What is Testicular Cancer?
Cancer occurs when cells start to multiply uncontrollably, often forming tumours. In testicular cancer, uncontrolled cell growth begins in one or both of the testicles, or testes. The testicles are part of the male reproductive system. They consist of a pair of egg-shaped organs located underneath your penis inside a sac-like pouch called the scrotum. The testicles are responsible for producing male sex hormones such as testosterone, as well as sperm for reproduction.
Like other cancers, the rapid growth of cancerous cells will deprive healthy cells of nutrients and oxygen, causing healthy cells to die. If left uncontrolled, the cancer cells may eventually travel to other parts of the body like the bones or other organs and start to grow there as well.
Testicular cancer is a rare form of cancer in Malaysia, according to 2020 statistics. It generally affects men aged between 20 to 40 years, though there are very rare instances of detection in young boys. Early detection is the best way to quickly treat testicular cancer.
Symptoms of Testicular Cancer
Some symptoms may appear early or only appear much later. Generally, symptoms to look out for are physical changes to your testicles. These may include:
- A lump or enlargement in either testicle
- A change in how the testicle(s) feel
- A dull ache in the abdomen or groin
- A sudden collection of fluid in the scrotum
- Pain or discomfort in a testicle or the scrotum
- Enlargement or tenderness of the breasts (due to hormonal changes)
It should be noted that these symptoms may not indicate that you have testicular cancer. If these changes seem abnormal, or if they do not improve over time, see a doctor as soon as possible to get proper medical confirmation.
If the cancer has advanced, you may also develop symptoms in other parts of the body. For example, if the cancer spreads to the lymph nodes, you may develop a backache or a dull ache in the lower tummy.
Types of Testicular Cancer
Almost all testicular cancers (that’s 95 per cent, according to the US National Cancer Institute) start in the germ cells in the testicles. These germ cells are specialised cells that make sperm. Germ cell tumours are divided into two categories: seminomas and nonseminomas.
Seminomas grow and spread slowly in most cases, and account for 90 per cent of all germ cell tumours. Seminomas are further divided into two types: classic seminoma, the most common type of seminoma which usually affects men aged 30 to 50; and spermatocytic seminoma, which is rarer but is more common in older men.
Nonseminomas, on the other hand, tend to affect those between their teenage years and early thirties. Nonseminomas comprise of four main subtypes:
- Embryonal carcinoma: a rapidly growing and aggressive tumour, accounting for approximately 40 per cent of nonseminomas
- Yolk sac carcinoma: a very common type found in children and rare in adults
- Choriocarcinoma: a very rare but aggressive type of tumour
- Teratoma: also a rare tumour, which can also be highly aggressive
The type of testicular cancer you have may also inform the medical team on planning a suitable cancer treatment plan.
Causes and Risk Factors of Testicular Cancer
The exact causes of testicular cancer are still not well known. However, there are certain risk factors that can increase or decrease the likelihood of developing testicular cancer. These include, but are not limited to:
- Undescended testicle: A situation where the testicle (or both, in very rare cases) that did not move to its proper position in the scrotum before birth
- Abnormal testicle development: this may be due to other medical conditions that can affect testicle development
- Germ cell neoplasia in situ (GCNIS): Formerly carcinoma in situ, refers to a situation where there are abnormal cells in the testicle(s), but it is not cancer, there are no symptoms, and there is no detectable lump in the testicle(s). If left untreated, it can develop into cancer within 5 years in 50 per cent of cases
- Family history: Family members who have had testicular cancer can increase the risk of getting it
- Age: It usually affects men between 20 to 40 years of age, but can still affect men at any age
- Previous testicular cancer
You must remember that having a risk factor does not mean you will contract the disease.
Testicular cancer is a rare disease that affects men between 20 to 40 years of age. Symptoms include physical changes to the testicles, such as a lump or a pain in the area. Testicular cancer is divided into seminomas and nonseminomas, with the former being the most prevalent. It may occur due to risk factors such as having an undescended testicle, a family history of testicular cancer, or abnormal cells that develop into cancer over time.
