Testicular Cancer
What is testicular cancer?
Figure 1. A tumour in the testicle.
The testicles lie in the pouch of skin that hangs below the penis and are a part of the male reproductive system. The testicles make testosterone and sperm. Testicular cancer is a tumour that starts in the testicle (Fig. 1) and can sometimes spread to other parts of the body.
The risk factors for getting testicular cancer include:
Age 18 to 35 years
An undescended testicle (cryptorchidism), in the past or the present
HIV
Certain genetic conditions that affect the testicles
Infertility
Family history of testicular cancer (father or brother)
What are the types and stages of testicular cancer?
Testicular (germ cell) cancers can be classified as a seminoma or a non-seminoma.
Stage 1: Cancer is only in the testicle.
Stage 2: Cancer has spread to the lymph nodes in the abdomen.
Stage 3: Cancer has spread beyond the lymph nodes to organs such as the lungs or liver.
How is testicular cancer diagnosed?
Testicular cancer most commonly presents with a lump in the testicle. Pain, whilst not typically associated with testicular cancer, may be present on some occasions. While many lumps are not cancer, if you do feel a lump in your testicles, you must see you doctor immediately.
After a thorough history and examination, your urologist will request some blood tests (tumour markers) and a testicular ultrasound. These tests may suggest testicular cancer but a definitive diagnosis is only obtained after surgical removal of the testicle (orchidectomy). Further CT scans may be obtained to assess if the cancer has spread to the lymph nodes of other organs.
How is testicular cancer treated?
Figure 2. Orchidectomy - incision in the groin.
Testicular cancer is usually treated with surgery. The testicle must be removed (orchidectomy) through a small incision in the groin to remove the cancer (Fig. 2).
Depending on the type and stage of your cancer chemotherapy drugs (usually given through an IV directly into the bloodstream one to four times at 3-week intervals) may be given.
If testicular cancer cells spread, they often go to the lymph nodes at the back of the abdomen.
Removal of these lymph nodes is called “retroperitoneal lymph node dissection” (RPLND). This surgery is generally usually only considered for men to remove any cancer that remains after chemotherapy. With adequate treatment and follow-up, cure rates for testicular cancer are over 95%.
What happens after treatment?
Your doctor will schedule you for regular visits after treatment to see if the cancer has come back (recurrence). Visits may include a physical examination, blood tests, chest x-ray, and/or a CT or MRI scan to look for new tumours. Follow-up typically continues for at least 5 years. If there is no recurrence, you do not need further treatment.
Living with testicular cancer
A cancer diagnosis is often stressful and confusing. Talk to your health-care team, family and friends who will be able to support you in your journey.
Living with one testicle
A man can usually do everything with one testicle that he would have done with two. If appearance is a concern, a false testicle (silicone implant) might be an option for a more natural look and feel.
Fertility
Treatment can affect semen quality, but most men with one testicle can still father children. You doctor will discuss whether you want to have semen analysis and preserve sperm samples in a sperm bank for later use.
Low testosterone
One normal testicle is usually enough to produce enough testosterone. Some patients may need treatment to restore normal hormone levels of testosterone in case of low levels. Symptoms of low testosterone may include tiredness, low sex drive, erectile dysfunction, gynaecomastia (swelling of breast tissue in men), or decreased body hair or beard growth.