Testicular Cancer

Overview

Testicular cancer occurs when cells in the testicles begin to grow uncontrollably. The testicles, also known as testes, are located in the scrotum, which is a loose bag of skin under the penis. These organs are responsible for producing sperm and the hormone testosterone. Although not a widespread form of cancer, this can develop at any age, with the highest number of cases seen in individuals between 15 and 45 years old.

What is Testicular Cancer?

Testicular cancer ensues in case malignant cells that grow in the tissues of one or, less commonly, both testicles. The testicles are two walnut-shaped glands that produce sperm and the hormone testosterone. They are located inside a skin sac called the scrotum, which hangs below the penis. Like any form of cancer, this is a serious illness. Fortunately, it is highly treatable and often curable.

Types of Testicular Cancer

Most testicular cancers originate in the germ cells, the cells responsible for sperm production. Doctors categorise germ cell tumours into two main types:

Seminoma

Seminomas usually develop and spread at a slower pace than non-seminomas. However, some can grow rapidly. There are two main subtypes of this cancer:

Classic Seminoma: Accounts for about 95% of seminomas.

Spermatocytic Seminoma: Typically occurs in elder men and has a favourable prognosis.

These seminomas can release HCG or human chorionic gonadotropin but generally do not produce other tumour markers. In case seminoma spreads beyond the testicle, it can be treated with radiation therapy or chemotherapy. Surgery may also be an option in certain situations.

Non-Seminoma (NSGCT)

Non-seminomas are highly variable in both prognosis and appearance. They may appear alone but are commonly seen like a "mixed" NSGCT containing multiple types. There are mainly four subtypes:

Teratoma: It typically appears as a mixed NSGCT. It tends to grow locally, often in retroperitoneal lymph nodes. Teratomas are resistant to both chemotherapy and radiation and are usually best treated through surgical removal.

Yolk Sac Tumor: Mostly common among children. It responds well to chemotherapy for both adults and children. Yolk sac tumours usually secrete AFP.

Embryonal Carcinoma: Present in approximately 40% of tumours. This is one of the fastest-growing and most aggressive types. It can secrete HCG or alpha-fetoprotein (AFP).

Choriocarcinoma: An aggressive and rare form of cancer, which may secrete HCG.

Testicular Cancer Symptoms

A painless lump in the testicle is the most common early indicator of testicular cancer. Other symptoms to be aware of include a bump or unexpected fluid buildup in the scrotum, swelling in any of the testicles and heaviness that may bring discomfort. Some people also experience a persistent or worsening soft ache in the lower abdomen or groin, discomfort or pain in the testicle or scrotum that varies in intensity, and, in some cases, a reduction in the size of a testicle (testicular atrophy).

Although these symptoms may also be associated with other conditions, it is essential to consult a healthcare provider for an accurate diagnosis. Early detection is critical, as delays can allow the cancer to spread and make treatment more challenging.

Testicular Cancer Causes

The exact cause of most testicular cancers is unknown. It usually begins when changes in the DNA of testicular cells occur. DNA provides instructions to cells, including when to grow and die. In this cancer, these changes cause cells to grow and multiply uncontrollably, forming a mass or tumour. Most testicular cancers begin in the germ cells, though it remains unclear why these DNA changes happen in these cells.

Testicular Cancer Diagnosis and Tests

Testicular cancer is often diagnosed when a person finds a lump during a self-exam or a routine physical exam.
Some common diagnostic procedures include:

Physical Exam and Medical History: Here, a healthcare provider examines the testicles for lumps and checks nearby lymph nodes.

Ultrasound: It is a painless test that uses sound waves to create images of the inside of the body, helping confirm the presence of a tumour.

Inguinal Orchiectomy and Biopsy: If an ultrasound shows evidence of cancer, the affected testicle may be removed through a groin incision, allowing examination under a microscope.

Additional tests include:

Serum Tumor Marker Test: This blood test measures substances linked to certain cancers, called tumour markers. Elevated markers include alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH). Different tumour types raise different markers.

Imaging Tests: These include CT scans, X-rays, and MRIs. A CT scan (or CAT scan) is used to see if the cancer has spread to the abdomen, pelvis, or lungs. An X-ray can help check for cancer in the lungs. In contrast, an MRI may be used if there is concern the cancer has spread to the brain or spinal cord.

Testicular Cancer Treatment and Medication

Treatment options depend on factors such as the person’s health, the cancer stage, and tumour type. Here are some of the different types of treatment for this cancer:

Surgery

Surgery is the standard treatment for testicular cancer, regardless of the cancer stage or tumour type. In some instances, your doctor may also remove nearby lymph nodes. The following are the types of surgery:

Radical Inguinal Orchiectomy: Removal of the cancerous testicle is the most common treatment, done for both seminomas and non-seminomas. This involves making an incision in the groin to remove the testicle, along with blood vessels and lymphatic tissue to prevent further spread.

Retroperitoneal Lymph Node Dissection (RPLND): This procedure, more common with non-seminomas, involves making an abdominal incision to remove lymph nodes behind the abdominal organs. RPLND can treat the cancer and may be used for staging.

Radiation Therapy

This therapy uses high-dose radiation waves to kill cancer cells and helps prevent their recurrence after surgery. Radiation is generally limited to treating seminomas.

Chemotherapy

Chemotherapy drugs like cisplatin, bleomycin, and etoposide can kill cancer cells. It is often used for both seminomas and non-seminomas and may be administered instead of surgery or following surgery, especially if cancer has recurred.

Preventive Measures for Testicular Cancer

It is impossible to prevent testicular cancer. If diagnosed, there was nothing you could have done to avoid it.

Myths and Facts Related to Testicular Cancer

Following are some myths associated with testicular cancer and the facts bursting them:

Myth 1: Most Testicular Cancers Begin in a Normal Testicle
Fact: Most testicular cancers originate in an undescended testicle, which fails to descend into the scrotum by nine months of age. Approximately 25% occur in normally descended testicles.

Myth 2: Older Men are at the Highest Risk for Testicular Cancer
Fact: While many cancers are more prevalent in older populations, testicular cancer is notably different. It primarily affects younger men, particularly those between the ages of 15 and 40. It is the most common cancer among this demographic.

Myth 3: Testicular Cancer is Difficult to Treat
Fact: Testicular cancer is highly treatable, with over 95% of patients fully recovering. Early detection often leads to successful treatment, and even in later stages of testicular cancer, this has a high cure rate, making it one of the most survivable cancers.

Myth 4: Surgery Can Spread Testicular Cancer
Fact: Surgery is a critical component in managing testicular cancer and does not spread the disease. After the diagnosis, the standard procedure involves removing the affected testicle(s) entirely. This approach is safer than performing a biopsy, which could inadvertently cause cancer cells to spread.

Myth 5: Ejaculation Frequency Affects Testicular Cancer Risk
Fact: The frequency of ejaculation, whether high or low, does not influence the risk of developing testicular cancer. There is no “safe” or “harmful” number of times to ejaculate, as this has no connection to testicular health or cancer risk.