Testicular Cancer

Facts about testicular cancer 

Q 1 What is testicular cancer? 

Testicular cancer starts in the cells of the testicle. Testicles are part of the male reproductive system. They’re held within a sac of skin called the scrotum. The scrotum hangs under the base of the penis.

Testicles have 2 main functions:

They make male hormones (androgens) such as testosterone.

They make sperm, the male cells needed to fertilize a female egg cell to start a pregnancy.

Q 2 What causes testicular cancer?

  • Undescended testicle

Men who had an undescended testicle (called cryptorchidism) have a higher risk for testicular cancer. It is the most significant risk factor for testicular cancer.

  • Family history of testicular cancer
  • Personal history of testicular cancer
  • Calcium deposits in the testicle

Calcium deposits in the testicle (called testicular microlithiasis) increase a man’s risk of developing cancer. They are usually found when an ultrasound is done for other reasons.

Q 3 What are the types of testicular cancer? 

Germ cell tumors

More than 90% of all testicular cancers are germ cell tumors. This type of cancer starts in germ cells, which are the cells that make sperm. 

  • Seminomas
  • Non-seminomas
  • Embryonal carcinoma 
  • Yolk sac carcinoma 
  • Choriocarcinoma 
  • Teratoma 

 Sex cord-stromal tumors

They start in cells of the stroma, which is supportive tissue in the testicle that makes hormones. There are 2 main types of stromal tumours:

  • Leydig cell tumors
  • Sertoli cell tumors

Q 4 What are the symptoms of testicular cancer?,/p>

  • Painless swelling or lump in 1 of the testicles, or any change in shape or texture of the testicles is the most common presentation 
  • Pain or a dull ache in the testicle or scrotum
  • Feeling of heaviness in the scrotum or abdomen
  • The buildup of fluid in the scrotum
  • Signs of puberty in boys, such as the voice getting deeper or growth of facial and body hair, at an earlier age than expected
  • Infertility

Symptoms of advanced testicular cancer

  • Low back pain, from cancer, spread to the lymph nodes 
  • Shortness of breath, chest pain or a cough (even coughing up blood) may develop from cancer spread in the lungs.
  • Belly pain, either from enlarged lymph nodes or because cancer has spread to the liver.

A word of caution 

All of these symptoms can also be caused by conditions that are not cancer. Kindly consult your doctor first.

Q 5 How is testicular cancer diagnosed? 

  • Medical history and physical examination 
  • Ultrasound of the testicles

An ultrasound is often the first test done if the doctor thinks you might have testicular cancer.

  • Blood tumor marker tests  AFP, LDH, and b-HCG
  • CT scan of abdomen and chest 

Surgery to diagnose testicular cancer

If ultrasound and blood tests suggest testicular cancer then the doctor can directly proceed for surgery (a radical inguinal orchiectomy) to remove the tumor as soon as possible without a biopsy. A biopsy is rarely done for a testicular tumor because it might risk spreading cancer. 

Q 6 What is testicular cancer staging? 

Staging is a measurement of how far cancer has spread.

After all the tests have been completed and the results are known, it should be possible to predict what stage the cancer is. The higher the stage, further cancer has spread.

Stage I: Cancer has invaded tissues next to the testicle, but has not spread to lymph nodes, or more distant sites in the body. Levels of a tumor marker may be normal or elevated. 

Stage II: Testicular cancers at this stage has invaded tissues next to the testicle and can now be found in at least one nearby lymph node. Tumor marker levels may be normal or slightly elevated

Stage III: Testicular cancers at this stage have spread to distant lymph nodes or organs

A word of caution 

The above staging is a simplified version for your basic understanding. The reader is advised to follow the TNM staging system developed by the American Joint Committee on Cancer (AJCC) in which 

  • T stands for the size and location of the primary tumor
  • N stands for nodes. It tells whether cancer has spread to the nearby lymph nodes
  • M stands for metastasis. It tells whether cancer has spread to distant parts of the body

Q 7 How testicular cancer is treated? 

Testicular cancer is curable if diagnosed at an early stage. Surgery is the only curative option. 

When deciding treatment options for a particular patient, the doctor will consider the following factors and will decide individual treatment plan:

  • The size of the cancer
  • The stage of the cancer
  • If you want to be able to get someone pregnant (fertility)
  • The risk of cancer coming back (recurrence) 
  • Your overall health and ability to recover from surgery, radiation therapy or chemotherapy
  • Your personal preferences

Following are the general guidelines but treatment may vary from patient to patient:  

Surgery

In all stages (stage1, 2, & 3) surgery is done first if the patient is fit. Surgery done is called radical inguinal orchidectomy.  

In radical orchidectomy, there is the removal of the testicle and spermatic cord. It is usually the first treatment for testicular cancer and it is done to remove the cancerous testicle and confirm the diagnosis.

Once the diagnosis is confirmed with a final pathology report of the operation, further treatment is planned in the form of chemotherapy and/or radiation therapy and/or surgery called RPLND (Retroperitoneal lymph node dissection)

The decision regarding chemotherapy or RPLND depends upon tumor markers level after radical orchidectomy, the status of the disease in the abdomen and chest and general condition of the patient