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Testicular Cancer
What is testicular cancer?
The testicles (or testes) are a pair of oval shaped sex glands. They're normally situated within the scrotum which is a pouch of skin located behind the penis. The testicles are the site of sperm production and they contain cells that release testosterone. This important hormone is required for male characteristics such as a deep voice, wide shoulders and body and facial hair. It also influences libido.
Cancer refers to a group of diseases in which there is abnormal growth of some of the body's cells. Normally, many of the cells that make up the tissues in our body divide and replace themselves over time so as to keep us healthy. Occasionally some cells lose the ability to control this division which leads to excessive growth of cells. In turn too much tissue is produced which causes a tumour to form. Tumours may be benign or malignant. A benign tumour is unlikely to spread to other parts of the body or pose a serious threat to life and because of this it's not classified as cancer. On the other hand, malignant tumours are cancers - they can invade and destroy nearby tissue, and may spread (metastasise) to other parts of the body. When cancer occurs it's more likely to be successfully treated if detected early before spread has occurred.
A tumour that develops in a testicle is called testicular cancer. It is the most common cancer in men aged 20-35 years of age, though it can occur at other ages too. Fortunately this disease is often curable if detected early. On many occasions the cancer is first detected by men themselves as a lump in either testicle - a good reason to perform a monthly testicular examination.
How do I know if I have testicular cancer?
Some of the warning signs of testicular cancer are listed below, but bear in mind that these symptoms can have other causes:
- A lump or swelling in either testicle
- Enlargement of a testicle
- A feeling of heaviness in the scrotum
- An ache in the lower abdomen or groin
- A sudden collection of fluid in the scrotum
- Testicular pain
If you're experiencing any of the above it's important to see your doctor to have it investigated as soon as possible. You may not have testicular cancer, but no matter the problem, the earlier you discuss it with your doctor the better the outcome is likely to be.
Performing a monthly testicular examination is an effective way of detecting testicular cancer at an early stage. The advantage of this is that recovery is much more likely and the treatment less aggressive. You should perform a testicular examination each month from about the age of 15 onwards. A good time to do this is after a warm shower or bath. The recommended steps are:
- Stand in front of the mirror and look for any swelling in the scrotal skin. Don't worry if one testicle appears larger than the other, that's normal.
- Examine each testicle in turn with both hands, placing your index and middle fingers underneath and your thumbs on top. Roll the testicle gently. It should feel smooth and you shouldn't experience any pain. Feel for any lumps or swellings.
- Towards the top and back of each testicle you should be able to feel a small elevation. This is the epididymis, which is a cordlike structure which carries and stores sperm. By becoming familiar with this structure you won't confuse it with a suspicious lump.
In time you will know the feel of your testicles - if you find any lumps or changes then see your GP right away.
Causes of testicular cancer
The exact cause of testicular cancer is not yet known, though we do know some of the risk factors:
- Race - testicular cancer is more common among white men.
- Undescended testicles - there's a higher risk of developing testicular cancer in boys that were born with their testicles located in their lower abdomen rather than in the scrotum (also called cryptorchidism).
- Prenatal oestrogen exposure - the administration of the female hormone oestrogen to pregnant mothers appears to be associated with an increased risk of testicular cancer in their sons.
There also seems to be an association between testicular tumours and trauma or injury to the testes. Some doctors believe that injury simply makes a cancer more likely to be identified.
How is it diagnosed?
If testicular cancer is suspected, it's likely that the doctor will take a medical history and perform a physical examination, which will include inspection of the scrotum. You will probably have a testicular ultrasound, and blood and urine tests. Although most lumps within the testicles are cancerous, the only way to be sure is for a section of tissue to be examined - this requires removal of the affected testicle via an operation known as inguinal orchiectomy. It is also the initial treatment for testicular cancer.
Usually further tests will be required to stage the cancer, that is, to determine its extent in the body. This will probably include a chest x-ray and CT scanning which is used to take pictures of the abdomen and pelvis.
Treatment of teticular cancer
The form of treatment a patient receives will depend on both the type and the stage of the cancer. Most testicular tumours arise from the sperm-forming cells of the testes and are divided into two types: seminomas and non-seminomas. In general, nonseminomas are more aggressive cancers. Rarely, another form of testicular cancer termed a teratoma can occur.
The stage of the cancer indicates the degree of spread in the body - the tumour may be confined to the testes, it may have spread to lymph nodes (glands) in the pelvis or abdomen, or it may have spread to more distant sites such as the lungs and brain. Although testicular cancer can be cured once it has spread beyond the testicles, this is much more likely if it's found early.
In general, the treatment strategies for testicular tumours are as follows:
- Seminomas are often treated using surgery followed by radiation therapy. When spread has occurred then surgery and chemotherapy are likely to be used.
- Non-seminomas that are confined to the testes may be treated with surgery alone. Following this, some patients will be offered surveillance (explained below). When spread of a non-seminoma occurs, then surgery and chemotherapy are often necessary.
Details of the different treatments are given below:
- Surgery - as mentioned, inguinal orchiectomy is often the first stage of testicular cancer treatment. Sometimes surgery will also be necessary to remove affected lymph nodes at the back of the abdomen (called RPLND surgery). Surgery to remove lymph nodes may lead to sterility as it can affect the nerves involved in ejaculation. However, the removal of a testicle is unlikely to cause infertility or affect the ability to attain an erection.
- Radiation therapy - this involves the use of high energy rays to stop the growth and spread of the cancer cells. It's usually directed towards lymph nodes in the abdomen. There are a number of side effects related to this form of treatment including nausea, tiredness, diarrhoea and skin reactions. These may respond to medication though plenty of rest, fluids and a healthy diet may help too. If you feel unable to eat much then you might try consuming a high calorie drink available at your local pharmacy. Radiation therapy also interferes with sperm production though fertility should return after a couple of months.
- Chemotherapy - here anti-cancer drugs are used to try to stop the cancer cells from growing. Chemotherapy may be given by tablet or administered into a vein. Normally a few treatments are required with rest periods of a week or more in between each of these. As chemotherapy affects not only cancer cells but some other cells in the body, temporary side effects are often experienced. These may include hair loss, nausea, vomiting, mouth sores, and greater susceptibility to infection. If possible patients should try to eat well so as to better withstand the effects of treatment - this may be made easier by consuming lots of snacks and high calorie drinks rather than large meals. Chemotherapy may also affect sperm production but fertility should resume in time.
- Surveillance - this involves regular testing to detect cancer recurrence, in which case further treatment will then be offered. Surveillance requires a high level of commitment by both the patient and doctor.
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