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Testicular Cancer

Testicular cancer

Introduction

The testicles are a pair of sex organs located inside the scrotum, located under the penis. The testicles or gonads store sperm and produce male sex hormones such as testosterone and dihydrotestosterone. Testicular cancer develops in the testicles when testicular cells in one or both the testicles divide uncontrollably and become malignant.

Testicular cancer is rare and typically affects adolescent males and adults under the age of 50.

Cause

Germ cells present in the testicles give rise to sperm. In the majority of testicular cancers, germ cells develop abnormalities and start to proliferate unchecked, eventually becoming a cancerous mass. It is not entirely known what causes healthy testicular cells to become cancerous. Germ cell testicular cancers are of two main types. A little less than half of testicular cancers are termed seminomas; the rest are non-seminomas. Non-seminomas include terratomas, embryonic carcinomas, choriocarcinoma and yolk sac tumors. Seminomas are not considered as aggressive as non-seminomas.

Other types of testicular cancers are even rarer and originate in cells other than germ cells. These include leydig cell tumors or interstitial cell tumors, sertoli cell tumors and lymphomas.

Risk Factors:

  1. Cryptorchidism (Undescended testes): Normally, the testes formed during fetal development descend into the scrotum during birth. When they fail to descend, the condition is called cryptorchidism and has been linked to an increased risk of testicular cancer. Surgically moving the testicle into the scrotum does not eliminate risk.
  2. A family history of testicular cancer makes one more likely to develop the disease.
  3. Having testicular cancer in one testicle increases the chances of the cancer spreading to the other testicle.
  4. Congenital abnormalities that result in abnormal development of testicles or kidneys and penile abnormalities may increase risk of testicular cancer.
  5. HIV infection and AIDS is also linked to greater risk of testicular cancer.
  6. Although men of all races are susceptible to the cancer, caucasian man are considered relatively high risk.
  7. Certain pesticides, coolant, polychlorinated biphenyls and dibutyl phthalate can increase testicular cancer risk.
  8. Some studies show that there is a correlation between height and testicular cancer risk. This is thought to be because of the cancer risk associated with high calorie diets typically fed to tall children.

 

Clinical Presentation

Signs and symptoms of testicular cancer include:

  1. Enlargement or swelling of the testicle
  2. Heaviness in the scrotum
  3. Fluid in the scrotum
  4. Dull ache in the abdomen or groin area, sometimes accompanied by backaches.
  5. Discomfort or pain in the scrotum and/or testicle

Differential

Hydrocele (Accumulation of fluid in the testicle), Epididymitis, Abdominal hernias, Non-Hodgkin’s lymphoma, testicular torsion (twisting of the testicle), varicocele (enlarged testicular veins), spermatocele (sperm containing cysts on the surface of the testicle) and Orchitis (inflammation of the testes).

Diagnosis

A doctor will record a patient’s medical history first, to check for any family history of cancer. A physical exam is done to detect lumps or swelling in the testicles. In fact in many cases men may discover the tell tale signs of testicular cancer during a testicular self-examination. A biopsy may be performed to detect malignancy of the tumor. Other tests such as ultrasounds and blood tests to detect testicular tumor markers may be performed. While tumor markers are normally found in the blood, an elevation in their levels may indicate cancer.

Once cancer has been confirmed, the stage of the cancer is determined. This is done by checking for the spread of cancer in the testicle and throughout the body. Blood tests, CT scans and MRI are normally done to determine this.

Treatment

Testicular cancer is one of the most curable types of cancer. The following treatment options are available to men diagnosed with testicular cancer:

Surgery: may be performed to remove the testicle. This procedure is termed radical inguinal orchidectomy and is the first line of treatment to eliminate all types of testicular cancers and at all stages. Surgery may also be performed to remove lymph nodes to prevent spread of the cancer. This procedure is termed retroperitoneal lymph node dissection.

Radiation: is done mostly in combination with surgery. On its own, it is effective in treating seminomas. Non-seminomas are not as sensitive to radiation. Radiation therapy however, can cause infertility. Since radiation affects healthy as well as cancerous cells, it is associated with many side effects such as fatigue, nausea and diarrhea.

Chemotherapy: uses anti-cancer drugs to kill cancerous cells. It is usually done after surgery to kill off any remaining cancerous cells throughout the body. It too can lead to infertility by interfering with sperm production. Chemotherapy is associated with many side effects such as fatigue, nausea, hair loss and vomiting.

As with all cancers, even after eliminating the cancer there is a chance of remission. Therefore regular checkups are necessary and any problems detected should be treated urgently.

Prevention

Testicular cancer cannot be prevented. Therefore, early detection is the key. This may be done by performing regular testicular self-examinations and being aware of the signs and symptoms of the disease. Any suspicion of the cancer should be treated seriously and a doctor consulted.