Distinguishing cancer from noncancerous issues that affect the male testes
Cancer is an unhealthy condition in which the cells of a part of the body rapidly divide and thrive without an apparent cause. These abnormally growing germ cells clump together, forming a buildup of tissue called a tumor that sets it apart from normal healthy tissue. When this happens in the testes, it is called testicular cancer. To form a clearer impression of this condition, it is useful to understand the anatomy of the testes.
The testes – an anatomical survey
The testicles are a pair of glands central to the male reproductive system. They sit in a loose sac of skin called the scrotum just below the male penis. The testes do two important things; they manufacture sperm for the better part of a man’s life. This sperm goes on to fertilize the female egg when a man impregnates a woman. The same testicles also produce an important hormone called testosterone, which plays a significant role in defining male sexual characteristics and which fuels the male sex drive.
The focal point of cancer invasion – the germ cells
What interests us is where the sperm are actually produced, because that is the area where cancer acquires a foothold before it spreads. Sperm are manufactured in the millions from nascent germ cells that line coiled tubular structures called seminiferous tubules. These germ cells are originally immobile spheroid structures that gradually transform into mobile sperm with a head, body, and tail.
Germ cell seminoma and non-seminoma cancer
More than 90 percent of all testicular cancer originates in germ cells that grow and multiply abnormally without our becoming aware of the process or what causes it. Depending on how the cancer cells are seen through the microscope, we label them broadly as the slow-spreading seminomas and rapidly-dividing non-seminomas, occurring in males in the age group from 20 to 35.
How testicular cancer spreads
If the cancer is noninvasive in nature, it remains confined to the testicular tissue. As soon as it acquires an invasive character, cancer gradually seeps into the lymphatic ducts and starts concentrating in the lymph nodes, which are bean-shaped clusters of white blood cells.
What is important to note is that there may be no outward signs or symptoms when cancer strikes root within germ cells in the testes. It takes time for cancer to evolve in the testes, and the affected man may go about his daily routine, completely unaware that anything is amiss.
When testicular cancer reaches an advanced stage, it starts causing external signs and symptoms that are detectable because of the discomfort they begin to cause in that region. However, not every symptom signals cancer, and it is possible for the testes to suffer inflammation following a bacterial or viral infection.
Signs and symptoms of testicular cancer
- There may be no pain initially, but you sense a swelling in one or both testicles, and it is unusual because it was never felt before. This is a crucial time, because many men ignore the development, thinking it could be a localized infection that may go away with over-the-counter medications. It would be a wise decision to consult a doctor and get your testicles palpated clinically. If suspicions are high, the doctor may decide to go ahead with tests that confirm or rule out cancer and save you loads of distress down the road. Therefore, make a point to visit the doctor at the earliest sign for speedy diagnosis so that you can nip this in the bud in more ways than one.
- The swelling that commences as a pea-sized nodule on the surface of the testicle hardens and enlarges, making the testicle much larger than it was originally. Once the testicle becomes enlarged, it can cause you pain and discomfort when walking and even when sitting.
- Now things begin to move along, and you start feeling a dull uncomfortable ache that causes the testicle to become tender to the touch, and because the testicle has grown bigger, there is a sense of heaviness in the scrotum. Since the testicle in question has become enlarged and tender to the touch, you may start to experience slight abdominal pains as a result of the enlarged testicle.
- The cancerous testicle will become harder, much like a nut compared to the healthy squishy testicle, and you can sense the change when you use your fingers to feel the surfaces of both testicles.
- A dull pain surfaces in your groin that radiates into the abdomen, and probably around this time, you may notice fluid accumulating within the scrotal sac, although this doesn’t happen all the time.
- Once cancer has established a foothold in the testes, it triggers the secretion of certain proteins that stimulate the male breast to grow and become sore and tender. This may go on, in extreme cases, to create an enlarged male breast called gynecomastia.
- Along with the dull ache in the testes and pain in the groin, you start experiencing episodes of pain in the lower back. In advanced stages, you begin to experience difficulty breathing, and there may be some pain and tightening in the chest with occasional signs of blood in the sputum that you cough up.
- Along with genital discomfort, you may experience pain and swelling occurring in one or both legs, and this could be diagnosed as deep vein thrombosis brought on by a clot that is hindering blood circulation. If the same thing happens in an important artery, you get an embolism that could prove fatal for the lungs and heart.
The signs and symptoms that could point to something other than testicular cancer
- The epididymis is a larger tubular structure sitting centrally on top of the testes. It acts as a kind of collection point for matured sperm before they are pumped away through ejaculation. Some cells lose their normal functionality to become cysts filled with a plain fluid that serves no apparent purpose. These cysts become large and start impacting the functioning of normal cells, causing swelling that can be felt externally as you manually rub and feel the surface of the testes.
- Painful swelling may also result when a vein servicing the testes becomes swollen, resulting in varicocele.
- The testes may be floating in a sea of secretion when the scrotum fills up with fluid, a condition called hydrocele.
- A weak abdominal muscle may have provoked a portion of intestinal lining to bulge through it, producing intense pain typical of a hernia, although the pain radiates downward into the scrotum and testes.
- Viral or bacterial infection in the epididymis may cause epididymitis, which triggers pain, swelling, and scrotal discomfort.
