Testicular cancer

Symptoms Of Testicular Cancer

Testicular cancer can cause several symptoms that affect your health. It is possible to experience more than one symptom at the same time. 

• Feeling a lump or swelling in either testicle 

• Feeling of heaviness in the scrotum

• Collection of fluid in the scrotum

• Experiencing pain or discomfort in one testicle or the scrotum 

• Testicular atrophy (shrinking of the testicles)

• Experiencing a dull ache in the abdomen or groin region

• Enlargement or tenderness of the breasts 

• Lower back pain

• Swelling of one or both legs or shortness of breath due to a blood clot. For some young or middle-aged men, developing a blood clot may be the first sign of testicular cancer

• Shortness of breath, chest pain, and blood in sputum or phlegm can be symptoms of later stage of testicular cancer due to spread to lungs

• Headaches and confusion in case the tumour spreads to the brain

Here are some common signs and symptoms that could be suggestive of cancer.
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Types Of Testicular Cancer

There are two types of testicular cancer:

• Seminoma: This kind of tumour occurs in all age groups. In the case of the elderly who develop testicular cancer, the cell type is more likely to be seminoma. In general, seminomas do not tend to be as aggressive as a nonseminoma. They are usually limited to the testicles and are less likely to spread to other parts of the body.

• Nonseminoma: Nonsemina is a tumour that has a tendency to develop in the earlier stages of life. Later it grows in size and spreads rapidly in the body. Nonseminoma tumours tend to involve the lymph nodes. There are different types of non-seminoma tumours including embryonal carcinoma, yolk sac tumour, choriocarcinoma, and teratoma. 

Causes Of Testicular Cancer

It's not exactly clear what leads to the development of testicular cancer. Typically, healthy cells in our body undergo division and growth to maintain optimal body function. However, sometimes these cells may develop some abnormalities. Such mutations can cause the previous healthy cells to start diving and growing out of control. These cancerous cells continue dividing despite the body not needing them. 

Slowly these cancerous cells start getting accumulated and start taking the space and nutrients available for healthy cells. This results in a cancerous mass that can be felt as a lump in the testicle. There are some particular cells in the testicles that produce immature sperm. 

Some researchers have found that most testicular cancer cells have an extra pair of chromosome number 12. They have also detected the presence of some other chromosomes or an abnormal number of chromosomes in some testicular cancers. 

Experts are studying these chromosomes and the DNA further to find more about the genes that get affected and lead to the development of testicular cancer. 

Risk Factors For Testicular Cancer

The following factors are associated with a high risk of testicular cancer.

• Age group of 15 to 44 years

• Failure of testicle to descend from the abdomen into the scrotum (cryptorchidism)

• Personal history of a testicular cancer 

• Family history of a testicular cancer

• Incidence is highest in white race, most rapidly increasing in Hispanic population and lowest amongst African-american individuals

• Infertility or having difficulty conceiving a baby

• Abnormal testicular development in conditions like Klinefelter syndrome

• Congenital defects like hypospadias (abnormality of the penis) and inguinal hernia (a lump in the groin)

• Issues before birth related to mother’s pregnancy such as abnormal bleeding and estrogen, or hormone therapy

• HIV infection or AIDS

Diagnosis Of Testicular Cancer

Your doctor will consider your symptoms and carry out some tests to rule out the diseases that mimic the symptoms of testicular cancer. In several cases, men are able to discover the presence of testicular cancer by themselves when they unintentionally discover a lump in their testicles. Your doctor can determine whether a lump is cancerous or not. 

1. Clinical examination

• Your doctor will perform an examination of affected testis and the contralateral normal testis to look for any abnormality. Many tumours will have a hard consistency, while some tumours may show testicular atrophy. 

• The doctor will also examine the abdomen, neck, upper chest, armpits, and groin for any evidence of enlarged lymph nodes, to evaluate any spread of  cancer.

• The breasts and nipples are also examined for any growth.

• The legs are examined for swelling from blood clots in veins in the legs, pelvis, or abdomen.

2. Ultrasound 

A testicular ultrasound is an examination modality that uses sound waves that helps in creating an image of the scrotum and testicles. A doctor or health provider uses a handheld probe and moves it over the scrotum to take the ultrasound. This in turn creates a digital image on the screen that can be viewed by the doctor. An ultrasound test helps in determining the size, nature, location of the lump and identifying whether the lump is filled with fluid or is solid in nature. It will also help your doctor determine the presence of lumps inside or outside the testicle. 

