Testicular cancer

Several factors may increase susceptibility:

• Being between 15 and 44 years old
• A history of undescended testicle (cryptorchidism)
• Prior diagnosis of testicular cancer
• Family history of the disease
• Higher occurrence among white males; growing rates in Hispanic men; lower rates in African-Americans
• Fertility issues or trouble conceiving
• Disorders such as Klinefelter syndrome leading to abnormal testicular development
• Birth defects like hypospadias or inguinal hernia
• Pregnancy-related complications in the mother, including hormone imbalances or bleeding
• Having HIV or AIDS

To diagnose testicular cancer, your doctor will consider your symptoms and perform several tests to exclude other conditions that may have similar symptoms. Often, men themselves notice a lump in the testicles, prompting a visit to the doctor. A healthcare provider can assess whether this lump is cancerous.

Physical Examination

A thorough physical exam will be conducted by the doctor, focusing on both the affected and unaffected testicle to identify any abnormalities. Tumors often feel firm, and in some instances, may result in shrinking of the testicle.

Other areas including the abdomen, armpits, groin, upper chest, and neck are examined to check for any swollen lymph nodes, which may suggest the spread of cancer. Breast tissue is checked for any abnormal growth, and the legs are examined for signs of swelling that could indicate blood clots in veins of the pelvis, abdomen, or legs.

Ultrasound Imaging

A testicular ultrasound uses high-frequency sound waves to create visual images of the scrotum and testicles. A probe is gently moved over the scrotum to produce these images, helping to identify the size, type, and position of any lump. It distinguishes whether the lump is fluid-filled or solid and whether it originates inside or outside the testicle.

Blood Tests

Your doctor may order blood tests to evaluate the levels of certain tumor markers that can indicate testicular cancer. These substances are normally present in the body but can be elevated in certain cancers.

The common markers include:

• Alpha-fetoprotein (AFP): Elevated in 60–70% of non-seminoma cases, but not in seminomas. Elevated AFP levels often suggest the tumor is not a pure seminoma. However, AFP can also be elevated in liver disease or genetic conditions causing persistent mild elevation.
• Beta-human chorionic gonadotropin (beta-hCG): Can be raised in both seminomas and non-seminomas. Higher levels (over 1,000 IU/L) typically point to non-seminoma. False positives can occur with marijuana use or hormonal disorders.
• Lactate dehydrogenase (LDH): A general marker used to gauge tumor burden or guide chemotherapy for metastatic non-seminoma. It’s not specific to testicular cancer.

It’s important to note that many patients with seminoma and some with non-seminoma may not have elevated markers. These blood tests are conducted before any biopsy is performed.

Imaging Scans

• CECT Abdomen: This scan is performed to assess the abdominal region, identify the tumor’s presence and size, and evaluate surrounding lymph nodes.
• Chest X-ray: Useful for identifying spread of cancer to the lungs. It’s often the first imaging test performed due to lower radiation exposure.
• CECT Chest: Recommended if lung nodules are detected on the X-ray or if there's suspicion of lung metastasis.

Orchidectomy (Surgical Testicle Removal)

The removal of the affected testicle is a key step in diagnosing and treating testicular cancer. The excised testicle is examined in a lab to confirm cancer type. Unlike most cancers, a needle biopsy is not done on the testicle due to the risk of spreading cancer cells through the lymphatic system.

There is currently no known method to prevent testicular cancer. However, early detection significantly improves outcomes. Regular monthly testicular self-examinations (TSE) are recommended.

TSE can be done during or after a warm shower or bath when the scrotum is relaxed. Using both hands, hold each testicle between the thumbs and fingers and gently roll it. It’s normal for one testicle to be slightly larger or hang lower than the other.

During the exam, locate the epididymis — a soft, tube-like structure on the back and top of the testicle — and don’t mistake it for a lump. Be alert for any hard lumps, usually painless and about the size of a pea or larger. If any irregularities are found, consult a doctor immediately.

When to See a Specialist

If you experience symptoms such as a lump, swelling, or size change in one or both testicles, it’s advisable to consult a medical professional. The following specialists can help in diagnosis and treatment:

• General Physician
• General Surgeon
• Urologist
• Oncologist

Management of testicular cancer depends on its type and stage, as well as the patient’s general health and preferences. The TNM staging system is used:

• Stage I: Cancer is confined to the testicle.
• Stage II: Cancer has spread to abdominal lymph nodes.
• Stage III: Cancer has metastasized to distant organs like the lungs, liver, brain, or bones.

The “S” category is added to reflect levels of serum tumor markers (AFP, beta-hCG, and LDH).

Surgical Treatment

• Radical Inguinal Orchiectomy: This is the first-line treatment. The testicle is removed through an incision in the groin. A prosthetic testicle may be placed for cosmetic purposes. For early-stage cancer, surgery alone may be curative.
• Retroperitoneal Lymph Node Dissection (RPLND): This procedure involves removing abdominal lymph nodes through a larger incision. Nerve-sparing techniques are used when possible, but nerve damage may cause ejaculation issues, although erections are generally unaffected.

