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Testicular Cancer

What is testicular cancer?

The testicles (also singularly known as testis or testes) are part of the male reproductive system. These two egg shaped glands are held in the scrotum below the penis.

Cancer is the abnormal growth of cells in the body; these cells grow in an uncontrolled way and produce masses or lumps called tumours.

Testicular cancer is an abnormal growth or tumour in the testis.

The cause of testicular cancer in most cases is unknown, however there are some risk factors that are associated with the cancer:

  • Undescended testes at birth whereby the testicle didn’t drop from the abdomen down into the scrotum.
  • History of testicular cancer in one testis is a risk factor for developing cancer in the other testes.
  • Fertility problems – men who have been diagnosed with fertility problems may have a greater risk than men with normal fertility.
  • Family history including father, brother or uncle with a history of testicular cancer, considered a low risk factor.
  • Down syndrome may increase a male’s risk of testicular cancer.

Types of testicular cancer

There are two main types of testicular cancer; these are differentiated by their cell type. These cell types act differently in the body and therefore respond differently to treatment options. There are other types of testicular cancer however they are quite rare.

The two main types are:

Seminoma - most common cell type, and contains only one type of cancer cell.

Non-seminomas (non-seminomatous germ cell tumour) a type of testicular cancer, which is comprised of many different cancer, cells. It is more commonly seen in younger men.

Symptoms of testicular cancer

  • A painless lump in the testicle
  • A feeling of heaviness in the scrotum
  • Swelling of the testicle, with or without pain felt
  • Pain or ache in the testicle, scrotum or groin area
  • Occasionally symptoms may include shortness of breath, coughing, backache or tenderness in the nipples.

Diagnosis of testicular cancer

Health history and physical examination – your doctor will undertake a full health history and physical examination of the affected testis, including the other testis.

Testicular Ultrasound – ultrasound uses soundwaves to enable pictures to be taken of the testes.

Blood tests – blood tests are available which can check for specific tumour markers (proteins made by most testicular cancers) these markers will be present in the blood tests if cancer is present.

Chest x-ray, CT scan of lungs, CT scan of abdomen and pelvis

Treatment for testicular cancer

Treatment options for testicular cancer depend on the type and stage of the cancer.

Radical Orchidectomy – is the surgical removal of the affected testis and its cord. It is the first stage of treatment for all suspected testicular cancer cases. The procedure is performed usually through a small incision in the groin. In some cases a testicular prosthesis (fake testis) may be placed for cosmetic reasons.

Further treatment – further treatment is dependent on the tumour cell type. The different cell types of testicular cancer act differently in the body therefore respond to different treatments.

Seminoma responds to surgery, radiation and chemotherapy treatment. Low stage seminomas may only require monitoring following surgery however in some cases radiotherapy or chemotherapy may be recommended.

Non-seminomas – may require surgery, or chemotherapy.

Blood tests, chest x-rays, and CT scans will be used to monitor for cancer recurrence or to further plan treatment.

Advanced testicular cancer – Testicular cancer which has spread to other areas of the body (including seminomas and non-seminomas) or early stage cancer which has returned may require surgery to remove the lymph nodes in the abdominal region behind the peritoneum. This procedure is called retroperitoneal lymph node dissection. Chemotherapy may also be required at this stage.

Before and after treatment sexual function and fertility

The removal of a single testis shouldn’t affect sexual function or fertility, unless the remaining testis is abnormal. The remaining testis should make enough testosterone to trigger sperm production.

Chemotherapy and radiation therapy can lower sperm counts (usually only for a short time period) therefore it is recommended all men discuss their fertility and individual situation with their health care team before treatment begins. Sperm banking or storage can be arranged prior to treatment commencing.