Family doctor

testicular cancer

Overview:

• Testicular cancer is a rare disease but it is one of the most common cancers among young men
• It mainly affects men between the ages of 20 and 40
• Males with undescended testicles during infancy are more at risk of testicular cancer
• Testicular cancer is one of the most curable cancers if it is found early
• Self examination once a month is important to help detect malignant lumps early

What is it?

Testicular cancer is a rare disease but is still one of the most common cancers among young men. However, the rate of the disease has increased in recent years.

About one percent of all cancers are due to testicular cancer.

The number of new cases each year have doubled in the United States.

It is most common in the 20 to 40 year age group. However, it can happen to men at any age.

Testicular cancer has a very high chance of cure if it is detected in the early stages.

The risk of testicular cancer is higher among men born with undescended testicles (the testicles are in the abdomen rather than the scrotum).

The risk is also higher among men whose testicles do not develop normally. There is no evidence that an injury to the scrotum causes testicular cancer.

There is concern that males whose mothers took the hormone medication diethylstilbestrol (DES) during pregnancy to prevent miscarriage may also be at higher risk of testicular cancer because abnormalities have been observed in the testicles of these offspring.

What are the symptoms?

The following symptoms need to be investigated to rule out testicular cancer. They can also be symptoms of other conditions:

• A small firm lump in one of the testicles (usually painless)
• A heavy feeling in the scrotum
• Swelling in either testicle
• Fluid collected in the scrotum
• Pain or aching in the groin, scrotum, testicle or stomach
• Tender or enlarged male breasts

A lump in the testicle may also be a cyst, hernia, or possibly a swollen blood vessel. An inflammed epididymis (a small gland) is a common cause of discomfort in the testicular region. However, any change needs to be checked by a doctor.

Diagnosis:

It is important not to delay having any of the above symptoms checked by a doctor.

The scrotum will be examined and several blood and urine tests will be carried out to help rule out other conditions.

Testicular cancer also causes the levels of some "tumour markers" in the blood to increase above usual levels e.g. alpha-fetoprotein (AFP), human chorionic gonadotrophin (HCG) and lactase dehydrogenase (LDH).

An ultrasound is a good non-invasive test and will help diagnosis if cancer is likely.

If cancer is suspected, referral to a urologist and oncologist is required for further diagnosis and treatment.

The definitive diagnosis is made by biopsy and examination of the tissue under a microscope. In nearly all cases this requires total removal of the testicle.

If testicular cancer is diagnosed then the extent of the cancer must be established. This process is called staging. This involves blood tests, x-rays, scans and surgical biopsy/removal of the testicle.

Stage I

Cancer is confined to just one testicle

Stage II

Cancer is found in the testicle and has spread to the lymph nodes in the abdomen.

Stage III

Cancer has spread to the lymph nodes and beyond, such as the lungs or liver.

What is the treatment?

Treatment for testicular cancer depends on the stage of the disease, the patient's age and their health. The treatment may also vary with slightly different types of cancer (e.g. seminoma or non-seminoma).

In most cases treatment involves removal of the testicle which has normally been done at the diagnosis stage. In many cases the lymph nodes in the abdomen are also removed to help prevent the cancer from spreading.

Radiation therapy, chemotherapy and bone marrow transplants are also used in the treatment of testicular cancer.

The cure rate for testicular cancer is about 96 percent when it is treated in the early stages. Even when found in advanced stages the cure rate is as high as 80 to 85 percent.

Radiation therapy and some chemotherapy medication can affect a man's ability to have an erection and can also damage sperm quality and production. Contraception should be used for 18 months following treatment until sperm quality returns to normal.

If future fertility is a concern, banking of sperm (to be frozen) before treatment is an option to consider; ask your doctor about this.

Removal of one testicle per se will not usually affect a man's ability to have sexual intercourse, or their fertility. An artificial testicle can be placed in the scrotum if a person is worried about the appearance.

Surgery to remove the lymph glands can have an effect on the nerves that control ejaculation. "Nerve-sparing surgery" can reduce the risk of this complication. Some men can recover the ability to ejaculate, and medication can be used in some cases.

Regular follow-up care is important for men who have had testicular cancer. Men who have had testicular cancer have a 1 percent chance of the disease affecting their other testicle, and in most cases it is a new disease rather than a recurrence of the original cancer. Most men receive check-ups for several years before they no longer need to see a doctor.

Testicular cancer is unlikely to recur after a person has been cancer-free for three years.

Self examination:

All men should be familiar with how their testicles normally feel in order to detect any abnormalities.

It is recommended that men examine their testicles once a month for any changes. The examination is best carried out during or after a warm shower when the skin is relaxed.

Each testicle should be gently rolled between the thumb and fingers for to check for any changes.

Future trends

Researchers are studying methods to detect testicular cancer in the very early stages before any symptoms occur.

Getting help

It is very important to see your doctor if you are suffering from any testicular problems.