Introduction

Testicular cancer or cancer of the testis is a cancer that occurs in the men and starts in the male gland called the testicle or testis (testes). It begins when some healthy cells in the testicle begin to change or grow abnormally, thereby creating a malignant tumor i.e., spreading to other parts of the body.

This type of cancer can affect any male person at any age (average age at diagnosis is 33 years), affecting mostly young and middle-aged men, but it is commonly found among men aged 15 to 44 years. Only 8% of testicular cancer cases occur after the age of 55 years. Due to its rare occurrence among the male species, testicular cancer is quite treatable, and with early diagnosis, it can be cured.

Signs and Symptoms of Testicular Cancer

Early Stages Signs and Symptoms

Symptoms of testicular cancer often appear at an early stage, but sometimes, they do not appear until much later; these symptoms can include:

• Lump or swelling of the testicles
• Dull ache in the lower abdomen
• Several forms of discomfort, pain, or numbness in the testicle or scrotum, either with or without swelling
• Sudden buildup of fluids in the scrotum
• Early puberty in boys

Advanced Cancer of The Testicles Signs and Symptoms

When testicular cancer spreads to other parts of the body, these symptoms can occur:

• Lower back pain
• Headaches
• Shortness of breath, chest pain, or a cough
• Swelling of the belly.
• Swelling of one or both legs which could have been caused by a blood clot in some vein.

What Causes Testicular Cancer?

Although the exact cause of testicular cancer is relatively unknown, certain factors may increase a person’s risk of having testicular cancer. These factors are referred to as risk factors.

Testicular Cancer Risk Factors

Certain risk factors for testicular cancer have been identified, including the following, which can be viewed as either unchangeable (general risk factors and genetics) or unchangeable factors (other conditions).

General Risk Factors (Unchangeable)

The general risk factors are usually unchangeable due to conditions that the person with testicular cancer cannot be changed.

• Gender: Testicular cancer only occurs among the male gender.
• Age: For testicular cancer, above 75% of males with this cancer are usually below the age of 44 years, with half of them occurring between the ages of 20 and 34 years. Yet, testicular cancer can occur and affect any male of any age including children and elderly men.
• Ethnicity and Race: The risk of having testicular cancer is higher in the white race than blacks.

Genetics (Unchangeable)

• Family History of Testicular Cancer: When close relatives such as an individual’s brother or father have been diagnosed with testicular cancer, there is an increased risk of a person’s being diagnosed with testicular cancer too, although approximately only 3% cases of testicular cancer occur in families.

Other Conditions (Changeable)

• Cryptorchidism (Undescended Testicles): Cryptorchidism is a medical condition where one or both testicles fail to drop from the abdomen into the scrotum before birth. This usually occurs in about 3% of males born. Testicular cancer is likely to occur in males with cryptorchidism, and it is more likely to develop in the undescended testicles. But 1 in 4 cases of testicular cancer occurs in descended testicles.
• HIV Infections: The risk of testicular cancer occurring in persons living with HIV is high according to certain medical research. It is higher in people who have developed AIDS.
• Carcinoma in Situ: This is a non-invasive cancer occurring that may progress into an invasive cancer if not properly managed. Its progress is usually discovered during a testicle biopsy because it doesn’t create any symptoms or mass tumors.
• Previous History of Testicular Cancer: Once there is a history of testicular cancer, there is an increased risk of testicular cancer occurring in the testicle other than the one it was previously found.

Prevention of Testicular Cancer

Preventing testicular cancer is currently not possible due to its unknown reversible causes. Moreover, many men who have been diagnosed with testicular cancer have no known risk factors, and those with known risk factors, such as undescended testicles, age, and family history, cannot be changed. However, with early detection one can prevent further advancement or spread of testicular cancer cells, by prompt treatment.

How Is Testicular Cancer Diagnosed?

Testicular cancer can be diagnosed through:

Self-Examination

This is done by examining the testicles during or after a bath or shower when the skin of the scrotum is relaxed or warm. This can be done by:

• Holding the penis out of the way, then examine each testicle separately
• Holding the testicles between the thumbs use the finger with both hands, and roll it gently between the fingers
• Feel the testicles to notice any form of lumps or nodules, changes in size, shape, or any form of difference in the testicles.

Though it is normal for a testicle to be slightly larger than the other, or for one testicle to hang lower than the other, one should always report any form of changes noticed to a medical doctor.

Physical Examination

In this form of examination, the testicles are felt for any form of swelling, tenderness, or hardening. The abdomen, neck, armpits, and upper chest for any form of enlarged lymph nodes in case the cancer has spread.