Diagnosis of Testicular Cancer
You can conduct a simple self-test at home. While some experts may be sceptical as to its effectiveness, being able to take a simple first step to self-screening is both empowering and reassuring, especially if you can catch the cancer in its early stages. It is advisable to do a self-examination during, or after, a bath or shower when the skin of the scrotum is relaxed. The American Cancer Society suggests the following steps:
- Hold your penis out of the way and examine each testicle separately.
- Hold your testicle between your thumbs and fingers with both hands and roll it gently between your fingers.
- Look and feel for any hard lumps or nodules (smooth rounded masses) or any change in the size, shape, or consistency of your testicles.
Once you see a doctor, be sure to share your findings, especially if you may have found an unusual lump or sensation in your self-examination. They may conduct a physical exam to confirm your own findings while looking at your medical history for information that could explain your condition. Most doctors do agree that examining a man’s testicles should be part of a general physical exam during routine health checks.
Typically, an ultrasound test will be conducted; it uses high energy sound waves to create an image of your testicles and scrotum. The ultrasound test will help the doctor to identify any lumps in the testicles, and whether they are solid or fluid-filled. Your doctor may also have a blood test done in order to detect any cancer markers in your blood. While a high level of a tumour marker is not a definite cancer indicator, it can still help your doctor in making the diagnosis.
If it is really needed, the doctor may decide to perform a radical inguinal orchiectomy. This involves the surgical removal of the entire testicle if the lump found is indeed cancerous. It will then be analysed to determine what type of cancer it is. This surgical procedure is also considered the main treatment plan for testicular cancer.
Questions to Ask Your Doctor
Before you see your doctor again, you may want some time to think about what you would like to ask regarding your diagnosis. Consider the following list of questions:
- What type of testicular cancer do I have?
- Where is the cancer located?
- What stage is my cancer?
- Are there other tests that need to be done?
- Has the cancer started to spread to the rest of my body?
- What are my options for treating the cancer?
- What treatment options do I have?
- What kind of side effects will I face?
- How will the treatment affect my daily activities/work?
- What symptoms or side effects should I inform you about immediately?
- Am I limited to what I can or cannot do?
- What kind of follow-up will I need after successful treatment?
This is not an exhaustive list but may help suggest other questions you might want to ask. There may be some questions that are too early to ask, but you can consider them at a later point in your treatment.
Staging of Testicular Cancer
Once a diagnosis is made, the next phase is to determine how far the cancer has spread. Depending on the stage, doctors will need to formulate different treatment plans to effectively treat cancer. In testicular cancer, there are three stages (four, if you account for the pre-cancerous stage).
- Stage 0: Abnormal cells are found in the tiny tubules where the sperm cells begin to develop. These abnormal cells can develop into cancer.
- Stage 1: The earliest stage of testicular cancer, where it is found in the testicles. It will slowly progress and affect other parts of the body, such as your lymph nodes and blood vessels.
- Stage 2: The cancer has spread to your lymph nodes, and is still spreading.
- Stage 3: The cancer has now spread to lymph nodes and/or other organs; it is usually determined after an inguinal orchiectomy.
Treatment for Testicular Cancer
The type of treatment required depends on the type of testicular cancer, its current stage, and other factors the doctor may deem important. Prior to beginning any treatment procedures, though, the doctor will recommend sperm banking. Sperm banking is basically the collection and storage of semen, which is stored at the hospital or a fertility centre. This is done as some treatment procedures for treating cancer, such as chemotherapy and radiotherapy, can cause infertility in some men.
After treatment, your doctor will recommend a follow-up schedule to ensure that your recovery is going along well and that the cancer has not returned.
Surgery – specifically, a radical inguinal orchiectomy – is normally the first, and sometimes only, step to treating the cancer. The doctor will surgically remove the affected testicle through an incision in your groin. You may have a prosthetic, saline-filled testicle, or a silicone implant, to replace your testicle. This can be done during surgery, or at a later time.
