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Testicular Cancer

cancer testis


Testicular cancer is a cancer that arises from a testis. Around half of all cases occur in men under 35 but testicular cancer rarely occurs before puberty. It is the most common cancer in men aged 15-44 years.

What are the testes?

The testes hang down behind the penis and make sperm. It is normal for one testis to be slightly bigger than the other, and for one to hang slightly lower than the other. The testes themselves feel like smooth, soft balls inside the baggy scrotum.

Type of testicular cancer

Almost all testicular cancers are classed as germ cell cancers as the cells which become cancerous are those involved with making sperm. Germ cell testicular cancers are divided into two main types

Seminomas which occur in about half of cases. They most commonly occur in men aged between 25 and 55 years.

Non-seminomas (sometimes called non-seminomatous germ cell tumours or NSGCTs). Non-seminomas usually affect men aged between 15 and 35 years.

Non-germ cell testicular cancers are rare. The rest of this leaflet deals only with germ cell testicular cancers.

What causes testicular cancer?

A cancerous tumour starts from one abnormal cell. In many cases, testicular cancer develops for no apparent reason. However, certain risk factors increase the chance that testicular cancer may develop. These include:

Geography. The highest rate of testicular cancer occurs in white men in northern Europe. So, some genetic or environmental factor may be involved.

Family history. Brothers and sons of affected men have an increased risk.

Undescended testes. The testes develop in the abdomen and usually descend into the scrotum before birth. Some babies are born with one or both testes which have not come down into the scrotum. This can be fixed by a small operation. There is a large increased risk in men who have not had their undescended testis surgically fixed. There is still some increased risk in men who had an undescended testis fixed when they were a baby.

Infertility. Infertile men with an abnormal sperm count have a slight increased risk.

Klinefelter's syndrome.

HIV/AIDS. Men who have HIV or AIDS have an increased risk.

What are the testicular cancer symptoms?

Lump on a testis

In most cases, the first symptom noticed is a lump that develops on one testis. The lump is often painless but some people notice some pain or discomfort coming from the affected testis. (Note: most swellings and lumps in the scrotum are not due to cancer. There are various other causes. However, you should always tell a doctor if you discover a swelling or lump in one of your testes.

Other testicular cancer symptoms

Sometimes there is general swelling in one of the testes. If the cancer is not treated and spreads to other parts of the body then various other symptoms can develop. These may include back pain or shortness of breath.

How is testicular cancer diagnosed and assessed?

To confirm the diagnosis

An ultrasound scan. This test can tell if the lump is a solid mass (likely to be a tumour) or a benign cyst (a fluid-filled lump which is common in the testes).

Blood tests. Testicular cancers often make chemicals which can be detected in a blood sample. They are a marker of testicular cancer.The tumour markers commonly tested for are alpha-fetoprotein (AFP), beta human chorionic gonadotrophin (beta-hCG), lactic dehydrogenase (LDH) and placental alkaline phosphatase (PALP).
 However, a negative result does not rule out cancer.

On the basis of of the examination, and the above tests, If cancer is diagnosed then the usual advice is to have an operation to remove the affected testis. The testis which is removed is examined under the microscope to confirm cancer.

Note: if you have one testis removed, it should not affect your sex life. You should still have normal erections, make sperm and hormones from the other testis and so can still father children. However, if you have chemotherapy or radiotherapy (see below) it may affect your fertility. But, many men find that their fertility returns to normal a year after they have received their chemotherapy or radiotherapy treatment.

Assessing the extent and spread

If you are confirmed to have testicular cancer then further tests are usually advised to assess if the cancer has spread. This assessment is called staging of the cancer and aims to find out:

Whether the cancer has spread to nearby lymph nodes and lymph nodes in the abdomen.
Whether the cancer has spread to other areas of the body (metastasised).
By finding out the stage of the cancer it helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis).

Tests which may be advised to stage the cancer include a CT scan, an MRI scan, chest X-ray or other tests.

What is the treatment for testicular cancer?

Treatment options which may be considered include surgery, chemotherapy and radiotherapy. The treatment advised for each case depends on various factors such as the stage of the cancer, the type of cancer (seminoma or non-seminoma), and your general health.

Surgery

Surgery to remove the affected testis is normally advised in all cases. This alone may be curative if the cancer is in an early stage and has not spread. If the cancer has spread then further surgery may also be needed for some men after radiotherapy or chemotherapy, to remove any cancer cells present in the lymph nodes of the abdomen or chest.

Chemotherapy

Chemotherapy is a treatment of cancer by using anti-cancer medicines which kill cancer cells, or stop them from multiplying. Whether you need chemotherapy and the length and type of treatment schedule depends on the type and stage of the cancer when diagnosed.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation which  kills cancer cells, or stops cancer cells from multiplying. It may be needed in addition to having the affected testis removed.

When chemotherapy or radiotherapy are used in addition to surgery it is known as adjuvant chemotherapy or adjuvant radiotherapy.

Follow-up after treatment

Follow up for several years following successful treatment to check that the cancer has not come back. This may include regular blood tests which check for marker chemicals You may also have regular chest X-rays or other scans or tests to check that you are free of any recurrence.

What is the prognosis (outlook)?

The outlook is usually very good. Treatment for testicular cancer is usually successful. During the last 40 years, testicular cancer has become a curable cancer in over 95% of cases.

If your testicular cancer is diagnosed and treated at an early stage, you can expect to be cured. Most testicular cancers are diagnosed at an early stage.Even if the cancer has spread to other parts of the body, there is still a good chance of a cure. The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. You should ask the specialist who knows your case about your particular outlook.

Detecting testicular cancer early

Young men and teenage boys should get to know how their testes normally feel. Report any changes or lumps to your doctor.


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