Testicular Cancer

Testicular cancer is a disease in which cells in one or both testicles become malignant (cancerous) and multiply in an uncontrolled manner. This form of cancer is relatively rare when compared with other types of cancer.

Testicular cancer accounts for approximately 0.5 percent of all cancers in men. In South Africa it is one of the most common male cancer in men between the ages of 15 and 49 (SA National Cancer Registry – 2014).

The overall cure rate is greater than 90% for testicular cancer detected at an early stage.

Most testicular cancers can be detected early – a lump or swelling may be the first sign that a medical practitioner should be consulted.

Statistics

1 in 1798 South African men will develop testicular cancer in their lifetime.

Signs and Symptoms

The most common cancer signs and symptoms in the testicles and scrotum include:

  • Lumps (masses)
  • Swelling
  • Pain

The symptoms of testicular cancer include:

  • Discomfort in a testicle
  • Presence of a painless lump on a testicle (can be as small as a grain of rice and can feel like hard rubber)
  • Enlarged or swollen testicle
  • Significant shrinking of a testicle
  • Change in the consistency of a testicle
  • Heavy or aching feeling in one’s back, lower abdomen, groin, or scrotum
  • In cases where the cancer has spread to the lungs, problems like shortness of breath, chest pain, or cough (with or without blood) may occur
  • Enlargement of breasts and tenderness in instances of testicular germ cell tumours

Diagnosis

A physical examination and biopsy need to be conducted by a qualified pathologist/ professional in an approved laboratory. 

These tests may include:

  • Blood tests measuring the levels of tumour markers, such as
    • alpha-fetoprotein (AFP)
    • beta-human chorionic gonadotropin (BHCG)
    • dehydrogenase (LDH)
  • Ultrasound
  • Biopsy – microscopic examination of testicular tissue by pathologist
  • In cases where testicular cancer is found, more tests might have to be conducted to determine whether the cancer has spread to other parts of the body.

Cryopreservation of Semen:

Testicular cancer diagnosis is a situation where semen deposits in a long-term storage bank is something each patient could consider.  Why consider this?  This offers options for future preservation of semen. Situations can change, and the affected individual may want to father a child after undergoing treatment for his testicular cancer.

Risk Factors

There is no way to prevent testicular cancer. Any person who believes that he may be at risk for testicular cancer should discuss this with his medical practitioner.

The following have been identified as risk factors for testicular cancer:

  • Having had an undescended testicle(s)/ cryptorchidism
    • The testicles start developing in the belly of the foetus and then move down into the scrotum before the baby is born.
    • An estimation of 3% of boys’ testicles do not move down into the scrotum before birth so they sometimes either get stuck in the groin or they stay inside the abdomen.
    • Men who have had cryptorchidism are much more likely to develop testicular cancer than those who do not have this condition.
    • The risk, however, is higher for men with a testicle in the belly than it is for when the testicle(s) has moved down at least part of the way.
  • Having a personal history of testicular cancer
    • Men who have had cancer in one testicle and have been cured have an increased risk of 3-4% of developing cancer in the other testicle.
  • Having a family history of testicular cancer
    • This increases the risk of getting testicular cancer as approximately 10% of testicular cancers are due to genetics.
  • HIV infection
    • There is some evidence that people with HIV (human immunodeficiency virus) have an increased risk of getting testicular cancer, and even more so for men who have AIDS (Acquired Immunodeficiency Syndrome).
  • Race
    • White men are 5 times more likely to get testicular cancer.
  • Age
    • On average, 9 out of 10 cases occur in men between the ages of 15 and 49.
  • Fertility problems
    • Having fertility problems puts men more at risk of developing testicular cancer.
  • Having a family history of breast cancer or malignant melanoma
    • Men whose family cancer history includes breast cancer or malignant melanoma have a higher risk of testicular cancer.
  • Smoking marijuana
    • Studies have found that men who had smoked marijuana are twice as likely to develop an aggressive form of testicular cancer than those who had not.

It’s important for young men to start testicular self-examinations soon after puberty. Men from the age 15 to 49 years need to examine their testicles each month, preferably after a bath or shower, to feel for any pea-sized lumps that could indicate testicular cancer

Treatment

  • Surgery
    • To remove affected testicle.
    • Usually done through an incision in the groin (called radical inguinal orchidectomy.
    • This usually does not cause erectile dysfunction and does not affect the ability to produce sperm (unless both testicles have been removed).
  • Radiation therapy (radiotherapy)
    • Uses high-energy rays to kill cancer cells and shrink tumours. Radiotherapy affects normal and cancer cells; thus, the side effects depend mainly on the treatment dose.
  • Chemotherapy
    • Anticancer drugs are used to kill cancer cells.
    • Usually given as adjuvant therapy (after surgery) to destroy cancerous cells that may remain in the body.
  • Follow-up treatment
    • Crucial as testicular cancer can recur and affect the remaining testicle.

Testicular Self-Examination (TSE)

It is important to do a TSE every month so one can become familiar with the normal size and shape of your testicles. 

Here’s what to do:

  • Do a TSE during or after a warm shower or bath as the skin becomes more relaxed.
  • Examine one testicle at a time:
    • Use both hands to gently roll each testicle between the fingers.
    • Place thumbs over the top of the testicle, while placing the index and middle finger of each hand behind the testicle, and then roll it between the fingers.
    • One should be able to feel the epididymis (sperm-carrying tube), which feels soft and rope-like. This is a normal lump.
    • When examining each testicle, feel for any lumps along the front or sides.
    • If one notices any swelling, lumps, or a size or colour change of the scrotum, contact a medical practitioner.