer cells. In some cases, seminoma may be treated with radiation therapy. It may also be recommended after surgery to remove your testicle. Side effects are fatigue, skin redness, irritation in your abdominal and groin areas, and infertility. Talk to your doctor if you are interested to preserve your sperm before starting radiation therapy.
  • Chemotherapy: Chemotherapy treatment uses chemical drugs to kill cancer cells. These drugs can destroy distant cancer cells that have migrated from the original tumor. Chemotherapy may be recommended before or after lymph node removal surgery or may be the only treatment option. Side effects are drug specific and most commonly include fatigue, nausea, hair loss and an increased susceptibility to infection. Chemotherapy can also cause permanent infertility. Therefore, talk to your doctor if you are interested to preserve your sperm before starting radiation therapy.

6 Prevention

Prevention of testicular cancer is not possible. Doctors have divided opinion on testicle self-examinations to identify testicular cancer at its earliest stage.

You may talk to your doctor about this. If you are in favor of testicular self-examination.

here some tips for proper examination:

  • Examine your testicles after a warm bath or shower when the heat from the water has relaxed your scrotum.
  • Stand in front of a mirror.
  • Observe the skin of the scrotum for any swelling.
  • Use both hands to feel each testicle.
  • Hold the testicle in such a way that your index and middle fingers are under the testicle while thumbs are on the top.
  • Glide your thumbs and fingers as if you were to roll the testicle. Remember that the testicles are usually smooth, oval shaped and somewhat firm. Usually, one testicle is slightly larger than the other.
  • Schedule an appointment with your doctor if you detect a lump.

7 Lifestyle and Coping

The emotional burden of a cancer diagnosis is scary, worrisome and full of insecurities. Follow these tips to better handle the situation:

Broaden your knowledge on testicular cancer to feel. Go for reliable sources of information like the National Cancer Institute and the American Cancer Society.

Take care of your health:

  • Eat a healthy diet rich in fruits and vegetables. 
  • Sleep enough.
  • Learn stress management.
  • Exercise
  • Quit smoking, if you do.

Join a support group: You may contact the American Cancer Society for support groups in your area.

Stay close to family and friends: Find people to listen to and talk to. Sharing is a great idea to mitigate pain and gain emotional support.

8 Risks and Complications

An undescended testicle (cryptorchidism): Men with an undescended testicle are more likely to develop testicular cancer.

Abnormal testicle development: Conditions such as Klinefelter's syndrome, may increase your risk of testicular cancer.

Family history: Family history increases your risk of testicular cancer.

Age: Testicular cancer is most commonly seen in teens and younger men, especially those between 15 and 35 years. However, it can occur at any age.

Race: White men are more prone to testicular cancer than black men.

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