Testicular cancer: basics you need to know

How common is testicular cancer?

Testicular cancer is the most common cancer in men between 15 and 49. Although it accounts for a small percentage of all cancers, its incidence has increased over the past few decades.

With early detection and advancements in testicular cancer treatment, the survival rate for testicular cancer is among the highest among all cancer types.

Do I need to check myself?

Young men should proactively engage in their health by performing regular testicular self-exam (TSE). This involves checking the testicles for abnormalities, such as lumps, swelling, or changes in size or shape. Men that develop testicular cancer do not necessarily have symptoms.

Cancer Research UK recommends that TSE be conducted monthly, ideally after a warm bath or shower when the scrotal skin is relaxed. Any concerns or unusual findings should be promptly reported to a healthcare professional.

What is the role of the testicles in men?

The testicles form part of the male reproductive system. The testicles produce sperm and produce the hormone testosterone.

What are the types and causes of testicular cancer:

There are two main types of testicular cancer: seminomas and non-seminomas.

• Seminomas: These tumours usually occur in men between the ages of 25 and 45 and tend to grow and spread more slowly. They are generally more responsive to radiation therapy.
• Non-seminomas: Non-seminomas are typically found in younger men and tend to grow and spread more quickly. They are often treated with a combination of surgery and chemotherapy.

Risk factors that cause testicular cancer?

The causes of testicular cancers are still unknown, but significant risk factor /s have been identified. These include:

• Undescended testicles: Men with one or both testicles that did not descend into the scrotum during infancy have an increased risk.
• Family history: Having a close relative, such as a father or brother, with testicular cancer increases the risk.
• Abnormal testicle development: Certain conditions, such as Klinefelter syndrome or testicular dysgenesis, may increase the risk.
• Previous testicular cancer: Men with testicular cancer in one testicle have an increased risk of developing it in the other testicle. This is the most significant risk factor.
  

What would I feel if I have testicular cancer?

Men need to be aware of the signs and symptoms of testicular cancer, which may include:

• A painless lump or swelling of the entire testicle
• Testicular pain or discomfort
• A feeling of heaviness in the scrotum
• Changes in the size, shape, or consistency of the testicles
• Enlargement or tenderness of the breasts (rare cases)

Men should seek medical attention promptly if any of these symptoms are experienced.

I feel a lump on my testicle. How is this investigated?

If an abnormality is detected during a testicular self-examination or if men experience any concerning symptoms, they should seek medical attention.

Healthcare professionals may conduct a thorough physical examination, including a detailed history and a physical inspection of the testicles. Additionally, several tests may be organised for further evaluation, such as:

• Ultrasound: This non-invasive imaging test uses sound waves to create a picture of the testicles. It helps determine the size, location, and characteristics of any abnormalities.
• Blood tests: These tests measure tumour markers, such as alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH). Elevated levels of these markers can indicate the presence of testicular cancer.
• Biopsy: In some cases, a biopsy may be performed to confirm the presence of cancer cells. However, it is not always necessary, as other diagnostic tests can provide sufficient information for diagnosis.
  

Fertility Concerns and Sperm Banking

If you are diagnosed with testicular cancer, its treatment can impact fertility in some men. The removal of a testicle or the necessity for radiation therapy or chemotherapy can affect sperm production and quality. Therefore, men diagnosed with testicular cancer must consider their fertility preservation options, especially if they desire to have biological children.

Sperm banking, also known as sperm cryopreservation, is a process that involves collecting and storing sperm samples for future use. Before undergoing cancer treatment, men can consult with a reproductive specialist to discuss sperm banking. This process typically involves providing multiple semen samples, which are then frozen and stored in a specialized facility. By banking sperm before treatment, individuals can preserve their fertility and have the option to use assisted reproductive techniques, such as in vitro fertilization (IVF), in the future to conceive a child.

It is important to note that sperm banking should ideally be undertaken as soon as possible after diagnosis to maximise the chances of preserving viable sperm. Healthcare professionals and reproductive specialists can provide guidance and support throughout the process, ensuring that individuals understand their options and make informed decisions regarding fertility preservation.

Treatment options for testicular cancer:

The treatment for testicular cancer depends on several factors, including the type and stage of cancer and the individual's overall health. The primary treatment options include:

Surgery:

The most common approach is a radical inguinal orchiectomy, which involves the removal of the affected testicle.

This procedure involves the removal of the affected testicle through an incision made in the groin area. The inguinal orchiectomy serves two primary purposes: accurate diagnosis through pathological examination of the removed testicle and removal of the cancerous tumour. While the prospect of losing a testicle can be emotionally challenging, it is essential to understand that an inguinal orchiectomy is a highly effective treatment approach for testicular cancer.

