Testicular cancer or cancer of the testis occurs when cancer cells form in one or both testicles. These cells begin to change and grow uncontrollably, forming a mass or tumor. The cells can also invade the blood stream and lymph system and spread, leading to tumors in other areas of the body called metastases.
Most often testicular cancer is detected as a painless lump in one of the testicles. Testicular cancer is highly treatable and one of the most curable forms of cancer. It is especially important to detect testicular cancer in the earliest stages where the cure rate is almost 100%. That is why self-exams, starting in the adolescent years, are key in early detection of testicular cancer.
The annual mortality rate per 100,000 people from testicular cancer in Malaysia has increased by 10.8% since 1990, an average of 0.5% a year.
Testicular cancer is the most common type of cancer affecting men between the ages of 15 and 35 years old–but it can strike any male, any time. This cancer is more common in males aged 65 years or above. Generally speaking, this cancer is rapidly dividing type of cancer, affecting males in earlier age. For all cases of testicular cancer the overall 5-year survival rate is 95% but the key is early detection.
Signs & Symptoms
Not much can be done to prevent testicular cancer so the best prevention/protection is to be aware of the risks, the signs, the symptoms and early detection by doing self-testicular exams. Prompt treatment will lead to the best outcomes.
Common signs and symptoms of testicular cancer include:
- Painless lump or swelling of the testicle
- A change in how the testicle feels
- A dull ache in the groin or lower abdomen
- A build-up of fluid in the scrotum
- Pain or discomfort in the testicle or scrotum
- A scrotum that feels heavy or swollen
- Bigger or more tender breasts
Testicular cancer is generally found in young men. The exact cause of testicular cancer is unknown and many men without risk factors develop testicular cancer. Strong connections between certain lifestyles, habits or activities, such as bike riding, have not been made with testicular cancer. Injuries and strains will not increase the risk of developing testicular cancer.
Young men between the ages of 15-35 are at the highest risk for testicular cancer. However, it can occur in men of any age.
Having a father, brother or uncle with testicular cancer may slightly increase one’s risk of developing testicular cancer.
Diagnosis & Testing
In order to diagnose testicular cancer a physician will need a full medical history and a physical examination. If a lump or abnormality is detected the doctor will order an ultrasound of the scrotum. If the ultrasound indicates that there is a solid tumor within the testicle then surgery will be required to remove the testicle and test the tumor to see if it is cancerous. Unfortunately, biopsies are not recommended for testicular cancer as the biopsy itself can increase the chances of the cancer spreading to other areas of the body. If the tumor is determined to be cancerous then other tests will be ordered such as a chest x-ray, CT scan and blood work in order to determine how advanced the cancer is and if it has spread.
Your physician will examine your testicles by gently rolling them between two fingers and thumb to identify any abnormal lumps. Your physician may also check your groin area, abdomen, armpits and neck to look for swollen lymph nodes. The doctor may also exam you for breast tenderness or enlargement and listen to your lungs.
Scrotal ultrasound is a painless non-invasive procedure in which high frequency sound waves are used to produce images of inside the scrotum and testicles. It is the same technology that is used in pregnant women when they get a sonogram. The images will show if there are any solid masses, swelling or fluid collections within the scrotum.
The cells that produce sperm are called germ cells. Almost all testicular cancers (95%) start in these germ cells and are considered germ cell tumors or GCTs.
The germ cell tumors are further classified as either seminomas or nonseminomas. There are other types of cancer that can develop in the testicles but they are very rare and will only be discussed briefly.
Sixty percent of germ cell tumors are seminomas and the others are nonseminomas. Each of these two types of germ cell tumors behave differently. Seminomas tend to spread slower while non-seminomas tend to spread and metastasize more quickly. To be considered a seminoma the tumor must only contain seminoma. If the tumor contains both seminoma and nonseminoma cell types then the tumor should be considered as a nonseminoma. There is also a precancerous condition called carcinoma in situ.
Testicular cancer spreads in a predictable and stepwise fashion. An exception to this is the presence of choriocarcinoma. This spread also indicates the stage of your testicular cancer. Staging is a way of describing the testicular cancer as to how big the tumor is, how much it has grown and whether it has spread to other areas of the body such as the lymph nodes or other organs.
Testicular cancer is highly treatable especially if caught early. With early detection treatments are more effective and often less aggressive than when the cancer is detected in the later stages. Treatments include surgery, radiation therapy and/or chemotherapy. The treatments depend on the type and stage of the testicular cancer as well individual preferences.
Chemotherapy is often used to cure testicular cancer when it has spread outside the testicle or to decrease the risk of cancer coming back after the testicle is removed. It is not used to treat cancer that is only in the testicle.
Doctors give chemotherapy in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Chemo cycles generally last about 3 to 4 weeks.