3. Blood tests

Your health provider may also request some blood tests depending on your signs and symptoms. This will help in determining the levels of tumour markers present in the blood. Tumour markers are compounds that normally occur in the body. But, in the case of certain ailments such as testicular cancer, these markers are elevated in the blood. The final diagnosis will be given by your doctor based on your results and other tests. 

Bloods tests to measure the levels of tumour markers such as serum alpha-fetoprotein (AFP), lactate dehydrogenase (LDH) and beta-human chorionic gonadotropin (beta-hCG) are recommended in patients suspected of testicular cancer. 

• AFP is elevated in 60-70% of patients with non seminoma. AFP is not produced by seminomas, hence an increased level of AFP is a sign that the tumour is not a pure seminoma.  A falsely elevated AFP may be seen in patients with liver disease or a condition called hereditary persistence of AFP in which patients may have baseline AFP levels that are mildly elevated.

• Beta- hCG may be elevated in both non seminomas and seminomas. However, beta-hCG levels above 1,000 IU/L generally indicate that the cancer is a non-seminoma and not a seminoma. False positive elevation of hCG may be seen secondary to hypogonadism or use of marijuana. 

• LDH is a nonspecific marker mainly used to help in the assessment of how much chemotherapy to give for metastatic non-seminoma. Many other cancers and non-cancerous conditions can increase LDH levels and it is not used to diagnose testicular cancer in particular.

Although elevation of serum tumour markers support the diagnosis of a testicular cancer, it should be remembered that most patients with seminoma and upto a third of patients with non seminomas do not have elevated levels. 

The levels of these markers are measured before a biopsy is taken that helps in determining testicular cancer. 

4. Imaging tests

• CECT abdomen: It is usually done for the evaluation of the  abdominal area. Presence, size and location of a tumour along with associated lymph nodes can be evaluated.

• Chest X-ray: A chest x-ray is used to ascertain any metastasis to the lungs. If a more detailed picture of the lungs is needed, the doctor may recommend a CECT of the chest. However, in many cases, an x-ray is preferred as it uses less radiation.

• CECT chest: It should be performed in case of metastasis to the lung or if lung nodules are identified on chest x-ray.

5. Surgical removal of testicle (orchidectomy or orchiectomy) 

Surgical removal of the affected testicle is done to examine it in the laboratory. In most cases, only one testicle is removed, as both testicles are rarely affected by cancer at the same time.

For most types of cancer, a biopsy is done by removing and examining some tissue from the tumour. However, biopsy from the testicle is not done because it has a risk of causing the cancer cells to spread to the lymph nodes.

Wondering which doctor to visit for male health problems? Here’s everything about different male health specialists and what they do.
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Prevention Of Testicular Cancer

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Unfortunately, currently, researchers have not found a way to prevent testicular cancer. However, early diagnosis can prevent the spread of cancer and present a good prognosis. Men are advised to perform a testicular self-examination (TSE) once a month. 

• Performing a TSE can be done while taking a shower or warm bath. A warm bath will help the scrotum to relax, making it easier for you to detect the presence of unusual lumps. 

• To do the examination, use both of your hands to examine each testicle. Use your index and middle fingers and place them underneath your testicles while placing your thumb on the top. 

• Now gently roll each testicle between your fingers and thumb. Your testicles can feel different in size which is quite normal. As you move your testicles between your fingers lookout for the epididymis. This structure is a tube that stores and transports sperm and feels like a cord on the top and back of your testicle. Do not confuse it with a lump. 

• You will be able to feel the presence of lumps since they can be the size of peas or bigger in size. They are often painless in nature. 

• In case you feel a lump or observe a change in the size of your testicle, contact your doctor for a medical opinion.

Specialist To Visit

You should visit a doctor if you are experiencing symptoms such as a lump in your testicles, swelling of a testicle or increase in the size of the testicle. These symptoms might indicate the possibility of testicular cancer. You can consult the following doctors for diagnosis:

• General physician 

• General surgeon

• Urologist 

• Oncologist

If you are a bit reluctant to visit a doctor personally, you can even consult a doctor online.
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Treatment Of Testicular Cancer

Testicular cancer can be treated based on the type and staging of cancer. It also depends on several other factors that include your overall health and personal preferences. There are several ways through which testicular cancer can be managed and treated. 

