What is testicular cancer?

Each year in the UK, around 2,300 men are diagnosed with testicular cancer, according to Macmillan Cancer Support UK. Testicular cancer is usually curable. It is a type of cancer that affects the testicles, which are part of the male reproductive system. While it is relatively rare, testicular cancer is the most common form among men aged between 15-45 years. Men in this age group need to be aware of the signs and symptoms of testicular cancer, so they can recognise them if they ever experience them.

The testicles

The testicles, also known as the testes, are an important part of a man’s urinary and reproductive system. The anatomy of the testicles is complex and includes the seminal vesicles, epididymis, vas deferens, scrotum, tunica albuginea and Leydig cells. They produce testosterone, the primary male hormone that helps regulate many features associated with male traits, such as muscle growth and facial hair. Additionally, the testicles are responsible for creating sperm necessary for fertility.

Testicular cancer is a type of cancer that begins in the cells of one or both testicles (the male sex organs located inside the scrotum). This type of cancer starts when healthy cells in the testicles change and grow out of control, forming a tumour. Cancer cells can grow quickly, and the tumour can grow beyond the testicle. Some cells might break away and spread to other parts of the body. Testicular cancer most often spreads to the lymph nodes, liver and lungs.

Types of testicular cancer

Testicular cancer is a type of cancer that can adversely affect both men and adolescents. It begins in the cells of one or both testicles located in the scrotum. There are several types of testicular cancer, including non-seminoma, seminoma and mixed germ cell tumours.

• Non-seminomas typically grow more rapidly than seminomas, which tend to be slower-growing and less aggressive. The 4 main types of non-seminoma tumours are embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and teratoma
• Seminomas tend to grow and spread more slowly than non-seminomas. The 2 main subtypes of these tumours are classical (or typical) seminomas and spermatocytic seminomas
• Mixed germ cell tumours may contain a combination of both non-seminoma and seminoma cells
• Other types include sex-cord stromal tumours and lymphomas

Depending on the type of testicular cancer someone has, they may have different treatments. Understanding the type of testicular cancer one has is important in selecting the best treatment plan for one as an individual.

What does testicular cancer feel like?

Testicular cancer can cause varying levels of discomfort, from mild to severe. It could be a dull ache or pain in the testicle, a feeling of heaviness within the scrotum, a dragging sensation in the lower abdomen or back pain, or any combination of these and more.

Testicular cancer pain may come and go intermittently over weeks or months, and changes in the size or texture of one testicle can be a sign that something is wrong. If you are experiencing any unexplained pains or abnormalities around your testicles, it’s important to have them checked out by a doctor as soon as possible. Early detection gives you the best chance at successful treatment and recovery.

What does testicular cancer look like?

The main symptom to look for is a hard painless lump or mass in your testicles that begins to grow. It’s important to keep an eye on changes in the size and shape of your testicles during regular self-exams. Other symptoms can include a change in the consistency of the testicle, scrotal pain and swollen lymph nodes near the groin region.

If you notice any lumps or other changes, you should visit your doctor as soon as possible for further examination and diagnosis. These symptoms could often be signs of a minor issue that does not require treatment; however, getting checked by a medical professional can help identify any issues that may need treatment right away.

How to check for testicular cancer

Checking for testicular cancer is essential to a man’s self-care routine. It can greatly reduce your risk of having this type of cancer advance to a more severe stage. It’s best to perform a testicular self-exam once a month:

• Begin by checking each testicle separately
• After standing with your hands at your sides, place the index and middle finger of one hand beneath the testicle while placing the thumb on top
• Firmly but gently, roll the testicle between your fingers to feel for any lumps or changes in size or shape
• Repeat this same process with the other testicle before continuing to inspect each one up close using both hands for comparison

If you are unsure or uncomfortable with performing this exam, you should speak with your doctor about how to proceed correctly.

What are the 5 warning signs of testicular cancer?

5 common warning signs to look out for are:

• Swellings or enlargements in one or both testicles
• A feeling of heaviness in the scrotum
• Growing aches or pains in the lower belly
• Collection of fluid in the scrotum
• Tenderness, discomfort or changes in the size or shape of the testicles

Does testicular cancer itch?

While many men think itching could indicate testicular cancer, it is rarely the primary symptom. This means that itching around your testicles may not require special testing or treatment for cancer. However, if you notice any unusual changes in your testicles, such as lumps or swelling, it’s important to immediately speak with a healthcare provider.

How fast does testicular cancer spread?

Testicular cancer can spread relatively quickly but varies based on the type. The two most common types, seminoma and non-seminoma, have different growth rates. Seminomas tend to grow slowly compared to non-seminomas which can spread more quickly.

It’s important to catch testicular cancer as soon as possible so treatments can be started before spreading too far. Your doctor will perform tests and discuss your treatment options based on how fast cancer will likely spread. Remember that many testicular cancers are either slow growing or even stop growing once treated, giving you a good chance for recovery.