If surgery is the only treatment required, the doctor will schedule regular follow-ups with blood tests and scans to monitor for recurrence.

Radiation Therapy

This technique uses focused high-energy beams to destroy cancer cells and is mostly used for seminoma cases. Radiation may follow surgery to reduce recurrence risk. Common side effects include fatigue, nausea, skin irritation in the treated area, and temporary reduction in sperm count. Sperm banking may be considered prior to therapy.

Chemotherapy

Chemotherapy involves the use of powerful drugs to eliminate cancer cells that may have spread. It may be administered before or after surgery, depending on the cancer stage.

Typical chemotherapy agents include:

• Bleomycin
• Cisplatin
• Etoposide
• Ifosfamide

Tumor markers are tracked during treatment and often return to normal by its completion. Side effects may include bone marrow suppression, hair loss, nausea, and in some cases, lung damage from bleomycin. Your doctor can help manage these effects and discuss fertility preservation options.

Bone Marrow Transplant

Also called stem cell transplant, this advanced therapy involves harvesting the patient’s bone marrow, treating it to destroy cancer cells, and freezing it. After high-dose chemotherapy or radiation to wipe out any remaining marrow, the saved marrow is reintroduced into the body to help restore healthy bone marrow function.

If left untreated, testicular cancer may lead to a variety of complications:

Hormonal Imbalance

• In some instances, testicular cancer may result in elevated levels of human chorionic gonadotropin (hCG), commonly known as the "pregnancy hormone." High hCG levels can cause breast tissue to enlarge in men, a condition known as gynecomastia. Other types of testicular cancers may also result in increased estrogen production, contributing to this condition.

Cancer Metastasis

• Delaying diagnosis and treatment of testicular cancer can result in the disease spreading from its origin to other areas of the body. These secondary growths, or metastases, may trigger various symptoms depending on their location. Symptoms could include back pain, swollen lymph nodes, or swelling and pain in the legs. Metastasis often begins in the retroperitoneum and may eventually reach the lungs—leading to breathing difficulties, chronic coughing, or coughing up blood—or even the brain, resulting in confusion or headaches.

Long-term Effects of Chemotherapy

• Patients undergoing cisplatin-based chemotherapy are more susceptible to conditions such as high blood pressure, abnormal lipid levels, metabolic syndrome, and cardiovascular issues. High cumulative doses of etoposide may also increase the risk of developing other cancers, including acute myeloid leukemia (AML), typically a few years after treatment concludes.

While standard medical treatment is necessary for managing testicular cancer, some patients find that complementary therapies help ease treatment-related side effects.

Acupuncture

• Acupuncture has been found to be beneficial for individuals experiencing testicular pain. The therapy involves inserting thin needles at specific body points and can also be helpful for conditions like epididymitis.

Aromatherapy

• Using essential oils during massages, aromatherapy can create a calming environment for cancer patients. Many find it useful for managing stress and improving relaxation during cancer treatment.

Recovery following an orchiectomy, a procedure to remove the affected testicle, typically takes anywhere from two weeks to two months. During this period, adhering strictly to your doctor’s post-surgery instructions is crucial.

Patients are generally advised not to lift objects heavier than ten pounds during the initial recovery phase. Engaging in sexual activity is also discouraged until full recovery is achieved. High-impact physical activities such as running, exercising, or participating in sports should be postponed for approximately four weeks following the operation.

Routine follow-up appointments are essential to monitor for any recurrence of testicular cancer. Although it is uncommon, cancer can reappear or affect the other testicle. Hence, keeping up with follow-up visits and learning how to conduct self-examinations is important. The length and frequency of these follow-ups will depend on your diagnosis and how the condition is expected to progress.

Receiving a diagnosis of testicular cancer can be emotionally challenging. Many men report a decline in life quality and may feel embarrassed about issues like low sperm count or difficulty ejaculating. However, prompt diagnosis and effective treatment can help alleviate many of these symptoms.

Educate Yourself

Understanding your condition can help you make more informed decisions regarding your treatment. Make a list of questions to ask during medical appointments and read from trustworthy sources to gain clarity on your options.

Prioritize Self-Care

Preparing your body for treatment requires adequate self-care. Maintain a well-balanced diet, increase your intake of fruits and vegetables, get enough sleep, and reduce stress through techniques like meditation. Discuss preparation strategies with your doctor.

Join a Support Network

Despite having supportive friends or family, testicular cancer can feel isolating. Connecting with others who have been through similar experiences through online or local support groups can offer comfort and practical insights.

Lean on Loved Ones

Cancer treatment, especially chemotherapy, can be exhausting. Don’t hesitate to accept help from friends or family for transportation to appointments or simply for emotional support during your treatment journey.