A Brief Overview of
Testicular Cancer
April is #TesticularCancerAwarenessMonth
By TBDfM
Dr Rafi Ahmed, a Junior Doctor working in the NHS, provides a helpful overview of testicular cancer.
Testicular Cancer is the most common malignancy affecting young adult men (aged 20-34 years old). Its incidence varies worldwide, with a higher number of cases in Northern Europe. In the UK, there are around 1400 new diagnoses of testicular cancer each year. It is highly curable (98%) when diagnosed early, but the long-term effects of treatment can compromise a patient’s quality of life.
April is Testicular Cancer Awareness Month, so we would like to take this opportunity to provide an overview of the condition, including what symptoms and signs to look out for, and to highlight some support available. We appreciate that it can be frightening to think or talk about cancer, but most men with Testicular Cancer make a full recovery and can have sex and children afterwards – even in advanced stages of the disease.
A brief look at male anatomy
The male scrotum consists of the testicles, epididymis and spermatic cord. These are the sites of sperm production, storage and transport, respectively. The blood and nerve supply are located nearby.
You may or may not know that the testicles are originally located in the abdomen. During development, they descend down into the scrotum – but occasionally this does not occur and is referred to as “undescended testes”.
(image courtesy of MacMillan Cancer Support)
What is testicular cancer?
Cancer occurs when normal, healthy cells that are regulated by the body begin to reproduce uncontrollably. In this condition, the cells in the testicles grow out of control and can form a lump which, if not picked up early and managed, can lead to cancer cells breaking off and spreading to other areas of the body.
There are few strong risk factors for testicular cancer, but these can include:
- Personal history or family member affected by testicular cancer
- Caucasian males
- Being born with an undescended testicle
Without going into too much detail, testicular cancer is classified according to the cells from which it arises. That is either Germ Cell (further divided into Seminoma and Non-Seminoma) and Non-Germ Cell tumours. There are also a few miscellaneous, rarer subtypes, as well as cancerous spread to the testicles from other parts of the body. It is important to note that testicular cancer is easier to treat than most types of cancer, due to the nature of cells involved and the anatomy of that region.
Once a diagnosis is made, testicular cancer is classified according to the extent of disease by the TNM Classification:
- T = size and extent of the primary tumour
- N = regional lymph node involvement
- M = presence or absence of distant metastases (spread)
What are the signs and symptoms?
The most common symptom of testicular cancer is a lump or swelling felt in your testicle, occurring for over 2 weeks. In 80% of cases this will be a painless lump, and it is rare for a lump to be felt on both sides. You also may find that one testicle has gotten bigger or smaller, or that you feel a dragging sensation/ache. Swelling or tenderness is not very common but may occur if the tumour releases a lot of hormones.
The most important thing to do is check yourself over regularly in order to spot the condition early. Examining your testicles for any lumps or asymmetry is quick and easy to do – set aside a moment in the shower once a month if you have to! This will enable you to notice when something feels different.
(image courtesy of Oddballs)
How is it investigated?
Most patients will be referred for an ultrasound scan, as this is highly sensitive for testicular cancer and it can also detect if there may be anything else going on, like infection or inflammation. Patients may also get a chest x-ray and/or CT scan of their body to screen for any potential spread.
Blood tests are also performed to check “tumour markers” – these are proteins and hormones that are released by certain tumour types. The common ones checked include bHCG, AFP and LDH.
How is it managed?
A tissue-based diagnosis of testicular cancer and its subtype is generally only achieved once part or whole of the involved testicle is removed, in a procedure called orchidectomy. At all stages of disease, orchidectomy should be performed for a suspicious mass highly suggestive of cancer, as it can be curative in the early stages. Men who have small tumours may be able to only have the tumour itself removed, rather than the whole testicle, but this is rare.
The idea of having your testicle removed will be understandably daunting, but in reality it is a simple, safe and effective procedure. Your other testicle can make all the necessary hormones and sperm that you need for sex and producing children.
Another common worry is that your testicles will look different after surgery. It’s important to know that surgeons often do not perform a cut on your scrotum – they gain access through the lower abdomen, near your groin. They will be able to reach the testicle through this cut. You can also have an artificial testicle placed (prosthesis) if you wish.
After surgery, some men may need chemotherapy or radiotherapy to kill off residual cancer cells, as well as surgery to affected lymph nodes. Some men will be cured by surgery alone.
What happens afterwards?
There is a very good chance you will be cured following surgery. Even in men where the cancer has spread, the chances of a full recovery are higher compared with other cancers. You will be able to go about your daily life after a period of rest and recovery.
Before any treatment, you should be offered the opportunity to have your sperm frozen, if you plan to have children later. Discuss this with your Consultant, as it is important in the rare cases where you may need both testicles removed.
Some final comments
A diagnosis of testicular cancer is a life-changing event that will leave you with questions and concerns, both for your physical and psychological wellbeing. It is important to have structured follow-up with your Consultant and seek support from wherever you can. Charitable organisations such as Oddballs Foundation and The Testicular Cancer Network are constantly fundraising and raising awareness of the condition and are a great source of support.
We hope that this provides a helpful overview as part of our focus on Men’s Health & Wellbeing.
At The Better Days for Men Foundation, we are always open to receiving questions and hearing your stories, so do feel free to reach out.
Best wishes and stay safe!
For and on behalf of
The Better Days for Men Foundation
References:
BMJ Best Practice
MacMillan Cancer Support
Oddballs Foundation
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