Testicular Cancer

Types of Testicular Cancer:

Testicular cancer is classified based on the type of cells involved. The two main types are:

1. Germ Cell Tumors: These tumors begin in the germ cells (cells that produce sperm). The majority of testicular cancers are germ cell tumors. There are two main types of germ cell tumors:
   • Seminomas: These are the most common type of testicular cancer, particularly in men aged 25 to 45. Seminomas tend to grow more slowly and are more sensitive to radiation therapy.
   • Non-seminomas: These tumors tend to grow more quickly and often occur in younger men, typically in their teens or early 20s. Non-seminomas are a group of cancers that include:
     • Embryonal carcinoma
     • Teratoma
     • Yolk sac carcinoma
     • Choriocarcinoma
     • Mixed germ cell tumors: Some testicular cancers are a combination of both seminomas and non-seminomas.
2. Non-germ Cell Tumors: These are much rarer and include tumors that develop in the supportive tissue (stromal tumors) of the testicles. These types are generally benign (non-cancerous) but can still cause symptoms.

Risk Factors:

Several factors may increase the likelihood of developing testicular cancer, although many men who develop testicular cancer have no known risk factors.

1. Age: Testicular cancer is most common in men between the ages of 15 and 35, though it can occur at any age.
2. Undescended Testicle (Cryptorchidism): Men who have had an undescended testicle at birth are at a higher risk of testicular cancer, even if the condition was surgically corrected.
3. Family History: If a close relative (father, brother) has had testicular cancer, you may have an increased risk.
4. Personal History of Testicular Cancer: If you’ve had testicular cancer in one testicle, you’re at a higher risk of developing cancer in the other testicle, although the overall risk is still low.
5. HIV Infection: Men with HIV are at a higher risk of developing testicular cancer.
6. Race and Ethnicity: Testicular cancer is more common in Caucasian men than in men of other races. Men of African descent have a lower risk.

Symptoms of Testicular Cancer:

Testicular cancer often presents with few or no symptoms in the early stages. However, some men may notice symptoms that prompt them to seek medical attention. Common symptoms include:

1. Lump in the Testicle: A firm, painless lump or swelling in the testicle is the most common sign of testicular cancer. The lump may feel hard or smooth, and it may be of varying sizes.
2. Pain or Discomfort: While testicular cancer is often painless, some men may experience pain or discomfort in the testicle or scrotum. This pain can also be a dull ache or a sharp, localized pain.
3. Swelling or Enlargement of the Scrotum: The scrotum may become swollen or feel heavier.
4. Pain in the Lower Abdomen or Groin: Testicular cancer can sometimes cause pain or a feeling of heaviness in the lower abdomen or groin.
5. Changes in the Shape or Texture of the Testicle: The affected testicle may feel different from the other one in terms of shape, consistency, or size.
6. Back Pain: If the cancer spreads to the lymph nodes in the abdomen or back, it can cause lower back pain.

Diagnosis of Testicular Cancer:

If testicular cancer is suspected, several tests may be performed to confirm the diagnosis and determine the stage (extent of spread) of the cancer.

1. Physical Examination: A doctor will perform a physical examination, feeling the testicles for lumps or abnormalities.
2. Ultrasound: A scrotal ultrasound is commonly used to create detailed images of the testicles and help identify abnormal growths. This is a non-invasive procedure that uses sound waves to produce images.
3. Blood Tests: Certain tumor markers (proteins produced by cancer cells) can be elevated in testicular cancer. These include:
   • Alpha-fetoprotein (AFP)
   • Human chorionic gonadotropin (hCG)
   • Lactate dehydrogenase (LDH) Elevated levels of these markers can suggest the presence of testicular cancer and help determine the cancer’s type and stage.
4. Biopsy: A biopsy (removal of a tissue sample for examination under a microscope) is typically not done for testicular cancer because removing the testicle itself is both diagnostic and therapeutic. The tissue removed during surgery is examined to confirm the presence of cancer and determine its type.
5. CT Scan or MRI: Imaging tests like a CT scan or MRI may be done to check for spread of the cancer to lymph nodes, lungs, or other areas of the body.
6. Chest X-ray: A chest X-ray may be performed to check if the cancer has spread to the lungs.

