The new study done 2018 shows that there are 9,310 new testicular cancer cases diagnosed. It also mentions that the rate is only increasing gradually and it is widely seen in seminoma. Cancer may not be common among the population but 1 in 250 male develops it; therefore, know all about the disease and its treatment here.
Testicular Cancer: Overview
Table of Contents
A normal human body contains over 37 trillion cells. These cells in our body have specific jobs to do. They divide in an orderly way and they die when they are damaged and worn out and new cells replace them. When these cells go out of control, they crowd out normal cells and these affected cells keep on growing and making new cells, we say that the area of the body is affected by cancer.
Cells in any part of the body can become cancer and can spread to any part of the body. Testicle cancer is the type of cancer which occurs in the testicles. To know more about testicular cancer, let us go through the structure and function of the male reproductive system.
Testis (a single pair of the testicle is called the testis) are a part of the male reproductive system. They are a “smaller than a golf ball” like organ located inside the scrotum a loose bag of skin located under the base of the penis.
The testicles are made up of many types of cells each of which can develop into different types of cancer. It is important to know where cancer has started in to understand what cells have been affected and what type of cancer it is to determine what treatment to go through.
Causes of Testicular Cancer
Testicles cancers occur when cells in the testicle become altered but what causes the abnormality is not yet known. There are certain risk factors which lead to testicular cancer.
Some of the common factors are:
Undescended Testicles (cryptorchidism) – The testicles form in the male baby’s abdomen at the time of fetal development. They generally move down into the scrotum in a year or at the time of birth. If they take time to move down or if anybody needs the help of surgery to bring them down, it is called undescended testicles.
Men with Undescended testicles are more prone to testicular cancer than men who do not suffer from cryptorchidism
Abnormal Cells in Testicles (Carcinoma in Situ)
CIS which stands for Carcinoma in Situ is not cancer. It means there is an abnormality in the cells of the testicle. There are also no lumps or any symptoms but if left untreated, CIS leads to cancer in 50% of the cases. CIS is found mostly when a testicular biopsy is made while checking for infertility. Removing the testicles is the only treatment for CIS from developing.
Fertility Problem
Men having fertility problem are prone to testicular cancer. The most common problems are,
- Sperm which does not have much movement
- A high proportion of abnormal sperm
- Low semen concentration.
Previous Testicular Cancer
A person having a history of testicular cancer has high chances of getting testicular cancer in the second testicle. Hence it is advised to attend follow up appointments after treatment.
Family History
Sons or brothers of people who have had testicular cancer have high chances of getting it. Men who have a father with the history of testicular cancer are around 4 times more likely to get this cancer and men who have brothers suffering from this cancer is around 8 times more likely to get Testicular Cancer.
Hypospadias
Men with an abnormality in their penis and urethra called hypospadias are likely to develop testicular cancer.
Inguinal Hernia
When a part of the bowel (intestine) slips through a weakness in the tummy (abdominal wall), it sometimes causes a lump in the groin area which is called the Inguinal hernia which can lead to testicular cancer.
Testicular Microlithiasis
Calcium specks in the testicles are called testicular microlithiasis. A healthy man with testicular microlithiasis is not prone to testicular cancer but people having other risk factors such as fertility problem or undescended testicles in addition to testicular microlithiasis are more likely to get this cancer.
Symptoms of Testicular Cancer
Men with testicular cancer may experience different signs or sometimes they some men may have signs which are similar to that of cancer but may have a different medical condition. But some common symptoms of testicular cancer are
- A lump or swelling on either testis. Initially, the testicular tumor can be of the size of a pea but it can eventually grow larger.
- A feeling of heaviness or weight in the scrotum. For example, one testis can become heavier than the other or one testis can grow larger or smaller than the other one.
- Numbness, discomfort or pain with or without swelling in the scrotum is a sign.
- Sudden buildup of fluid in the scrotum
- A sense of dull ache in the scrotum.
- Gynecomastia is a condition wherein certain testicular tumors cause hormones to grow breast tissues or cause can breast tenderness.
- Chest pain, shortness of breath, lower back pain, bloody sputum or phlegm can be symptoms of late-stage testicular cancer.
- Shortness of breath from a blood clot or swelling of one or both legs can be symptoms of testicular cancer.
Diagnosis for Cancer in Testicles
The medical professional checks the signs and symptoms, type of cancer, medical condition and age for proceeding with the diagnosis procedure. Once you notice a lump in testicles, you can seek medical help for primary care. The general physician may refer a urologist further.
Physical Examination
The healthcare professional feels the testicles for checking any sign of hardening, tenderness or swelling. In order to understand whether cancer has spread in other parts of the body, the doctor checks neck, armpits, abdomen or groin to find evidence of any enlarged lymph nodes.
Blood Test
Through the blood tests, the hormones or markers are identified in the blood. Cancer in testicles generates the markers and alpha feto protein and human chorionic gonadotropin are the indicators.
