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MEN'S HEALTH

Testicular Cancer

Written by Dr Gunasaegaram

31—MAR—2021 16:58 GMT
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nxiety levels peak as you ask the question “Doctor, I have a lump on my testicle, what could this be?”

 

I’m here today to give you a run-down on the possibilities of a testicular lump and the best thing you should do if you do find a lump on your testicle. First things first, let’s not get too ahead of ourselves and jump into conclusion with the C-bomb. There are other common causes of scrotal lumps that should be considered first such as inguinal hernia, varicocele (enlargement of your veins), hydrocele (fluid around the testicle) and epididymal cyst (a fluid collection around the ‘bank’ of sperms).

However, it should be noted that testicular cancer is the most common solid malignancy affecting males between the ages of 15 and 35 (1). Approximately 9600 men are diagnosed with testicular cancer each year in the United States, approximately 400 men will die of this disease. The worldwide incidence is lowest in Africa and Asia, and highest in the Scandinavian countries. Good news is, with modern innovation in the field of surgical and radiochemotherapy, patients with testicular cancer now have a 95% 5-year survival, making it the most curable solid cancer in males.

"Patients with testicular cancer now have a 95% 5-year survival."

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Make sure you get to know your neighbours downstairs.
Image from Irish Cancer Society

Symptoms of testicular cancer include: 

- Lump – almost 100%

- Dull ache in the lower abdomen/ scrotum – 30%

- Pain – 10%

In more advanced cases, the symptoms could be related to the spread of the cancer, so some patients might experience shortness of breath, bone pain, neck swelling and leg swelling. 

"Testicular cancer is the most common cancer in young men aged between 15-44. If caught early, testicular cancer is very treatable and is nearly always curable."

How can I reduce the risk of developing testicular cancer?

Unfortunately, there aren’t many risk factors we can actively change to limit our exposure to testicular cancer. Several risk factors, such as cryptorchidism (when your testes do not move to their normal position in the first few months of your life), family history of testicular cancer, Caucasian race and infection with HIV (2) can increase your chance of developing testicular cancer.

What investigations will my doctor do?

Your doctor will start off with a detailed physical examination of your genitalia. This is followed by a scrotal ultrasound which could help aid the diagnosis.

 

Other blood tests that might be used include specific tumour markers for testicular cancer. Tumour markers are substances, usually proteins, that are found naturally in your blood, urine and tissues. These substances normally circulate in our bodies, however, a significant rise in one or more of these markers could be highly indicative of cancer. The markers used for testicular cancer are beta-HCG (beta-human chorionic gonadotropin), alpha-fetoprotein (AFP), and lactate dehydrogenase (LDH). 

 

The combination of the scrotal ultrasound and blood tests is usually sufficient to make a firm diagnosis.

 

To determine the extent of your cancer, your doctor will use various scans such as a CT or MRI scan to study the spread. This is also called the ‘staging’ process. It is an important step that will help direct management plan. 

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Yes you are correct, science laboratory = investigation, simple minds eh?
Image from Trnava University

How is testicular cancer treated?

Surgical treatment is the preferred method as it is shown to be the most effective. The surgery involved is called a radical orchiectomy. This surgery involves removing the cancerous testicle and spermatic cord. After the surgery, the doctor will send off a sample of the tumour to determine the type of testicular cancer. There are two main groups: seminomas, and non-seminomas. The latter has the least favourable prognosis. This means you might have to undergo extra treatment to clear the cancer from your body; such as chemotherapy and radiotherapy. These are used to kill the rapidly growing tumour cells.

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An anatomical picture to show where the incisional line for radical orchiectomy is.
Image from SpringerLink

What happens after my testicle is removed?

After undergoing radical orchiectomy, patients have the option of inserting prosthetic implants to preserve the natural appearance of the scrotum. This can be achieved during the same surgery immediately after removal of the testis.

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Who you are is not defined by what’s in your pants.
Image from Metro.co.uk

Would treatment for testicular cancer make me infertile?

Infertility is an expected and common side effect of testicular cancer treatment. All patients who have yet to complete their family should be counselled on freezing their sperm prior to the surgery.

What are the chances of my other testicle developing cancer? 

The 15-year cumulative risk of a developing testicular cancer in the previously unaffected side was 2% (3). Your doctor will regularly arrange follow-ups in the first couple of years to ensure the cancer does not ‘relapse’ (cancer returning). They’ll do this with a series of blood tests and scans. 

 

If you’re concerned that the lump you have is testicular cancer, contact your GP. It can be embarrassing to raise questions about your private parts to the doctors. But it’s important to make sure that the lump isn’t anything dangerous! Preventive medicine is the best medicine. Catching the cancer early can lead to successful treatment.

References

1. Kier, M., Lauritsen, J., Almstrup, K., Mortensen, M., Toft, B., & Rajpert-De Meyts, E. et al. (2015). Screening for carcinomain situ in the contralateral testicle in patients with testicular cancer: a population-based study. Annals Of Oncology, 26(4), 737-742. https://doi.org/10.1093/annonc/mdu585

2. Siegel, R. (2021). Cancer statistics, 2020. Retrieved from https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21590.

3. Testicular Cancer: Risk Factors. Cancer.net. (2020). Retrieved from https://www.cancer.net/cancer-types/testicular-cancer/risk-factors.