The staging of testicular cancer is based upon understanding the pattern of spread. One staging classification that is used is the TNM system:

• Stage I: Tumour (T) is limited to the testis

• Stage II: Tumour has spread to the lymph nodes (N) in the back of the abdomen (retroperitoneum)

• Stage III: Metastasis (M) of the cancer has happened, i.e. it has spread to other parts of the body such as lungs, liver, brains, and bone.

For testicular cancer, an S is also added to the TNM system. Serum tumour marker (S) indicates any elevation of serum tumour markers like AFP, beta-hCG, and LDH.

1. Surgery 

Radical inguinal orchiectomy: It is the foremost treatment option for testicular cancer at nearly all stages and types. This procedure is done by a surgeon who will make an incision in the groin region and remove the involved testicle through the opening. According to your choice, a prosthetic and saline-filled testicle can be inserted into the scrotum to make up for the removed testicle. In the early stages of testicular cancer, this surgery can be enough and often the only treatment needed for testicular cancer. 

Retroperitoneal lymph node dissection: It is another surgery that is done by making an incision in your abdomen. In this surgery, your surgeon will do their best to avoid injuring nerves that surround lymph nodes. However, in some cases, it may be unavoidable and hence comes with some level of risk. Damage to the nerves can lead to difficulty with ejaculation; however that won't prevent you from having an erection. 

Sometimes surgery can be the only treatment option for testicular cancer. In such cases, your doctor will recommend a schedule of follow up appointments. These appointments are usually carried out every month for the initial few years. The frequency of the appointments decreases later and you will be required to undergo blood tests and CT scans. Your doctor may recommend other procedures that will allow them to check for signs that can indicate the return of cancer. 

2. Radiation therapy 

Radiation therapy is a treatment modality that uses high powered energy beams that work as an effective treatment to kill cancer cells. During a radiation therapy appointment, the patient is asked to lie flat on a table. A large machine that emits the energy beam moves around the body and aims the beam at precise points. Radiation therapy is often recommended for patients who have the seminoma type of testicular cancer and can also be recommended after surgery done to remove a testicle. 

Radiation therapy can lead to some side effects including nausea and fatigue. It can also cause some level of skin erythema and irritation near the abdominal and groin areas. In some cases, radiation therapy can lead to a temporary decline in the levels of sperm count and can also affect fertility. Before the radiation therapy, you can talk to your doctor about the side effects and methods of managing the same. Several men opt to preserve their sperm before beginning radiation therapy. 

3. Chemotherapy 

Chemotherapy treatment is a treatment modality that uses strong medicines that are effective in killing cancer cells. These drugs circulate around the body and aim at destroying cancer cells that may have travelled from the original tumour. According to the stage of testicular cancer, chemotherapy may be your only treatment option or a patient can be advised chemotherapy prior to or post a lymph node surgery. 

Commonly used chemotherapeutic agents in treatment of testicular cancer are:

• Bleomycin

• Cisplatin

• Etoposide

• Ifosfamide

Serum tumour markers are monitored throughout the treatment and usually normalise during or after treatment. 

Cisplatin-based chemotherapy is associated with side effects like myelosuppression (bone marrow is not able to make enough blood cells), nausea, vomiting and hair loss. Bleomycin may be associated with pulmonary fibrosis (lung tissue becomes damaged and scarred). Your doctor can recommend various medications or other treatment options that can help in managing the side effects of chemotherapy.

Talk to your doctor about the risks and benefits of the treatment and about the various options that can allow you to preserve your sperm prior to beginning chemotherapy.  

4. Bone marrow transplantation

Bone marrow transplantation, also known as stem cell transplantation, is the latest state of the art treatment modality. In this procedure, the bone marrow is taken from the patient and treated with drugs to do away with the cancer cells. The marrow is then frozen. The patient is given high-dose chemotherapy with or without radiation therapy to destroy the remaining marrow. The marrow earlier removed from the patient is thawed or warmed and injected into a vein of the patient to replace the marrow that was destroyed.

Home-care For Testicular Cancer

It generally takes about two weeks or two months to recover from an orchiectomy that allows doctors to remove the affected testicle. It is important to follow the post-op instructions given by your doctor during your recovery time. 

• You will be advised to avoid lifting anything over ten pounds for the first few weeks of the surgery.

