Testicular cancer

Testicular cancer is a relatively rare form of cancer and accounts for only 1 percent of cancers in men; however it is the most common cancer in men between the ages of 15 and 40. Nevertheless, testicular cancer is one of the most treatable forms of cancer, with cure rates approaching 100% if detected early.

The testes or testicles are part of the male reproductive system and produce sperm cells, as well as the male sex hormone testosterone. The testes are suspended in a membranous sac called the scrotum that hangs below the groin and the penis. Behind each gland is the epididymis, a tube that transports the sperm to the urethra for ejaculation through the penis.

The most common sign of testicular cancer is a painless swelling or lump in one testis. About a third of the time, a man may experience a dull ache or a feeling of heaviness in the lower stomach, scrotum or groin area.

Testicular cancers are sometimes referred to as Germ Cell Tumours (GCT’s). There are three main types of testicular cancer: Seminoma, Non-Seminoma and a third type which is a mixture of the two. Seminomas tend to be slower-growing and occur in the fourth decade of life, while non-seminomas occur more often when men are in their 30s. Non-seminomas are generally more aggressive than seminomas. Between 65 and 85% of seminomas are limited to the testes when first diagnosed, while approximately 75% of non-seminomas have already spread to the lymph nodes when diagnosed.

Testicular Self Examination (TSE)

All men should be familiar with the size and feeling of their testicles, so they can detect any type of change. Men are advised to perform testicular self-examinations. A TSE is best done after a warm bath or shower when the skin of the scrotum is relaxed. After observing for any changes in appearance, each testis is carefully examined by rolling it between the fingers and thumbs of both hands to check for any lumps. Since the symptoms commonly associated with testicular cancer can also be caused by infections or illnesses other than cancer, it critical to see an urologist for an accurate diagnosis.

Tests

As with other urological malignancies there may be a number of treatment options available to individual patients. These include Surgery, Chemotherapy, Radiation Therapy and Bone Marrow Transplant. The best course of treatment for each individual case depends on a number of factors including the type of testicular cancer you have, its stage and grade and the general health of the patient. A series of tests may need to be conducted in order to plan the best treatment available. This work up may include a physical examination; a pathological examination or biopsy of the tumour; imaging studies such as CT, and blood tests to determine proteins that are specific markers of testicular cancer.

Staging is an assessment of the extent of disease. Staging allows the doctor to gauge the size and location of any tumours by using information gathered from imaging studies such as CT scans etc., as well as information from pathological and physical examinations. Once a stage has been defined, the physician can determine how a patient may do over time and determine what therapy is indicated.

Basically, in Stage 1 the tumour is confined to the testes. In Stage 2 the tumour may have spread to lymph nodes but is restricted to the abdomen. Finally, in Stage 3 the tumour has spread to visceral sites or beyond the lymph nodes in the abdomen to other parts of the body.

Blood Tests

A blood sample is taken and examined to check for ‘Tumour Markers’ that some cancers of the testis produce. These markers mirror the activity of the tumour and indicate to the doctor the behaviour of the malignancy.

CT Scans

A CT scan may be taken to check the lymph nodes in the abdomen and the other organs in your body to ascertain whether the cancer may have spread or not.

Treatments & Surgery

A biopsy of the suspect tissue can provide an absolute diagnosis of testicular cancer. If a suspicious mass is found and other conditions are ruled out surgery is the most common form of treatment for most testicular cancers. There are two main types of surgery depending on the type of cancer that is found.

Orchidectomy

Orchidectomy involves the surgical removal of the testicle. This procedure is performed in hospital under general anaesthetic. An incision is made into the groin, where the blood vessels leading to the testicle is first cut off in a bid to prevent cancer cells ‘spilling’ into the rest of the body.

Side Effects

Most side effects from this surgery tend to be temporary. Typically pain and discomfort around the operation site are the most common side effects, but this pain can be managed with painkillers, and should subside over time.

If you have had one testicle removed prosthetic testicle can be made and inserted into the scrotum at a later date; sexuality and fertility should not be affected.

Removing both testicles leads to infertility. Hormone therapy may be needed to replace the lack of testosterone production; taking hormones will mean that sexual activity can continue and that erections and ejaculation will still be possible – although no sperm will be produced.

Talk to your doctor about possible side effects and the methods available to alleviate them.

Lymphadenectomy

Sometimes an operation to remove the lymph nodes in the abdomen is performed as well as Orchidectomy. This is usually done if the cancer is thought to have spread into the other parts of the body.

Side Effects

Lymphadenectomy can have both temporary and longer term side effects, including erectile dysfunction (impotence), an inability to ejaculate and infertility. Again it is worthwhile talking with the specialist regarding what side effects may be experienced and the possible duration of these.

Bone Marrow Transplant (BMT)

Bone Marrow is tissue found in the centre of bones and is responsible for producing various components of blood, including

• Red Blood Cells – Which carry oxygen around the body
• White Blood Cells – Which fight infection in the body
• Platelets – Which helps blood to clot and prevent bleeding

Bone marrow transplants are performed when the existing bone marrow is destroyed by chemotherapy or radiotherapy. With autologous BMT, the patients donate Bone Marrow to themselves. Bone marrow is harvested when the carcinoma is in remission, given high dose chemotherapy to destroy any undetected cancer cells, then re-infused back to the patient when the marrow has stimulated enough blood components, usually after 2 to 3 weeks.

Side Effects

Because the white cell count is low, the body’s natural defence against infection is poor and therefore there is a risk of bacterial and viral infections.

Bleeding may also occur due to the low level of platelets, common occurrences are in the mouth and nose. Platelet transfusions may be given to remedy this.

Potential side effects of any treatments should be discussed with the doctor along with possible remedies for these associated conditions.