Testicular Cancer

Overview

Testicular cancer is an uncommon cancer in males. It can affect young men in the prime of their life, and become life-threatening. However if treated soon after diagnosis, there is a good chance of cure.

Risk Factors

Undescended testes
During normal foetal development, the testes descend into the scrotum by the time the baby is born. In some men, the testes remain in the body and do not descend into the scrotum. Such men are at higher risk of developing testicular cancer.

Calcifications in the testes (microlithiasis)
Men with calcifications in the testes detected on ultrasound have a slightly higher chance of developing testicular cancer.

Symptoms

The usual symptom is the detection of a lump in the testis. In some patients the lump may be painful.

In advanced cases, the symptoms may be due to spread of the disease, depending on where the disease has spread, eg. cough, difficulty breathing (spread to the lungs), nausea and vomiting (spread to the abdomen), back pain (spread to the lymph nodes at the back of the abdomen).

Testicular self-examination
It is recommended that men who have risk factors for testicular cancer examine their own testes regularly for lumps. This will help in detection of disease at an earlier stage, before it spreads.

Diagnosis

Ultrasound of the testis will show a mass in the testis. The levels of testicular tumour markers in the blood (specifically AFP, HCG and LDH) should be checked. CT scans are usually necessary to establish if the cancer was spread. Ultimately, the testis affected by the tumour should be removed surgically as part of the treatment and also to determine the type of tumour.

Types

The majority of testicular tumours are classified under germ-cell tumours, of which they can be subdivided into different types such as seminoma, embryonal carcinoma, choriocarcinomia, teratoma and yolk sac tumour.

Other less common types of testicular tumour include: lymphoma and gonadal stromal tumours.

It is important to know the type of tumour as treatment varies according to the type.

Treatments

The first treatment for the cancer would be complete removal of the affected testis and spermatic cord. This procedure is known as radical orchidectomy.

Radical orchidectomy
This surgery is performed through a small incision in the groin, similar to that of a hernia surgery. Through the incision the affected testis together with the attached spermatic cord is removed.

Once the tumour stage and type are known, the following additional treatments may be necessary.

Chemotherapy
The patient can be treated with chemotherapy if there is a high chance of microscopic spread to the lymph nodes, or if there is already established spread to lymph nodes or distant organs.

Radiotherapy
This is an alternative to chemotherapy, if the patient has seminoma and there is a high chance of microscopic spread to the lymph nodes in the abdomen and pelvis.

Retroperitoneal lymph node dissection (RPLND)
This is a major surgical procedure and an alternative to chemotherapy if the patient has high chance of microscopic spread to the lymph nodes in the abdomen and pelvis. The purpose of surgery is to remove all the lymph nodes that could be affected by the cancer.

Active surveillance
If there is no obvious spread of disease, the patient can be closely monitored with blood tests and scans.