Staging of Testicular Cancer:

Testicular cancer is staged to help guide treatment decisions. The stages of testicular cancer range from Stage I (localized to the testicle) to Stage III (advanced cancer that has spread to other parts of the body). Staging involves evaluating:

• Stage I: Cancer is confined to the testicle and has not spread.
• Stage II: Cancer has spread to nearby lymph nodes (in the abdomen or pelvis).
• Stage III: Cancer has spread to distant organs, such as the lungs or liver.

The International Germ Cell Cancer Collaboration Group (IGCCCG) uses a risk classification system based on factors like tumor markers, type of cancer, and the extent of spread. This helps doctors determine the most appropriate treatment approach.

Treatment of Testicular Cancer:

Treatment for testicular cancer depends on the stage, type of tumor, and other factors like the patient’s age and general health. The primary treatment options are:

1. Surgery (Orchiectomy):
   • The most common and effective treatment for testicular cancer is the removal of the affected testicle, a procedure called radical inguinal orchiectomy. This is usually done through an incision in the groin. In cases where cancer has spread, additional surgery may be needed to remove lymph nodes or other affected tissue.
2. Surveillance:
   • After surgery, some men with early-stage testicular cancer may be monitored with regular check-ups, including blood tests and imaging. Surveillance is particularly common for patients with Stage I seminomas, who have a very high cure rate.
3. Chemotherapy:
   • Chemotherapy uses drugs to kill cancer cells. It is commonly used for non-seminomatous tumors or if cancer has spread to other parts of the body. Chemotherapy is highly effective for testicular cancer and is often used after surgery to ensure that any remaining cancer cells are destroyed.
   • Cisplatin is a commonly used chemotherapy drug for testicular cancer.
4. Radiation Therapy:
   • Radiation therapy is often used for seminomas, especially when cancer has spread to nearby lymph nodes. It uses high-energy X-rays to target and kill cancer cells. However, radiation is used less frequently today due to the effectiveness of chemotherapy.
5. Stem Cell or Bone Marrow Transplant:
   • In very rare cases, for advanced or recurrent testicular cancer, a stem cell or bone marrow transplant may be considered. This is typically used after chemotherapy fails.
6. Retroperitoneal Lymph Node Dissection (RPLND):
   • For non-seminomatous testicular cancer, surgery to remove lymph nodes in the abdomen may be necessary if cancer has spread to these nodes and they have not responded to chemotherapy.

Prognosis and Survival Rates:

Testicular cancer is highly treatable, and the 5-year survival rate for localized testicular cancer is 99%. Even for men with advanced testicular cancer, survival rates are very high, especially with modern treatments like chemotherapy.

• Stage I: The survival rate for men with early-stage testicular cancer (confined to the testicle) is over 99%.
• Stage II: Survival rates remain high (approximately 96-98%), especially with chemotherapy or radiation treatment after surgery.
• Stage III: For advanced stages with metastasis, survival rates can vary, but 90% of men with metastatic testicular cancer can be cured with chemotherapy.

Fertility Considerations:

One potential side effect of testicular cancer treatment, particularly chemotherapy and radiation, is infertility. Since treatment may impact sperm production, men who are concerned about fertility may consider sperm banking before starting treatment.

Prevention:

Currently, there is no known way to prevent testicular cancer. However, regular self-examinations may help detect any changes early. While self-exams are not a replacement for medical check-ups, some men choose to do monthly testicular self-exams to check for lumps, pain, or swelling. Early detection significantly improves the prognosis.

Conclusion:

Testicular cancer, while rare, is highly treatable, especially if detected early. Most men with testicular cancer can be cured, even in cases of advanced disease. Early diagnosis, effective treatment options, and follow-up care contribute to the high survival rates. If you have any concerns or symptoms that might indicate testicular cancer, it’s important to see a healthcare provider promptly.