Testicular cancer occurs in the testicles (testes), which are situated inside the scrotum, which is a loose bag of skin beneath the penis.
The testicles develop the male sex hormones which control the development of the reproductive organs and other masculine physical accessories
(testosterone) and is responsible for sperm production.
In comparison to other types of cancer, testicular cancer is quite rare. But testicular cancer is the most prevalent cancer in American males between the ages of 15 and 35. In the United States, about one male in 250 males develops testicular cancer during a lifetime.
The typical age at diagnosis is 33 years; this disease generally affects young and middle-aged men, while in some sporadic cases, it can occur before puberty, and only eight percent of cases occur after the age of 55.
Symptoms
Symptoms of testicular cancer often materialize at an early stage, but occasionally, do not emerge until much later, which the Individual or Doctor may notice during a routine physical examination.
A prevalent early symptom is a swelling or development of a painless lump inside the testicle. Changes occur in the testicles for various reasons.
A lump does not invariably mean cancer, but anyone who notices a change should see a doctor because of early detection in most cases of cancer is key to recovery. Other symptoms can also be:
- An alarming difference in size between the testicles
- A dull ache in the abdomen or groin
- A heavy feeling in the scrotum
- Pains in the testicle or scrotum and back
- Fluid collection in the scrotum
- Often, hormonal changes will induce breast enlargement and make it sore.
In the later stages, as cancer spreads to other organs in the body, a person may notice other symptoms like :
- Headaches and confusion, if it spreads to the brain
- Abdominal pains and discomfort, if it affects the liver
- Difficulty in breathing, if it affects the lungs
- Lower back pain, if cancer reaches the lymph nodes
Causes of Testicular Cancer
Most cases of testicular cancers begin in the germ cells, which are the cells in the testicles that produce immature sperm.
Doctors and scientists have not been able to establish why testicular cells become cancerous, but some hereditary factors may increase the risk. Testicular cancer is more likely to occur in people with the following risk factors:
Cryptorchidism (undescended testicle)
The testes form in the abdominal area during fetal maturation and typically descends into the scrotum before birth.
Men who have a testicle that did not descend are at a more considerable risk of testicular cancer than men whose testicles descended naturally. The chances are higher when the testicle has been surgically relocated to the scrotum.
Although, the majority of men who have testicular cancer don’t have a record of undescended testicles.
Abnormal testicle development
Conditions that can cause abnormal growth of the testicles, such as Klinefelter syndrome, may compound the risk of testicular cancer.
A family history of testicular cancer
If family members have had testicular cancer, one may have an increased risk.
Race
Testicular cancer is more prevalent in white men than in black men than black or Asian
Age
Testicular cancer affects teens and younger men, particularly those between ages 15 and 35. Nonetheless, it can occur at any age. Having HIV increases the risk of testicular cancer, although vasectomy does not increase the risk.
Prevention and Treatment of Testicular Cancer
Although there is no way to prevent testicular cancer. Some doctors have recommended regular self-examinations of the testicles to recognize testicular cancer at its earliest stage. But not all doctors agree.
Testicular cancer is highly treatable, especially in the early stages. Most persons with a diagnosis of testicular cancer can live at least another five years after diagnosis.
Treatment can usually involve a combination of the following:
- Surgery
- Radiation therapy
- Chemotherapy
- Stem cell treatment
- Surveillance
Surgery
A surgeon will extract both or one testicles to prevent the cancerous tumor from spreading.
The person will receive a general anaesthetic before the surgeon will make an incision in the groin and remove the testicle through the incision.
Removing one testicle can affect fertility or sex life as removing both testicles means that the individual will not be able to impregnate a woman, although additional fertility options are available naturally.
For example, the doctor might recommend sperm banking for future use, if needed. Other effects of removing the testicles may include:
- A decreased sexual drive
- Difficulty in achieving erections
- Exhaustion
- Hot flashes
- Loss of muscle mass
This might lead the doctor to prescribe testosterone supplements which can come in the form of patches, injections, or gel, to help with the above-enumerated issues.
It is also practical to restore the appearance of testicles by having a prosthesis, which a surgeon can implant in the scrotum. It is usually injected with saltwater.
A person who has had surgery in the early stages may not need any additional treatment.
Lymph node surgery
If cancer has spread to lymph nodes, which is usually the lymph node situated around the large blood vessels at the back of the abdomen, the surgeon will need to remove them. A surgeon can do this as laparoscopic surgery.
This procedure will not impact fertility directly, although nerve damage during the surgery can affect ejaculation. This may imply that sperm does not come out from the urethra but moves to the bladder instead.
This is not dangerous, but a lower sperm count can affect fertility.
