What is Testicular Cancer and what are the symptoms?
Testicles are male reproductive organs that make sperm and testosterone, and are located within the scrotum. Testicular cancer occurs when cancer cells develop within one or both of the testicles. There are different types of testicular cancer, but 95% of all cases develop from germ cells, which are the cells that eventually develop into sperm cells. These are further divided into two major forms of germ cell cancer—nonseminomatous germ cell tumors and seminomatous tumors. The only undisputable risk factor for testicular cancer, other than being a young male, is having a history of cryptorchidism, which is undescended or partially descended testes.
Regardless of the type, the first symptom that generally develops is a painless lump in the scrotum. This may also be accompanied by scrotal swelling. Occasionally, someone with testicular cancer may complain of a dull ache or sensation of fullness, but only 10% of patients first seek medical care because of pain. Another sign may be that a previously smaller testicle has enlarged to normal size.
How is it Diagnosed?
Anyone who finds a lump, swelling, or has testicular pain should consult your doctor. A urologist has the expert knowledge and skills to evaluate the source of your symptoms. Initially, a testicular ultrasound, which uses sound waves to measure size and characteristics of the testicle and the lump, can determine if this is a solid mass or something filled with fluid, and if it inside or outside of the testicle. Tumors are solid and testicular cancer is always within the testicle. While a positive ultrasound will not be enough proof to diagnose cancer, it can be highly suggestive. At this point, a procedure called an orchiectomy, which is complete removal of the testicle for biopsy, will be recommended. This is the only way to make a definitive diagnosis of testicular cancer.
Staging of the tumor describes the extent of the tumor, and whether it has spread. Stage one testicular cancer is only in the testicle, stage two has spread to surrounding structures and lymph nodes, and stage three had spread to other organs. CT scans will be necessary to evaluate the stage of the illness. There are also a number of blood tests to look for markers associated with testicular cancer. The three tests are alpha fetoprotein (AFP), beta human chorionic gonadotropin (beta-hCG) and lactate dehydrogenase (LDH). The higher the levels, the worse the disease generally is.
People who have stage one cancer are always considered to have a good prognosis (or expect a good chance of recovery). Stage 2 and 3 are generally evaluated further for prognostic classifications. The different classifications are “good prognosis”, “intermediate prognosis”, and “poor prognosis”. The things that determine where one might fall in this spectrum include type of tumor, location of the tumor, stage of the tumor, the levels of tumor markers and if or where it has metastasized (spread).
What is the Treatment?
Treatment (and diagnosis) of all types of testicular cancer begins with a radical inguinal orchiectomy. The entire testicle is removed. An artificial testicle can be implanted to preserve appearance. Because this procedure results in a very high incidence of infertility, it is recommended that sperm banking be done prior to any surgery, and any radiological testing.
Chemotherapy, which is medicine that targets and kills fast growing cells, will often be utilized in addition to surgery. Cancer cells are fast-growing, however other cells such as those in your gut, hair, and bone marrow will also be affected. This is the reason for many of the side effects associated with chemotherapy, such as hair loss and nausea.
Because the most common area for spread of testicular cancer is in the back of the abdomen, some men will undergo surgery to remove these lymph nodes. This procedure requires the intervention of a surgeon with specialized training. An alternative to surgery is watchful waiting through periodic cat scans.
Radiation therapy is another form of treatment for testicular cancer. This entails the targeting of cancer cells with high doses of radiation. It is effective because cancer cells are unable to repair the damage from X-rays, especially if in high doses, over several days. It is administered by exposure to an external beam that is directed at the lymph nodes of the pelvis, not the testicle. However, there is a risk of impaired fertility as well as other cancers and heart disease. This type of treatment is usually used for older men, particularly those who cannot tolerate chemotherapy.
Finally, some men with small stage 1 cancers are candidates for surveillance, which means watching for recurrence. This would entail a physical exam, blood tests and X-rays or CTs every few months, for 3 to 4 years. After that, the visits can be less frequent, but will continue for at least 10 years.
In summary, while testicular cancer is the most common cancer found in younger men, the prognosis is generally very good. The best way to protect yourself is to perform routine, monthly self-exams while in the shower. If you find anything abnormal, including a lump, swelling, or tenderness (or if you experience a new feeling of pelvic or lower abdominal fullness), it is important to seek medical attention right away. The education and training of a board-certified urologist makes him or her the ideal provider to guide you through both diagnosis and treatment of potential testicular cancer.
If you have any further questions regarding testicular cancer, or any other urological concerns, please call Ironwood Urology at (480) 961-2323 to learn more, or request an appointment online.