Pure seminomas seldom give rise to the HCG level but they do not raise AFP level. And the non-seminomas frequently raise HCG levels and AFP levels. The high level of AFP refers to existing non-seminoma element in the tumor. Leydig and Sertoli cell tumors are not responsible for producing the substances.
Lactate dehydrogenase indicates how active the cancerous cells in testicles are. The increased level of LDH or lactate dehydrogenase is the indicator of the critical stage. However, in rare cases, the LDH level is caused due to several non-cancerous conditions.
Ultrasound
A scrotal ultrasound scan is a type of procedure which utilizes high-frequency sound waves for producing a picture of the internal side of the testicle. Only through this way, the medical professional can find out whether the lump is malignant or benign.
If the testicular lump is only filled with fluid or only solid, you are freed from worrying. The swelling lump is generally a sign of cancer and the ultrasound scan results in determining the position or any abnormality in the testicles.
Testicular Cancer Treatment
Research says there are not many casualties when it comes to testicular cancer. The survival rate is 99% for men with cancer which has not spread beyond the testicles and the chances go down to 96% when cancer spreads to the lymph nodes in the back of the abdomen. Surgery, chemotherapy and radiotherapy are the three main treatments for testicular cancers.
Determining the type of cancer is the first step in treating testicular cancer. The entire testicle is examined under a microscope after it is pulled out of the scrotum through an incision in the groin.
The doctor then determines the type of cancer cell (seminoma or non-seminoma). Staging comes next which determines how far cancer has spread.
Orchidectomy
One of the definitive ways to confirm the cancer is to examine the lump in testicle under a microscope. If the lump is confirmed to be cancerous, the testicle may be removed through orchiectomy.
Orchidectomy is a surgical procedure to remove testicles. Removing the affected testicle is always better than removing only the tumour because it may lead to cancer spreading. This also improves the chances of making a full recovery. Orchidectomy does not affect sex life and it does not affect the ability to become a father.
But it can be the only treatment required if testicular cancer is detected early in its stage.
Retroperitoneal Lymph Node Dissection
It is a surgery for removing the retroperitoneal lymph nodes which are at the back of your abdomen. This retroperitoneal lymph node dissection starts with the incision down the middle part of the abdomen. It is a complex surgery which is only carried out by a skilled surgeon.
RPLND after Chemotherapy
If a patient is in stage III or stage II non-seminoma and has retroperitoneal masses after finishing the chemotherapy, this surgery may be required. Even if the masses remain longer 1 cm after completing the chemotherapy, the surgery will be helpful. Around 35%-40% of men who undergo the surgery may have a mass which contains teratoma.
Surgery near the lymph nodes can result in a problem with ejaculation but it does not affect erection.
Chemotherapy
Chemotherapy uses medication for killing the drugs. When the drugs start to travel throughout the body, the cells of the carcinogenic tumor are killed. It may be done before or after the lymph node surgery.
The side-effects vary from drugs to drugs used in the chemotherapy. Nausea, infection, hair loss and fatigue are the common side-effects of this treatment. However, infertility may be another concern for the men.
Radiation Therapy
Using high-powered energy beams like x-rays, the therapy can kill the cancer cells. At the time of radiation therapy, the patient is positioned on the table and the beams are placed at the exact points of the body.
The therapy is an option for a man who has seminoma. It is generally recommended after the surgical procedure for removing the testicle. There are side-effects including fatigue and nausea.
You may also have irritation and redness around the groin and abdominal areas. Another problem caused after the radiation therapy is the reduction of sperm count and negative impact on infertility. You should consult with your doctor before undergoing the therapy.
Understanding and Taking Support
Before going through the whole treatment procedure, it is better to make a list of questions to ask the medical professional. Other than following the doctor’s recommendations, you should focus on healthy choices.
Eat plenty of fresh vegetables and fruits to keep your health nourished. Unnecessary stress can be a negative factor for getting a quick recovery. Also, exercising is essential to stay fit after the surgery. You can also professional help to rid of smoking habit by following solid strategies.
Connect with the cancer survivors to prepare yourself with the uphill battle and also do not forget to take adequate support from the support groups, if needed. Let the loved ones in to support in your journey and do not isolate yourself from extensive medical help.
As there is a high chance of recovering yourself from testicular cancer, you should seek medical help at the earliest stage. However, the new research studies imply that different genes like REX1, SOX2, NANOG and PLAP are the reasons for testicular cancer. New drugs have also been found. The high-dose chemotherapy may be done after stem cell transplant for treating the disease.
It is observed that this type of cancer is treatable with the rapid advancement of medical science and service. Educating yourself is the basic step to take after the doctor confirms the disease. After going through the surgical procedures, you should not miss the follow-ups from the medical professional. Therefore, get full knowledge of symptoms and contact the doctor promptly to get recovery soon.
Sources:
https://www.nhs.uk/conditions/testicular-cancer/diagnosis/
https://www.cancer.net/cancer-types/testicular-cancer/diagnosis
https://www.cancer.org/cancer/testicular-cancer/detection-diagnosis-staging/how-diagnosed.html