Testicular Cancer
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What is it?
Testicular cancer occurs when normal cells in one or both testicles change into abnormal cells and grow out of control. The testicles are found inside the skin sac called the scrotum, and function to normally make testosterone and sperm for reproduction.
Although testicular cancer is rare, it is still the most common solid tumor in males between the ages of 15-35 years old. There are numerous different kinds of testicular cancer, but most cases can be treated with a good long-term prognosis even if there is spread of the cancer outside the testis.
What are the Possible Symptoms?
- A painless lump or “knot” on the testicle
- Abdominal, back, scrotal, or testicular pain
- Breast tenderness
- Trouble breathing or shortness of breath
Who is at Risk?
Unfortunately, testicular cancer is still poorly understood. Men at higher risk for testicular cancer include those who are born without one or both testicles dropping into the scrotum (cryptorchidism), those with conditions that promote abnormal testis development (Klinefelter’s Syndrome), a family history of testicular cancer, and Caucasians.
How is it Diagnosed?
It is important for men to perform self-examinations monthly in the shower to look for any abnormalities of the testicle and scrotum. Any changes should prompt a consultation with a Urologist. At this visit, a scrotal ultrasound and labs looking for tumor marker elevation may be important to confirm the diagnosis. In more serious cases, a CT scan of the chest, abdomen, and pelvis may be necessary to stage the tumor and asses whether the cancer has spread outside of the testicle.
What is the Treatment?
Surgery
If your Urologist determines that there is a true mass on the testicle suspicious for cancer, the next step may be a radical inguinal orchiectomy. This is an outpatient, or day procedure, where the testicle is removed from the body along with a portion of the spermatic cord. The incision is always made in the groin above the scrotum. Once the testicle has been taken out ,it will be sent for testing by the Pathology department.
Most testicular cancers are either seminomas or non-seminomas. Seminomas are the most common and tend to be less aggressive. Non-seminomas, such as teratoma, yolk sac tumor, and choriocarcinoma tends to grow and spread more rapidly. In certain situations, if the tumor has spread to regional lymph nodes, a patient may need to have these removed in a procedure called a retroperitoneal pelvic lymph node dissection (RPLND).
Chemotherapy
Chemotherapy is a type of systemic therapy made to kill cancer cells outside the testis. Sometimes this treatment is used in combination with radiation and/or surgery for more complex testicular tumors that involve spread outside the testicle. There are numerous different chemotherapeutic regimens, and each one has its own particular side effect profile.
Chemotherapy candidates usually experience nausea, tiredness, GI disturbances, and hair loss. This option, along with radiation, can lead to male infertility so be sure to discuss saving your sperm (sperm banking) before you start treatment.
Radiation
Radiation treatment uses high-powered energy beams pointed directly at the cancer cells to kill them. This treatment is usually only used for seminomas after a radical orchiectomy has been performed. Common side effects for this treatment modality include skin redness, nausea, tiredness, and abdominal discomfort.
Frequently asked questions
What can I do to prevent testicular cancer?
Nothing can be done to stop the cancer from starting. However, monthly self-examinations in the shower are important for adolescents and those who are at higher risk.
Can the cancer come back?
It is possible that the cancer could come back. After definitive treatment, you will see your doctor regularly for blood tests and CT scans to monitor for any signs of recurrence. These regular checks with your Urologist may happen every 3 to 6 months for the first 5 years. Afterward, the interval of visits should decrease if no cancer recurrences are identified.
Will I still be able to have kids?
If you want to father a child one day, it is crucial to talk with your doctor about preserving your sperm prior to any of the above treatments. Sperm banking can one day be used for in-vitro fertilization if sperm cells are permanently damaged during treatments.