Factors that may increase your risk of testicular cancer

Various factors have been linked to an increased risk of testicular cancer:

• Age is the primary factor, with diagnoses disproportionately affecting men between 15 and 40 years of age
• A family history of testicular cancer and having undescended testicles (cryptorchidism) in the past
• Having mumps at an older age

A number of lifestyle-related risk factors are thought to contribute as well, including using anabolic steroids, heavy alcohol use, being overweight or obese, poor diet and lack of exercise, exposure to hazardous chemicals in the workplace and smoking or recreational drug use.

How is testicular cancer diagnosed?

Diagnosing testicular cancer typically begins with a physical exam by your doctor, who will feel the scrotum area to test for any lumps or unusual enlargements. Your doctor may also recommend a blood test to check for tumour markers. The tumour markers that are often elevated in testicular cancer are alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG or beta-HCG) and lactate dehydrogenase (LDH).

Ultrasound is usually the next step, which can reveal if there are any tumours present on the testicles or other suspicious areas nearby. Your doctor may also order a biopsy to confirm or rule out the presence of cancer cells.

If you have been diagnosed with testicular cancer, your doctor may suggest additional tests such as chest x-ray and CT scans to see if the cancer has spread beyond the testicles. Along with diagnosing this type of cancer, these screenings are important in planning treatment and predicting prognosis.

This information will help the oncology and urology team identify the most appropriate treatment regimen, as each type of testicular tumour responds differently.

Testicular cancer treatment

There are three main treatments for testicular cancer: surgery, radiation therapy and chemotherapy. Surgery is typically the first line of treatment and involves the removal of the testicle containing the tumour, which can reduce pain and improve the signs and symptoms of cancer. Radiation therapy uses high-energy beams to kill any remaining cancer cells, while chemotherapy uses drugs to kill cancer cells. Treatment plans for testicular cancer may also include hormone therapy, depending on cancer type, stage or spread.

Surgery – Orchiectomy

If testicular cancer is detected in its early stages, orchiectomy may be the only treatment you require. Orchiectomy is a surgical procedure to remove one or both of the affected testicles. It can help relieve discomfort and reduce the chance of cancer spreading throughout the body.

There are potential side effects that patients should discuss with their doctors before undergoing an orchiectomy; these could include erectile dysfunction and reduced fertility in men since there will no longer be any sperm production. If both testicles are removed (a bilateral orchidectomy), you’ll be infertile. You may be able to use sperm banking before having a bilateral orchidectomy to allow you to father children if you decide to.

After the testes are removed, hormone therapy may be administered to ensure that testosterone levels remain balanced. Orchiectomies can have significant physical and psychological effects. Hence, it is important for anyone considering this procedure to speak with a medical professional beforehand in order to understand their options fully.

Retroperitoneal lymph node dissection (RLND)

More advanced cases of testicular cancer may require retroperitoneal lymph node dissection. This procedure may be performed if testicular cancer has spread to nearby lymph nodes and the doctor attempts to remove the affected cells.

RLND is considered a more complicated procedure than other testicular cancer surgeries. During this operation, doctors work very hard to minimise side effects such as male infertility and other complications such as damage to the nerves involved in ejaculation.

Radiation therapy

Radiation therapy is an important tool used in the treatment of testicular cancer. In some cases, radiation therapy can be used alone to treat cancer if it is found early. However, in more advanced stages, radiation therapy is usually recommended after surgery to remove the tumours or as a follow-up for other treatments such as chemotherapy.

During radiation therapy, high-energy x-rays are delivered directly to the area where the tumour was removed, which helps destroy any remaining cancer cells. Radiation treatments must be done regularly over some time and patients may feel fatigued during and shortly after treatment. Despite its drawbacks, if appropriately administered, radiation therapy can be incredibly effective at treating testicular cancer.

Chemotherapy

Chemotherapy is a treatment for testicular cancer that uses drugs to kill cancer cells. It is often used when other treatments have not worked or have been unsuccessful. Patients will be given medication through an intravenous (IV) line or orally during chemotherapy. The exact cocktail of drugs and the length of treatment depends on the stage and type of cancer being treated, but it can last weeks to months.

Chemotherapy can sometimes be painful, cause nausea and vomiting, lower fertility in men temporarily and cause fatigue and hair loss. Despite these potential side effects, this treatment effectively combats testicular cancer and provides many long-term survivors with a better quality of life.

All these treatments have been tested in clinical trials and work to treat testicular cancer in over 95% of cases successfully. Often combinations of different therapies are used to achieve the best outcome with minimal side effects. Your doctor will work with you to find a treatment plan that fits your needs.

Survival rates of testicular cancer

According to Cancer Research UK, testicular cancer has become one of the most survivable cancers, with a 95% 1-year and 5-year survival rate and a 90% 10-year survival rate in England. No UK-wide survival statistics are available for testicular cancer that has spread.

Seek help early

Testicular cancer can be a frightening diagnosis, but it is a treatable form of cancer with the proper cancer care from an experienced oncologist. Knowing about its risks and early signs can help diagnose it early so that treatment can begin sooner and help improve outcomes significantly. If you experience any signs or symptoms of this disease, it’s important to see your doctor immediately for further evaluation and treatment if necessary. With proper medical care, most patients can fully recover from this type of cancer.

Sources

• Testicular Cancer – NHS 
• Testicular Cancer Survival – Cancer Research UK 
• What is testicular cancer – Cancer