- Sports injuries might cause genitals to swell and become inflamed, a condition rectified through antibiotics and anti-inflammatory medicines.
- Weakening of scrotal muscles may cause the spermatic cord (testes-supporting structure) to twist uncomfortably, causing the sharp pain peculiar to testicular torsion.
- Testicular cancer can also be diagnosed by studying the patient’s history, and biopsy of the testicular tissue can also be done to identify the root cause.
- Testicular cancer can be identified by discovering a lump or swelling in a testicle, and fluid collection or pain in the testicular area is also pivotal in discovering such issues.
It is a major issue for men between the ages of 20 and 35, but any men with testicular cancer have no known risk factors, and because of this reason, most of the testicular cancer cannot be prevented in the early stages.
Whether testicular swelling, pain, and discomfort are due to cancer or non-cancerous issues, you need to consult a qualified and experienced urologist to rule out the worst-case scenario that is testicular cancer.
It is important to remember that the prognosis is extremely good if testicular cancer is detected in the early stages when it has not moved out of the testes. Once detected, the immediate option is surgery. The cancerous testicle can be surgically removed through an inguinal orchiectomy. Once the source of cancer is physically removed, recovery is 100 percent assured.
If symptoms indicate that the cancer has spread through the lymphatic system to the lungs, liver, or brain, more extensive treatment involving chemotherapy and radiation will be necessary following surgical intervention to remove the testes.
Treatment for testicular cancer
The treatment for testicular cancer depends on whether the cancer in question is tagged as seminomas or non-seminomas, with the treatment varying accordingly. There are five stages to treating testicular cancer, and it starts with surgery to remove the enlarged testicle.
Once your physician has diagnosed your condition as testicular cancer, further tests are done to determine the spread of the cancer to lymph nodes and other parts of the body. Post the tests, the doctor would usually recommend surgery to be followed by a multi-regimen treatment to prevent recurrence of the same issue. Post diagnosis, you would be taken to staging where a further determination would be made by the doctor regarding the surgery and to determine the extent of what needs to be surgically incised and removed.
The doctor would make his recommendation after consulting the other specialists, and after this, he would carry out the procedure to surgically remove the testicle and some of the affected lymph nodes. After this, you would be taken to the post-operative room, where a further series of consultations would be held to determine further course of treatment to prevent recurrence of the cancer.
Usually, he would recommend adjuvant therapy, where you would be made to undergo chemotherapy or radiation therapy to kill the germs and prevent recurrence of cancer. This treatment depends more on the severity of the case, after which you can expect to be meet up with your doctor regularly where your health would be monitored for a short while, to help determine if there is a recurrence or not.
Radiation therapy: Radiation therapy is where your body is bathed in powerful X-rays, which are used to kill the cancer germs. The process is of two types: one where a machine shoots powerful X–rays directly onto the affected area, and the other process is by where the doctor utilizes radioactive elements wrapped up in plastic and placed next to the affected area. However, for treating testicular cancer, external therapy is often preferred to help treat the same.
Monitoring: Post surgery, you may be put under surveillance and regular checkups to help monitor the current status of your health and to determine if there has been a resurgence of the cancer cells. As part of this process, you may have to visit the specialist more often, be asked to disrobe, and given a thorough medical checkup to see if there is any recurrence of cancer. While some patients prefer to undergo chemotherapy as an alternative to monitoring, it should be pointed out that chemotherapy comes with its own side effects, whereas surveillance does not. After a certain period, and once the doctors are satisfied that there is no recurrence, you would generally be given a clean bill of health.
High dose chemotherapy with stem cell therapy: This treatment is usually reserved for the more severe cases and consists of bathing the affected area with high doses of radiation. This radiation actually kills off the blood-forming cells in the body, and it is at this point, post the chemotherapy, that the patient is given an infusion of stem cells from a donor. The stem cells should help to regenerate the body’s blood cells. This treatment comes with its own side effects, and prolonged chemotherapy treatment can even cause your hair to fall out. However, it is effective when treating patients for cancer, by killing off the cancer cells right away.
Clinical trials: You can also take part in clinical trials for treating cancer, but the selection process can be a bit rigorous. Apart from that, you are expected to understand all the risks associated with clinical trials, where you will be subject to new treatment methodologies and treatment to cure cancer. There is no guarantee that the new drug will work, hence the trial.
Post op diagnosis: Your doctor may request several follow up tests to be done on you to determine the efficacy of the treatment and whether it should be changed to achieve a better outcome.
Testicular cancer treatment side effects:
Some of the side effects can last a long while, which is why post-operative care and monitoring the patient is important. Some of the long term side effects are posted below, as a result of cancer treatment and drugs used to treat the same.
Lung problems: Some cancer drugs can cause the patient to develop lung problems, as a result of ingesting this medication.
Kidney damage: Cisptalin is often used to treat testicular cancer, and one of the side effects of this drug is that it can cause kidney damage.
Heart and blood vessel problems: Vinblastine and bleomycin combined with each other are known to damage your heart and blood vessels.
Nerve damage: Advanced chemotherapy can damage your nerves, causing you to feel dizzy and disoriented.
Hearing loss: Cipslatin can, at times, can cause you to experience hearing loss.
Secondary cancer: Sometimes you may develop a second cancer as a result of all that radiation. For some reason, undergoing chemotherapy can make you highly susceptible to developing secondary cancer.