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Causes | Symptoms | Diagnosis | Stages | Treatment

testicular

Testicular cancer is a rare disease in men caused by abnormal growth of cells in the tissues of one or both testicles. The male sex gland, testicles (testes or gonads) are the body’s main source of male hormones which is involved in the production of sperm. The testicles, two in number, which look round and a little smaller than golf balls, are located behind the penis in a pouch of skin called the scrotum.

Testicular cancer usually arises between the ages of 15 and 49, more likely between 20-35. Testicular cancer or malignant tumour (also called germ cell tumour) begins when cells within the testicle become cancerous and begin to grow out of control. Seminoma and Nonseminoma are the two types of testicular cancer. Nonseminomas include four sub-types namely Choriocarcinoma, Embryonal Carcinoma, Teratoma, and Yolk sac tumors. Seminomas, made up of immature germ, are slow growing and tend to stay localized in the testicle for long periods. Nonseminomas arise from more mature, specialized germ cells and tend to be more aggressive than Seminomas. Tumors can also arise in the supportive and hormone-producing tissues of the testicles and are called Gonadal Stromal tumors. Leydig cell tumors and Sertoli cell tumors are two types. Secondary testicular tumors are those that start in another organ and then spread to the testicle. The most common secondary testicular cancer lymphoma, arise from lymphatic tissue (tissue that forms part of the immune system) within the testicle. These are very rare.

Causes

The causes of testicular cancer are unknown, but it is not contagious. It is more common in men who have a testicle that has failed to descend. Men with a family history of testicular cancer may have an increased risk of developing testicular cancer. Baby boys born with undescended testicles (also called cryptorchidism) have a higher-than-average risk of developing testicular cancer in later life. It is a condition where the testicle does not move into the scrotum before birth. The male children of women who takes hormones while pregnant may also be at greater risk. Men who have already had testicular cancer have a higher risk of developing a tumor in the other testicle.

Signs and Symptoms

Testicular cancer
does not always produce symptoms. In some cases there are few or no symptoms and it is only after the cancer has spread, that the primary tumour can be detected in the testicle itself. The first sign is usually a firm, painless and smooth testicular mass or lump varying in size and sometimes producing a sense of testicular heaviness. Most lumps in the scrotum are not testicular cancer.

Other symptoms include :

*Testicular swelling and hardness
*A feeling of heaviness or aching in the scrotum or lower abdomen.
*A dull ache in the abdomen or groin
*Any change or pain in the testicle or scrotum.
*Enlarged male breasts and nipples.
*Blood or fluid that accumulates suddenly in the scrotum.

Some types of testicular cancer produce high levels of human chorionic gonadotropin [HCG], estrogen and testosterone hormones. Increased levels of HCG may cause breast tenderness and abnormal growth of breast tissue (gynecomastia). Increased levels of estrogen may cause a loss of sexual desire (libido) and increased levels of testosterone may cause premature growth of facial and body hair in boys. In advanced stages, signs and symptoms include urethral obstruction, abdominal mass, cough, hemoptysis, shortness of breath, weight loss, fatigue, pallor and lethargy.

Diagnosis

Routine regular self examination of the testicle should be done by all men, beginning at the age of 15 years. Most testicular cancers are found by men themselves. The best method of examination is known as testicular self-exam or TSE. Men should be familiar with the normal weight, texture and consistency of their testicles. With early detection, there are 90%  chances of a complete cure.

Testicular self examination

Testicular self examination should be carried out once in a month and the best time to feel the testicles is following a bath or shower when the organs are warm and relaxed. Use a mirror  to become familiar with the normal size and appearance of the testicles. Check out for any swelling on the scrotal skin. Examine each testicle with both hands. Place the index and middle fingers under the testicle with the thumbs placed on top. Roll the testicle gently between the thumbs and fingers. If you are familiar with the epididymis, a small firm, soft, tubelike structure at the back of the testicle that collects and carries sperm, you won’t mistake it for a suspicious lump. Look out for any extra increase in size or weight which might indicate  abnormality. Cancerous lumps usually are found on the sides of the testicle but can also show up on the front. Lumps on the epididymis are not cancerous.