Radiation therapy
Radiation therapy damages the DNA in the tumor cells and eliminates their ability to reproduce. This method can remove cancer and prevent it from spreading or recurring.
A person who has had surgery may need radiation therapy to ensure the removal of any remaining cancerous cells. If cancer has spread to lymph nodes, a doctor may also recommend radiation therapy.
The following short term side effects may occur:
- Nausea
- Fatigue
- Rashes
- Muscular and joint stiffness
- A decrease in appetite and eating disorder
These symptoms stop as soon as the treatment is over.
Chemotherapy
Chemotherapy uses medications to destroy cancer cells that travel around the body to destroy every cell that might have migrated from the original tumor and stops the cells from dividing and growing.
Chemotherapy can lead to infertility in some men, which can be permanent in most cases. The discussion should be held with the doctor about possible options for preserving sperm before chemotherapy.
A doctor may recommend chemotherapy if testicular cancer has spread to other parts of the body. A doctor will give the medication either orally or as an injection.
Chemotherapy kills healthy cells as well as cancerous ones, Although side effects depend on the drugs being administered but can include the following side effects which usually subside at the end of treatment
- Nausea and vomiting
- Hair loss
- Mouth sores
- Fatigue and a general feeling of being unwell
- Diarrhoea
Stem cell treatment
In some cases, stem cell therapy can enable a person to receive increased doses of chemotherapy medications that would otherwise be too dangerous to administer.
During the period before treatment, a specialized machine will collect stem cells from the person’s blood. Healthcare specialists will freeze and store these cells.
The person receives a higher dose of chemotherapy, and they will then receive the stem cells into a vein as a transfusion.
These cells attach themselves to the bone marrow and start making new blood cells, which facilitates faster recovery from higher doses of chemotherapy.
Disadvantages of this type of therapy can include:
- Due to the high dose of chemotherapy, it is dangerous and may involve life-threatening effects.
- It can also lead to an extended stay in the hospital.
- It is usually expensive.
Surveillance
This is not a treatment method; it’s a post-treatment procedure where a Doctor will carry out surveillance after a person has had treatment for testicular cancer, to check for signs of recurrence of cancer.
This Inspection does not involve active treatment, but the individual will go to regular appointments and undergo examinations.
Diagnosis
To diagnose testicular cancer, a doctor will recommend:
Blood tests
These can help measure levels of lactate dehydrogenase, alpha-fetoprotein, and human chorionic gonadotropin, which are tumor markers that may suggest the presence of cancer.
Ultrasound
This can demonstrate the presence and magnitude of a tumor.
Biopsy
The doctor will collect a small tissue sample from the testicle for examination using a microscope. A biopsy can discern the presence of cancer.
Types of testicular cancer
If tests show that testicular cancer is present, the doctor will also need to ascertain the type of cancer it is and what stage it is arrived at before discussing a treatment plan with the individual.
There are two main types of testicular cancer:
- Seminoma: This type grows slowly and generally not aggressive and contains only seminoma cells. There are two subtypes: classic and spermatocytic.
- Nonseminoma: This can involve various kinds of cancer cells. There are several subtypes, including teratoma, carcinoma, yolk sac, embryonal carcinoma, and choriocarcinoma
Other tumors that are not cancerous include Sertoli cell tumors, Leydig tumors, and stromal tumors,
Staging the cancer
This helps to determine the extent of cancer; it helps establish whether cancer has spread outside the testicles. The stage of the tumor will also affect treatment plans.
- Localized: Here, the cancer is only in the testis and has not dissipated.
- Regional: Cancer has entered the lymph nodes in the abdomen.
- Distant: Cancer has spread to other sites in the body, such as the bones, liver, brain, and lungs.
Step by step instructions for self-examination
The best period to check for lumps which can be indications testicular cancer is when the scrotal skin is relaxed, after a warm shower or bath.
To perform a self-exam:
- Gently carry the scrotum in the palms of both hands. Stand in front of a mirror and look for any swelling on the skin of the scrotum.
- Feel the scope and weight of the testicles
- Press around the testicles with the fingers and thumbs, and take note of any lumps or unusual inflammation.
- Feel each testicle separately. Place the index and middle fingers under each testicle with the thumbs on the top. Gently swirl the testicle between the thumbs and forefingers. It is usually smooth, oval-shaped, and somewhat firm, with no lumps or swellings. The top and back of each testicle should have a tubular like section, called the epididymis, where sperm is stored.
Repeat this process once each month, checking for alterations in the weight, feel, or size of the testicles.
Many males have one testicle that hangs more downwards than the other or one testicle that is larger than the other, but as long as these proportions remain the same over time, it is not a cause for concern.