For many men, losing a testicle can impact their self-esteem and body image. To help address this concern, testicular prostheses can be considered. A testicular prosthesis is a synthetic implant that can be surgically placed within the scrotum to mimic the appearance and feel of a natural testicle. These prostheses are typically made of silicone or saline-filled materials and are available in different sizes to match the remaining testicle or the patient's desired aesthetic.

The decision to undergo testicular prosthesis implantation is highly personal and may depend on individual preference, body image concerns, and the desire for symmetry. It is recommended that individuals discuss this option with their healthcare provider before the inguinal orchiectomy procedure.

Testicular prostheses help restore physical appearance and provide psychological benefits, allowing men to regain confidence and maintain a positive body image. It is important to note that the decision to pursue testicular prosthesis implantation can be made any time after the initial surgery, and there is no rush in making this choice. Healthcare professionals can provide guidance, information, and support to individuals considering this option, ensuring they have the information required to make an informed decision about their post-surgical appearance and well-being.

Surgical Complications

1. Bleeding: There is a small risk of bleeding at the surgical site. Most cases of post-operative bleeding are minor and can be managed conservatively. However, in rare instances, significant bleeding may require further surgical intervention.
2. Infection: Signs of infection may include increased pain, swelling, redness, or discharge. Infections are typically treated with antibiotics.
3. Haematoma: Occasionally, a collection of blood can cause swelling and discomfort. Most haematomas resolve independently, but in some cases, they may need to be drained surgically.
4. Scrotal swelling is usually temporary and resolves over time as part of the healing process.
5. Nerve damage: While rare, there is a slight risk of injury to surrounding nerves during the surgery, which may result in temporary or permanent numbness or altered sensation in the scrotum or groin area.
6. Testicular pain: Some individuals may experience mild to moderate testicular pain or discomfort following the surgery.
7. Hernia

In some cases of testicular cancers, additional surgeries, such as retroperitoneal lymph node dissection (RPLND), otherwise called lymph node surgery or lung surgery, may be required to remove cancerous lymph nodes or lesions. This would be the can of metastatic testicular cancers.

Additional treatment to cure testicular cancer after orchidectomy

• Radiation therapy: High-energy X-rays are used to target and kill cancer cells.
• Chemotherapy: Anti-cancer drugs are administered orally or intravenously to destroy cancer cells. Adjuvant Chemotherapy is often used for non-seminomas and may be given before or after surgery. It is the mainstay treatment for metastatic testicular cancer.

Hormone testosterone replacement therapy

The need for testosterone replacement therapy (TRT) after an inguinal orchiectomy for testicular cancer depends on various factors, including individual circumstances and discussions with healthcare professionals.

After removing one testicle, the remaining testicle should still produce enough testosterone to maintain adequate hormone levels in most cases. However, there are instances where testosterone levels may be affected, such as when both testicles are removed or when there is pre-existing testosterone deficiency.

If testosterone levels are low following an inguinal orchiectomy, healthcare professionals may consider TRT. Testosterone replacement therapy involves administering synthetic testosterone to restore testosterone levels to a normal range.

It is important to note that TRT is not recommended for everyone and has potential risks and side effects. Before starting TRT, healthcare professionals will evaluate your overall health, including any other medical conditions you may have, and consider possible contraindications. They will closely monitor your hormone levels and adjust to ensure optimal testosterone balance.

The prognosis for testicular tumours

The prognosis for testicular cancer is generally good, especially when detected and treated early. The overall five-year survival rate for testicular cancer is approximately 95%.

Regular follow-up appointments and adherence to post-treatment care guidelines are essential for long-term monitoring and early detection of potential recurrences.

What is the psychological impact of having testicular cancer?

Receiving a testicular cancer diagnosis can be emotionally challenging. Individuals and their families must have access to cancer support specialists and resources. Several organisations and support groups provide information, counselling, and assistance to those affected by testicular cancer. Some notable resources include:

• Cancer Research UK: Offers comprehensive information on testicular cancer, treatment options, and support services.
• Macmillan Cancer Support: Provides practical, emotional, and financial support for people living with cancer, including those with testicular cancer.
• Movember Foundation: A global charity that raises awareness and funds for men's health issues, including testicular cancer. They offer resources and support for men and their families.

Reflection from a consultant urologist

Testicular cancer is a significant health concern for young men in the UK, but the chances of a successful outcome are high with early detection and appropriate treatment. Men should be proactive in their health by performing regular testicular self-examinations and seeking medical attention if they notice any abnormalities or concerning symptoms. Diagnostic tests, such as ultrasounds and blood tests, can aid in early detection. Treatment options for testicular cancer include surgery, radiation therapy, chemotherapy, and targeted therapy, depending on the type and stage of cancer. Regular follow-up appointments and access to support resources can further enhance the well-being and recovery of individuals affected by this condition.