Ultrasound

Here, sound waves are sent to the body to show images of the inside of the body. The ultrasound helps to show any changes which can include benign conditions (such as hydrocele or varicocele) or solid tumors. When the lump is shown to be solid, it is more likely to be a cancer.

Blood Tests

Some blood tests can help diagnose testicular tumors or cancer. Testicular cancers can produce high levels of certain proteins in the body which are referred to as tumor markers such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). So, blood tests can help detect these abnormalities in the blood and help proffer a better treatment plan.

Biopsy

A biopsy is the removal of a small amount of tissue for examination under a microscope. For testicular cancer, a small amount of sample from the testicle for further investigation under a microscope. The result from the biopsy would help determine if there is a presence of testicular cancer or not.

Imaging Test

This is the use of X-rays, sound waves, and radioactive substances to create images of the internal part of the human body.

• X-rays: The X-rays create pictures of different parts of the internal part of the body especially the chest, using a small amount of radiation. When X-rays are done on the chest, it is used to determine the stage of the cancer; to know if the cancer has spread to the chest, and also for follow-up screening.
• Computed Tomography (CT) Scan: Just like X-rays, the CT scan sends various pictures of the body but from different angles. It is usually used to know the stage or extent of the cancer by showing if testicular cancer might have spread to the lymph nodes, lungs, liver, or other organs.
• Magnetic Resonance Imaging (MRI) Scan: An MRI scan uses a magnetic field to create images of the inside of the body, and it can determine the size of the tumor. Generally, an MRI scan is used to examine the brain and the spinal cord of the body, but when medical doctors have reasons to believe that testicular cancer might have spread to the brain or the spinal cord; they also make use of an MRI scan.
• Positron Emission Tomography (PET) Scan: Generally, PET scan is not used for the diagnosing of testicular cancer except when combined with CT scans. A PET scan helps spot cancer cells in the body. It is used to see if testicular cancer might have spread to the lymph nodes that are still enlarged after chemotherapy.
• Bone Scan: A bone scan is used to show if there is any presence of cancer in the bones, especially if there is a reason to think testicular cancer has spread to the bone due to symptoms such as bone pain, or probably if other forms of test result show no clarity.

Treatment of Testicular Cancer

Treatment of testicular cancer usually involves one or the combination of the following:

Surgery

For testicular cancer, one or both testicles are usually removed to prevent the tumor from spreading. The removal of the testicle is referred to as Orchiectomy. Side effects associated with surgery include infertility (when both testicles are removed), loss of sex drive, fatigue, loss of muscle mass, and difficulties while developing erection.

Radiation Therapy

Radiation therapy can also be given as an option if testicular cancer has spread to a distant organ such as the brain. Its side effects include loss of appetite, tiredness, muscles and other joint stiffness, nausea, and rashes.

Chemotherapy

In testicular cancer, chemotherapy is usually used when the cancer cells have spread beyond the testicles, or probably when the serum tumor markers increase after surgery has been performed. Medications used during chemotherapy for testicular cancer are injected into a vein so that it can enter the bloodstream and reach cancer cells throughout the body. It is beneficial in reducing the recurrence of testicular cancer.

Side effects include nausea, vomiting, mouth sores, tiredness, feeling unwell, and loss of hair.

Surveillance

Surveillance is usually done after testicular cancer treatment has been completed and does not usually involve any form of treatment but routinely regular check-ups, physical examinations, tumor marker tests, and imaging tests. This helps to know and check for signs if testicular cancer has re-occurred.

NOTE: All side effects that occur after each treatment option usually stop once each treatment plan has been completed.

Treatment for Children

Testicular tumors are quite rare in children but they can be found; and if diagnosed early, treatment is always successful. But when these tumors have spread, treating them tends to be more difficult.

The most common treatment plan for children includes:

• Total Orchiectomy: This is the total removal of the testis once a biopsy reveals the presence of cancer. This is usually done when there are high tumor markers; a large tumor; and tumors found during puberty.
• Testis Sparing Surgery (TSS): For this treatment option, most patients are given a chance to choose a particular option especially when there are signs that the tumor might be benign.
• Inguinal Exploration: This is a type of surgery where a part of the skin near the public bone around the scrotum is cut and the testicles are then guided out of the scrotum. This is usually done to a child with a testicular tumor.
• Other treatment options such as radiation therapy, and chemotherapy are done when the tumor or cancer tends to be more aggressive.

After treatment is completed, most children are observed for at least two (2) years with different physical examinations, tumor markers, and imaging tests. Most boys treated for testicular cancer usually end up healthy and can have children when they grow up.