Any change or pain in a testicle should be shown to a general practitioner, preferably a Urologist, with out delay.  He will carry out a physical examination to rule out any other conditions or infections that can cause similar symptoms. If the doctor suspects testicular cancer he may perform an ultrasound scan or blood test to clarify the diagnosis. An ultrasound scan using sound waves determines if a mass is solid or fluid filled. A solid tumour in the testicle is usually cancerous. Certain types of testicular cancer raise the level of substances known as tumor markers (which are found in higher than normal amounts when a tumor is present) in the blood. Blood tests that measure the levels of these substances are used to diagnose testicular cancer
and, in some cases, to determine the extent of the disease.

When a solid tumor is detected by ultrasound, a Computed Tomography (CT scan) or chest x-ray is performed to check for any signs that the cancer has spread to lymph nodes or other organs. CT scans are helpful in staging the cancer or determining the extent of its spread.

Stages of the Disease

Once the tumor is identified, more tests will be done to find out if the cancer has spread from the testicle to other parts of the body. This is known as staging. There are three stages for the testicle cancer and they are :

Stage I - Cancer is confined only in the testicle.

Stage II - Cancer has spread to the retro peritoneal lymph nodes in the abdomen (lymph nodes are small, bean-shaped structures),  located in the rear of the body below the diaphragm and between the kidneys. They produce and store infection-fighting cells.

Stage III - Cancer has spread beyond the lymph nodes in the abdomen. There may be cancer in parts of the body far away from the testicles, such as the lungs, brain, liver and bones.

Treatment

The treatment of testicular cancer is determined by the type and stage of the tumor. It is a highly treatable and usually curable form of cancer. Treatment methods include surgical removal of the lump or testicle (Orchidectomy), Chemotherapy and Radiation therapy and surveillance. Chemotherapy and radiotherapy can temporarily interfere with sperm production and therefore fertility.

Surgery
Surgery which is the normal treatment for testicular cancer involves removal of the affected testis. An incision is made in the groin, and the testicle is withdrawn from the scrotum through the opening. A cut is made through the spermatic cord that attaches the testicle to the abdomen. This procedure is known as a radical inguinal orchiectomy. The removal of one testicle does not affect a man’s sex life or his ability to have erections or father children.

If the testicular cancer has spread to the lymph nodes in the abdomen, a major surgery, called retroperitoneal lymph node dissection (RPLND) is often performed. In this procedure all of the lymph nodes connected to the affected testicle are removed .

Side Effects : Pain at the incision site and numbness in the area surrounding the incision are common, and pain relievers are often prescribed. Driving and heavy lifting should be avoided for several weeks.

Chemotherapy
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs can be swallowed in pill form or can be injected by needle into a vein or muscle. It is an effective way to destroy any cancer cells that break off from the main tumor and travel in the bloodstream to lymph nodes or distant organs. The most commonly used drugs to treat testicular cancer are cisplatin, vinblastine, bleomycin, cyclophosphamide, etoposide, and ifosfamide. In some cases, chemotherapy is given to patients after surgery to kill any remaining tumor cells in the body. This is referred as adjuvant chemotherapy.

Side Effects : Drugs used in chemotherapy can cause side effects, but these can usually be well controlled with medicines.
The possible side effects are lowered resistance to infection, bruising or bleeding, anaemia (low number of red blood cells), nausea and vomiting, sore mouth, hair loss, breathlessness, hearing changes, fatigue, diarrhea or constipation. Most side effects disappear when your course of treatment ends. Some drugs can cause long-term side effects like damage to kidney’s and lungs, small blood vessels and nerves, abnormal tingling and hearing loss etc.

Radiation Therapy
Radiation therapy is the treatment using a beam of high-energy rays or particles to destroy cancer cells or slow their rate of growth. It is given to prevent the cancer coming back after surgery or to treat any cancer cells that have spread to the lymph glands at the back of the abdomen. Seminomas which very sensitive, can be treated with radiation. Radiation therapy is also called x-ray therapy, radiotherapy, cobalt treatment, or irradiation.

The main drawback of radiation therapy is that it may destroy nearby healthy tissue along with the cancerous cells. The side effects of radiation are diarrhea, fatigue, nausea and skin irritation that resembles sunburn.

The earlier the stage at which your cancer is diagnosed, the better your chances are for recovery. After treatment, a patient should regularly examine the opposite testicle for possible recurrence for many years. Patients will probably have check-ups once per month during the first year after surgery, every other month during the next year, and less frequently after that.