Testicular Cancer

Testicular Cancer

Testicular cancer is a type of cancer that develops in the testicles, which are the male reproductive glands located in the scrotum. Testicular cancer is relatively rare but is the most common cancer in young men aged 15-35 years. 

The exact causes of testicular cancer are unknown, but certain risk factors, such as a family history of the disease, undescended testicles, and HIV infection, have been identified.

Types of Testicular Cancer

There are several types of testicular cancer, including:

1. Seminoma: This is the most common type of testicular cancer, accounting for around 50% of all cases. It arises from germ cells in the testicles and typically affects men in their 30s and 40s.
2. Non-seminoma: This type of testicular cancer includes several subtypes, such as embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma. Non-seminomas tend to be more aggressive than seminomas and are typically diagnosed in men in their late teens or early 20s.
3. Mixed germ cell tumors: These are tumors that contain both seminoma and non-seminoma cells.
4. Leydig cell tumors: These are rare tumors that develop in the Leydig cells, which produce testosterone in the testicles. They are usually benign, but in some cases, they can be malignant.

Testicular Cancer

5. Sertoli cell tumors: These are also rare tumors that develop in the Sertoli cells, which support the growth of sperm cells in the testicles. They are usually benign, but in some cases, they can be malignant.

Symptoms 

The most common symptoms of testicular cancer include –

1. A lump or swelling in one or both testicles
2. A feeling of heaviness in the scrotum
3. Pain or discomfort in the testicle or scrotum
4. A build-up of fluid in the scrotum
5. A dull ache in the lower abdomen or groin area
6. Enlargement or tenderness of the breasts
7. Back pain (in advanced cases when cancer has spread)
8. Swelling of 1 or both legs

All the lumps or swelling in the testicles are cancerous. Many symptoms and signs of a non-cancerous condition are also witnessed including –

• Cyst or a benign tumor. 
• Enlargement of the blood vessels from the testicle 
• A buildup of fluid in the membrane 
• An opening in the abdominal muscle is called a hernia.
• Infection of the testicles and epididymis

Diagnosis 

To diagnose testicular cancer, a healthcare provider will typically perform a physical examination of the testicles, scrotum, and groin area. The provider will also ask about any symptoms you may be experiencing, as well as your medical and family history. If testicular cancer is suspected, one or more of the following tests may be recommended:

1. Physical Examination – a healthcare provider will examine the testicles for any lumps, swelling, or changes in size or shape. If a lump or abnormality is detected, further tests may be ordered.
2. Ultrasound – This imaging test uses high-frequency sound waves to create images of the testicles and scrotum, which can help detect any abnormalities.
3. Blood tests – Blood tests can be used to check for certain proteins and tumor markers that may indicate the presence of testicular cancer.

If testicular cancer is diagnosed, additional tests may be done to determine the extent, or stage, of cancer and whether it has spread to other parts of the body. These tests may include chest X-rays, CT scans, and MRI scans. The results of these tests will help healthcare providers develop a treatment plan tailored to your specific needs.

Other Tests 

If the cancer is detected, then other tests may be used to diagnose testicular cancer include –

1. CT scan – This test uses X-rays and computer technology to create detailed images of the inside of the body. A scan will also help in determining the tumor’s size. It will evaluate tumors in the abdomen, pelvis, chest/lungs, brain, and other areas.
2. Magnetic resonance imaging (MRI) scan – This test uses a strong magnetic field and radio waves to create images of the inside of the body. MRI scans have recently begun to be used as an alternative to CT scans for imaging the abdomen and pelvis in patients who prefer to avoid CT scans. MRI scan is a preferable choice for scanning the brain or spine.
3. Positron emission tomography (PET) scan – This test uses a small amount of radioactive material to highlight areas of the body where cancer may be present. In this procedure, a radioactive sugar substance is injected into the body to determine the location of cancer cells in the body. 
4. Chest X-ray: This test can help determine if cancer has spread to the lungs. It also helps in identifying the stage of cancer for follow-up screening.
5. Biopsy: In some cases, a biopsy may be needed to confirm the diagnosis of testicular cancer. It is a surgical procedure in which a small amount of tissue is removed for examination under a microscope. In testicular cancer, tissue is removed from the lungs, retroperitoneum, or other locations in the body to find the growth and spread of cancer. 

It’s important to note that not all of these tests are necessary for every case of testicular cancer. The specific tests used will depend on the individual case and the recommendations of the healthcare provider.

Stages

Testicular cancer is staged based on the size of the tumor, whether it has spread to nearby lymph nodes, and whether it has metastasized (spread) to other parts of the body.

The stages of testicular cancer are:

1. Stage I: The cancer is confined to the testicle and has not spread to lymph nodes or other parts of the body.

• Stage 1A: The cancer is limited to the testicle and the tumor is less than or equal to 2 centimeters in size.
• Stage 1B: The cancer is limited to the testicle and the tumor is larger than 2 centimeters in size.

2. Stage II: Cancer has spread to nearby lymph nodes, but has not spread to other parts of the body.

• Stage IIA: The cancer is spread to the lymph nodes in the abdomen or pelvis on the same side as the affected testicle.
• Stage IIB: The cancer is spread to the lymph nodes above the diaphragm (the muscle that separates the chest from the abdomen) on the same side as the affected testicle.

3. Stage III: Cancer has spread to distant lymph nodes or other parts of the body, such as the lungs or liver.

Within stage III, there are further sub-stages that provide more specific information about the extent of cancer. These sub-stages are:

• Stage IIIA: The cancer is spread to distant lymph nodes or organs, but the tumor markers in the blood are within normal limits.
• Stage IIIB: The cancer is spread to distant lymph nodes or organs, and the tumor markers in the blood are elevated.
• Stage IIIC: The cancer is spread to distant lymph nodes or organs, and there are large tumors in the abdomen.

Determining the stage of testicular cancer is important in order to determine the best course of treatment. Treatment options may include surgery, radiation therapy, chemotherapy, or a combination of these treatments.

Treatments

The treatment for testicular cancer depends on the stage and type of cancer, as well as the patient’s overall health and preferences. The primary treatments for testicular cancer include:

1. Surgery: The standard treatment for testicular cancer is surgery to remove the affected testicle, a procedure known as a radical inguinal orchiectomy. This is often the first step in treating testicular cancer, and it may be the only treatment needed for some early-stage tumors.
2. Radiation therapy: Radiation therapy uses high-energy beams of radiation to kill cancer cells. It may be used after surgery to treat any cancer cells that may remain in the body, or it may be used to treat tumors that are not surgically removable.
3. Chemotherapy: Chemotherapy uses drugs to kill cancer cells throughout the body. It may be used after surgery to treat any remaining cancer cells, or it may be used as the primary treatment for more advanced cancers.
4. Surveillance: In some cases, especially for early-stage testicular cancer, a “wait and see” approach may be recommended, in which the patient is closely monitored with regular physical exams, blood tests, and imaging studies to detect any signs of cancer recurrence or spread.

Other treatments, such as targeted therapy or immunotherapy, may also be used in some cases, particularly for more advanced or aggressive cancers.

The specific treatment plan for testicular cancer will depend on the type and stage of cancer, as well as other factors such as the patient’s age, overall health, and preferences. It’s important to work closely with a healthcare provider with expertise in the treatment of testicular cancer to determine the best course of action.