WHAT IS TESTICULAR CANCER?

This condition is categorized based on the type of cells where it starts.

Most cases begin in germ cells, the specialized cells that produce sperm. Germ cell tumors are divided into two main types:

1. Seminomas

These account for approximately one-third of all testicular germ cell tumors. They generally grow and spread more slowly than other types. They typically affect men between 20 and 40 years old, though they can occur at any age.

2. Nonseminomatous Germ Cell Tumors (NSGCTs)

The majority of testicular germ cell tumors fall into this category, particularly among younger men aged 15 to 35. NSGCTs tend to grow faster than seminomas and may require more aggressive treatment.

In rare cases, testicular cancer originates from other cell types within the testicles, including Leydig, Sertoli, and granulosa. These non-germ cell tumors make up about 5% of testicular cancers.

A common early sign of testicular cancer is a lump or swelling in one of the testicles. That’s why performing regular self-exams is crucial, as it helps you detect these early changes and seek medical care quickly.

Although these lumps are often painless, some men experience discomfort or a dull ache in the affected testicle. Other possible symptoms include a feeling of heaviness in the lower abdomen, groin, or scrotum.

If you detect a lump or experience other symptoms, your doctor will examine your testicles and abdomen. Diagnostic tests may include:

• Testicular ultrasound – a non-invasive imaging test that uses sound waves to create detailed anatomical images.
• Blood tests – elevated levels of specific proteins, known as tumor markers, can indicate the presence of testicular cancer. Common markers include:
  • alpha-fetoprotein (AFP)
  • beta-human chorionic gonadotropin (beta-hCG)
  • lactate dehydrogenase (LDH)
• Surgical biopsy – If cancer is suspected, the next step is often a surgical procedure to remove the affected testicle, called a radical inguinal orchiectomy. Surgery allows for a definitive diagnosis as the tissue is examined under a microscope.

Staging helps to understand the extent of testicular cancer and determine the appropriate treatment strategy.

• Stage I: The cancer is confined to the testicle.
• Stage II: The cancer has spread to the abdominal lymph nodes.
• Stage III: The cancer has spread to other parts of the body, such as the lungs, liver, bones, or brain.

Treatment typically involves surgery to remove the affected testicle. Some men opt for implanting a prosthetic testicle, which maintains the appearance of the scrotum.

In early-stage cancer, surgery may be the only treatment needed, followed by regular monitoring to ensure the cancer doesn’t return. This approach, known as surveillance, includes routine blood tests and imaging studies.

If further interventions are needed, this may include:

Chemotherapy

Powerful medications are used to target and destroy cancer cells that have spread throughout the body. It’s commonly used when cancer has spread beyond the testicle or if there’s a high risk of recurrence.

Radiation therapy

Particularly effective for treating stage I seminomas, it targets the abdominal lymph nodes to prevent cancer from spreading and helps to destroy any remaining cancer cells after surgery.

Lymph node surgery

If the cancer has spread to the lymph nodes, surgery may be required to remove them. This procedure, called retroperitoneal lymph node dissection (RPLND), is usually performed after chemotherapy in more advanced cases.

Many men are concerned about their fertility following treatment. Surgery, chemotherapy, and radiation can all affect the ability to father children. If you plan to have children in the future, sperm banking before treatment may be an option to consider.

Other potential side effects that may arise from treatment are:

Short-term

Chemotherapy and radiation can cause temporary side effects, such as fatigue, nausea, and hair loss. A decrease in blood cell counts can also increase the risk of infections.

Long-term

Some treatments, especially chemotherapy, may lead to long-term issues such as kidney damage, nerve damage, lung scarring, or an increased risk of heart disease. Additionally, there’s a slight chance of developing a secondary cancer later in life due to the treatment.

Even after successful treatment, ongoing follow-up care is required. Testicular cancer can recur, particularly within the first two years after treatment. Your doctor will monitor your recovery through regular blood tests, imaging, and physical exams.

Testicular cancer has one of the highest cure rates of any cancer, especially when detected early. Even in advanced cases, treatment is often highly successful, allowing many men to lead healthy, active lives post-treatment.

1. What are the risk factors for testicular cancer?

Some factors that increase risk include having an undescended testicle, a family history of testicular cancer, or a personal history of the disease. Other factors, such as age, may also play a role.

2. How often should I perform a testicular self-exam?

It’s recommended that men perform a testicular self-exam once a month, especially if they are in the age group at higher risk for testicular cancer. To perform a self-exam, gently roll each testicle between your fingers after a warm shower, checking for any lumps or unusual textures. Regularly performing this helps you become familiar with the normal look and feel of your testicles, making it easier to detect any changes early.