•  You will also be asked to refrain from engaging in any kind of sexual activity until you have recovered. 

• Activities such as exercising, running or playing sports should be avoided for nearly four weeks post-surgery. 

• You will be asked to maintain a schedule of follow up appointments to minimise the risk of testicular cancer returning. There is a small risk that cancer may return or grow in the other testicle. Hence, it is vital that patients maintain follow-up appointments and learn how to perform self testicular examinations. The duration of your follow up care may alter based on your diagnosis and diseases prognosis your follow up care. 

Complications Of Testicular Cancer

Untreated testicular cancer can lead to certain complications such as:

1. Excessive female hormone 

In some cases, testicular cancer can lead to the increased production of another hormone known as human chorionic gonadotropin or hCG. This hormone is also known as the “pregnancy hormone”. In some cases, the excessive production of hCG can lead to the abnormal enlargement of breast tissue in men. This condition is known as gynecomastia. Some other types of testicular cancer can lead to the development of gynecomastia due to an increase in the levels of another female hormone known as estrogen. 

2. Metastasis or spread of cancer

There can be several complications in case testicular cancer is undiagnosed or left untreated for a long duration of time. This can result in the spread of cancer from the original tumour to other parts of the body.

The site to which the original tumour spreads is known as a secondary or metastatic tumour. In the case of metastasis, a patient can present with several symptoms based on the location of the metastatic tumour. These symptoms will include lower back pain, swollen lymph nodes, or swelling and pain in the lower extremities.

Retroperitoneum is the most commonly involved site in metastatic disease. Most blood borne metastasis occurs after the lymph node involvement. Lungs are the most common organ involved by blood borne metastasis. If the secondary tumour is present in the lungs, it can result in shortness of breath, coughing up of blood or the presence of chronic cough. Symptoms such as headaches or confusion can be seen if a secondary tumour spreads to the brain. 

3. Late effects of chemotherapy

Patients treated with cisplatin based chemotherapy have increased risk of development of hypertension, hyperlipidemia, metabolic syndrome, and cardiovascular events. Patients treated with high cumulative dose of etoposide may experience some risk of developing other cancers like acute myeloid leukaemia (AML), typically 2-3 years after therapy.

Alternative Therapies For Testicular Cancer

Testicular cancer requires orthodox medical treatment. However, some patients feel that a complementary approach via alternative therapies can help in the management of the side effects caused during the treatment. 

1. Acupuncture 

Acupuncture has proven to be a successful alternative therapy form in patients that have testicular pain. It involves the insertion of needles through the skin at specific points on the body. Acupuncture can also provide relief for patients who have epididymitis (inflammation of the epididymis present at the back of the testicle).

2. Aromatherapy 

Aromatherapy uses a mix of essential oils for massages that can make a person feel relaxed. Often patients feel that alternative therapies such as aromatherapy help them cope with the treatment of cancer and allow them to feel relaxed.  

Living With Testicular Cancer

Being diagnosed with testicular cancer can cause stress and anxiety in men. This medical condition directly affects the quality of life, and patients struggle with the concept of cancer itself. Some men also face a decreased sperm count or experience difficulty in ejaculating, leading to embarrassment. However, timely diagnosis and treatment can help you in managing the signs and symptoms linked with testicular cancer. 

Learn about testicular cancer 

Learning about testicular cancer can help you make comfortable decisions regarding your treatment choice. It is better to empower yourself with the knowledge of what’s about to happen than to fear the unknown. Pen down the questions that you would like to ask your doctor at the next appointment. You can also use reputable sources of information to read more about the condition and the treatment options available for the same. 

Take care of yourself 

Preparing for the treatment of testicular cancer can seem like a daunting task. To do so you need to take care of yourself and your body. Eat a healthy diet that is well balanced. Increase the number of fruits and vegetables you intake and get plenty of rest every night. Try to practice meditation and eliminate sources of stress from your life prior to the treatment. Talk to your doctor about strategies that can help your body prepare for the treatment. 

Join support group

Dealing with testicular cancer can be isolating even if you have friends and families. In such times it is often helpful to talk to people who have gone through the same experience. There are several support group forums available online that include cancer survivors. 

Take the help of your loved ones 

Undergoing chemotherapy can be tough. Take help from the people near you for accompanying you to the doctor's appointments or to the treatment centre. Talking to people who love you during the course of the treatment can help you cope with the fear of cancer.