For late stage cancers, some lymph nodes may also need to be removed, and the surgeon will take extra care not to damage your other nerves when conducting the operation. There is still some risk of damage, though, and damaged nerves can cause some minor complications, such as a difficulty in ejaculation. Consult your doctor on the possible side effects and complications that could arise.
Stage 1 testicular cancer typically requires surgery to treat it, after which you will be monitored regularly for any changes, or if the cancer may come back. If there is some risk of the cancer recurring, you may need to undergo a single round of chemotherapy.
Chemotherapy uses drugs that target and kill cancer cells that are in your body or stop them from multiplying. Chemotherapy is usually needed in stage 2 or 3 testicular cancers to remove any cancer cells that may have spread to other parts of the body. It can also be used to treat either seminoma or nonseminomas.
Chemotherapy can help improve the survival rate for those with testicular cancer, but can also cause adverse side effects to your body, such as fatigue, nausea, hair loss and an increased risk of infection due to a weaker immune system.
Radiation therapy, or radiotherapy, uses high-powered energy beams, like X-rays, to eliminate cancer cells. Radiotherapy may be used in treating seminomas to prevent a recurrence, though it may also be used in advanced stages of cancer if someone is unable to tolerate chemotherapy, or if the cancer has spread to the lymph nodes.
Radiotherapy can also cause side effects such as nausea, fatigue, as well as skin redness and irritation in your abdominal and groin areas.
Testosterone Replacement Therapy
In some cases, there may be a reduction in hormone production after removing a testicle. Normally, one testicle is still enough to produce testosterone, but if you had both testicles removed, or if you suddenly exhibit symptoms like a loss of libido or erectile dysfunction, testosterone replacement therapy will be recommended for you.
Testosterone will be given to you in the form of an injection, a skin patch or a gel to rub into your skin. You may need to have them every 2 to 3 months. There may be some mild side effects, such as breast enlargement and swelling, or a need to urinate more frequently than usual.
Diagnosing testicular cancer can start with a simple self-examination by yourself. If you find any changes to your testicles, consult your doctor immediately. They will conduct various diagnostic tests to determine if it is testicular cancer. Treatment of it depends on the type of testicular cancer and its current stage. The first option of treatment is surgery, where the affected testicle is surgically removed and replaced with a prosthetic one (if needed). Chemotherapy and radiotherapy are used for more advanced cases in order to kill the cancer cells that remain in the body.
Preventing Testicular Cancer
The first step to cancer prevention starts with a change in lifestyle. Taking good care of yourself is a surefire way to keep you healthy and cancer-free. Start with adopting a more well-balanced diet, with more fruits and vegetables in your servings, and reducing your intake of less healthy foods and beverages like fast food or processed meats. Manage your portion sizes as well, and stay consistent. Get sufficient rest each night so you wake up feeling refreshed and empowered.
Frequent, regular exercise is also another way to keep cancer away. Even 20 minutes of exercise three times a week can help you stay healthy and fit. Take up meditation exercises to help you ward off stress, or find other ways to be more mindful of your feelings, such as keeping a gratitude journal. On top of that, quit habits like smoking and alcohol consumption to better improve your outlook as well.
Self-examination is also important to detect cancer early. Follow the steps given in the previous section and be sure to communicate with your care providers if needed. Be open when communicating with your loved ones, and seek their support through this difficult period. It can seem like an embarrassing topic to discuss, but having their support will help you greatly in facing your fears and be more assured that all will be well.
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Support Groups for Testicular Cancer
If you are a cancer survivor, survivorship requires a similarly health-oriented approach to prevent a recurrence of cancer. Reaching out to cancer support groups, such as the National Cancer Society Malaysia, can be a good way to help you find others with similar stories and connect with them. Through their support and experience, you will be better equipped to move on with your life and find new meaning in surviving your cancer, together with your family and close friends.
If you find it difficult to do things with your cancer, or simply require an additional helping hand, consider contacting our Care Advisor.
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