Testicular Cancer Management: Symptoms, Risk Factors and Treatment

Testicular cancer, though less prevalent than other malignancies, is a dangerous illness affecting men. It arises when malignant cells form in the tissues of one or both testicles. The testicles are two walnut-shaped sex glands that generate both sperm and testosterone. They are contained in the scrotum, a skin sac found below the penis. Testicular cancer, like all other cancers, is a dangerous ailment. Fortunately, testicular cancer is very treatable and curable.

Types of testicular cancer

• Seminoma: Slow-growing cancer that typically affects people in their 40s or 50s.
• Non-seminoma: Cancer that grows faster than seminomas. It primarily affects people in their late teens, 20s, and early 30s. There are four forms of non-seminoma tumors. Each is called after the type of germ cell that forms the tumor. Non-seminoma tumors include embryonic cancer, yolk sac carcinoma, choriocarcinoma, and teratoma.

Symptoms

The signs and symptoms of testicular cancer are:

• A lump or swelling in either of the testicles
• Feeling heavy in the scrotum.
• A dull ache in your lower belly or groin
• A sudden increase in scrotum thickness
• Pain or discomfort in the testicles or scrotum
• Breast enlargement or tenderness
• Back pain

Usually, testicular cancer only occurs in one testicle.

Major risk factors for testicular cancer

Major epidemiological risk factors for testicular cancer are:

• Age: The age between 15-35 years is highly prevalent for testicular cancer.
• Undescended testicles: During fetal development, testicles form inside the abdomen and typically fall into the scrotum before birth. Undescended testicles are those that don't descend and may need surgery. Even after surgery, having this disease from birth may raise your risk of developing testicular cancer.
• Family history: If a parent or sibling has testicular cancer, you may be more likely to have it as well. Certain inherited genetic illnesses, such as Klinefelter syndrome, may also increase your risk. A testicular cancer in one testicle increases the risk of acquiring a second cancer in the other.
• Infertility: Some of the variables that cause infertility may also contribute to the development of testicular cancer. More research is needed to determine the connection.

Diagnosis and Tests

Your provider may diagnose testicular cancer after examining a lump or other alteration in your testicle discovered during a self-exam. A basic physical checkup might sometimes reveal the presence of testicular cancer. The common methods and tests used to diagnose testicular cancer include:

• Physical exam and history: Your doctor will ask about your symptoms and extensively examine you to look for indicators of testicular cancer. The doctor looks for the presence of lumps and lymph nodes.
• Ultrasound: If the doctor experiences any abnormalities in testicles during the examination, they perform ultrasound for confirmation of cancer. Ultrasound is safe for the cancer patient and provides the exact status of tissue inside the body.
• Inguinal orchiectomy and biopsy: If the ultrasound detects cancer, your doctor will remove the afflicted testicle via an incision (cut) in your groin. A doctor will examine tissue from your testicle under a microscope to check for cancer cells.

Other tests may include:

• A serum tumor marker test
• CT scans, X-rays, and MRIs

Management and Treatment

What are the treatments for testicular cancer?

The selection of treatment modalities is determined by several factors, such as overall health and tumor types. Seminomas typically grow slower and react better to radiation therapy than non-seminomas. Chemotherapy is effective in treating both kinds of testicular cancer tumors. If testicular cancer has both seminoma and non-seminoma tumors, your doctor will treat it as a non-seminoma.

Surgery

The most common therapy for testicular cancer is surgical removal of the diseased testicle, regardless of the cancer stage or tumor type. In special situations, doctors may also remove the lymph nodes.

1. Radical inguinal orchiectomy: A doctor can perform orchiectomy, i.e., removal of a diseased testicle, to treat seminoma and non-seminoma types of cancers. During the procedure, your provider will make an incision into your groin to remove the testicle with the tumor. They’ll also close off blood vessels and lymphatic tissue to prevent the spread of cancer from the tumor site to the rest of your body.
2. Retroperitoneal lymph node dissection (RPLND): Depending on the stage and type of cancer you have, your doctor may conduct retroperitoneal lymph node dissection. RPLND is more prevalent in non-seminoma testicular tumors. During the operation, your provider will create an incision in your belly and remove the lymph nodes located behind your abdominal organs. RPLND may be used to treat and stage cancer.

Your provider may also perform surgery to remove tumors that have spread to your lungs or liver.

• Radiation therapy uses high doses of X-rays to kill cancer cells. Radiation may be administered following surgery to prevent the tumor from returning. Radiation is mostly exclusively used to treat seminoma.
• Cisplatin, bleomycin, and etoposide are examples of chemotherapy medications that are used to kill cancer cells. Chemotherapy has increased survival rates for persons with seminomas and non-seminomas. Depending on your malignancy, you may be treated with chemotherapy rather than surgery. It can be administered before an RPLND operation or after a radical inguinal orchiectomy. Chemotherapy can also be used to treat cancer that has recurred after being in remission.

Prevention

Testicular cancer cannot be prevented, but you can perform testicular self-exams (TSE) to identify changes in your testicles that you should report to your doctor. Your provider should be aware of any lumps, nodules, hardness, or a testicle that has grown larger or smaller. TSEs can be completed in as little as two minutes. Many doctors recommend that you perform a testicular self-exam once a month.

You can follow the below steps to self-examination.

• Do the examination after a warm shower or bath.
• Use both hands to examine each testicle.
• Understand what is usual.
• Feel for any lumps.

If you notice a change in the size of your testicles or feel a lump, consult your doctor.

Conclusion

Testicular cancer is curable if detected in an early stage. A painless lump or swelling is the main symptom of testicular cancer. Early detection of risk factors such as undescended testicles, family history and other specific disorders helps with cancer treatment and identification of high-risk individuals. Surgery, radiation, chemotherapy and monitoring are all successful treatment options, with over 95% of patients surviving for more than five years when diagnosed early. Early detection and effective treatment require regular self-checks and consultation with health professionals.