Testicular Cancer

Testicular cancer also called Germ Cell Tumour most commonly presents with a painless lump/swelling in the testis. It may occur at any age in men but most commonly occur between 15-44 years of age. This cancer when diagnosed early in the initial stages is curable in up to 96% of the patients. Men with a history of undescended testicles (cryptorchidism) are more likely to develop a tumour than other men, risk being 8 out of 100 patients.

Testicular cancer is a rapidly growing cancer so when diagnosed must be operated on early.

Why Testicular Self-Exam is Important

A careful testicular self-examination in men is one of the best ways to find out testicular cancer at an early stage. A good time to do a self-exam is after a warm bath or shower while standing when the scrotum is relaxed. If any abnormal lump or swelling is noted in the testis particularly when there is no pain, inflammatory signs or history of trauma, medical help should be sought.

Diagnosis

Diagnosis is established on the basis of:

Testicular Cancer Stages

Stages

As testicular cancer advances it may spread to other parts of the body. Its stages of development are:

Stage 0: This is also called “Germ Cell Neoplasia In Situ (GCNIS)”. This is not really cancer, but a warning that cancer could grow.

Stage I: Cancer is found only in the testicle. It has not spread to nearby lymph nodes.

Stage II: Cancer has spread to one or more lymph nodes in the abdomen. It has not spread to other parts of the body.
Stage III: Cancer has spread beyond the lymph nodes in the abdomen. Cancer may be found far from the testicles, like in distant lymph nodes or the lungs. Tumour marker levels are high.

The main types of germ cell tumors (GCTs) in the testicles are either seminomas or non-seminomas:

Seminoma – The most common cell type of testicular cancer. They grow slowly and react well to chemotherapy and radiation.
Non-seminomas – There are a few types of non-seminomas: choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumors. These cells grow more quickly and are less responsive to radiation and chemotherapy.

There are also rare testicular cancers from cells that support other roles. Leydig cell tumors form from the Leydig cells that make testosterone. Sertoli cell tumors come from the Sertoli cells that support normal sperm growth.

Testicular Cancer Treatment

A multidisciplinary team of best urologists, medical oncologists and radiation oncologists should work together to find the best treatment plan for each patient. Treatment options depend upon the stage of the disease and may include one or more of the following options:

Sperm or testicular tissue banking is used in those who want to have kids. It is done before the treatment with either chemotherapy or radiation therapy started.

Surveillance

All patients who undergo treatment for testicular cancer must be followed up with regular surveillance. This includes a physical examination, tumour marker tests, and imaging tests at periodic intervals based on the stage of the disease and initial treatment.

Surgery

Surgery is the mainstay of treatment for early-stage testicular cancer. Most often, radical orchiectomy is done to remove the entire testis and spermatic cord. It diagnoses as well as treats early-stage testicular cancer.
If one testicle is removed and the other is normal, testosterone levels should be fine and the person continues to perform normally.

Primary retroperitoneal lymph node dissection (RPLND). This surgery is an option for certain patients with stage I cancer with a high risk for recurrence. Surgery is also performed to treat those patients who have advanced spread disease and they are left with residual masses in the abdomen after treatment with chemotherapy.

Radiation

Radiation is a useful adjunct to surgery in certain kinds of testicular cancer. It is also used when cancer has spread to specific organs like the brain.

Chemotherapy

Chemotherapy is the mainstay of treatment in those cases where cancer has spread beyond the testis.

Author:

Dr Irfan Ahmed

Consultant Urologist & Cancer Surgeon