Testicular cancer: Symptoms, Causes and Treatment

Testicular cancer is a relatively rare but serious disease that primarily affects young and middle-aged men. The testicles, or testes, are part of the male reproductive system, responsible for producing sperm and the hormone testosterone. Early detection and treatment significantly improve the prognosis, making awareness of symptoms, causes, types, and treatment options essential.

Symptoms

The most common symptoms of testicular cancer include:

1. Lump or Enlargement: A painless lump or swelling in either testicle is the most common symptom. Men may notice a change in size, with the affected testicle becoming larger.
2. Heaviness in the Scrotum: A feeling of heaviness or aching in the lower abdomen or scrotum can be an early sign.
3. Pain or Discomfort: Some men experience pain or discomfort in the testicle or scrotum, which may be persistent or intermittent.
4. Back Pain: Lower back pain may occur if the cancer has spread to the lymph nodes.
5. Breast Tenderness or Growth: Hormonal changes caused by testicular cancer can lead to breast tenderness or gynecomastia (enlargement of breast tissue).
6. Sudden Fluid Collection: A sudden buildup of fluid in the scrotum, known as a hydrocele, can also be a sign.

Causes

The exact cause of testicular cancer is not known, but several risk factors have been identified:

1. Undescended Testicle (Cryptorchidism): Men with a history of undescended testicle(s) are at higher risk, even if surgery was performed to correct the issue.
2. Family History: A family history of testicular cancer increases the risk.
3. Age: Testicular cancer is most common in men between the ages of 15 and 35.
4. Race and Ethnicity: White men are at a higher risk compared to men of other races.
5. HIV Infection: Men with HIV, particularly those with AIDS, have an increased risk.
6. Previous Testicular Cancer: Men who have had cancer in one testicle are more likely to develop it in the other testicle.

Types

Testicular cancer is classified into two main types based on the cells in which the cancer begins:

1. Germ Cell Tumors (GCTs): These account for more than 90% of testicular cancers and are further divided into two subtypes:
   • Seminomas: These tumors grow slowly and are sensitive to radiation therapy. They typically occur in men aged 30 to 50.
   • Non-seminomas: These tumors grow more quickly and are more common in younger men. They include several subtypes such as embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma.
2. Stromal Tumors: These are rare and develop in the supportive and hormone-producing tissues of the testicles. Examples include Leydig cell tumors and Sertoli cell tumors.

Diagnosis

Diagnosing testicular cancer involves several steps:

1. Physical Examination: A thorough physical examination of the testicles to check for lumps or abnormalities.
2. Ultrasound: An ultrasound of the scrotum helps in distinguishing between benign and malignant masses.
3. Blood Tests: Blood tests to measure tumor markers like alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH).
4. Imaging Tests: Additional imaging tests like CT scans or MRIs to determine if cancer has spread.
5. Biopsy: In some cases, a biopsy may be performed to confirm the diagnosis, although it is less common due to the risk of spreading cancer cells.

Staging

Staging helps determine the extent of cancer spread and is crucial for planning treatment. Testicular cancer is staged from I to III:

1. Stage I: Cancer is limited to the testicle.
2. Stage II: Cancer has spread to nearby lymph nodes in the abdomen.
3. Stage III: Cancer has spread to other parts of the body, such as the lungs or liver.

Treatment

The treatment of testicular cancer depends on the type and stage of the cancer, as well as the patient’s overall health and preferences. Treatment options include:

1. Surgery: The primary treatment for all stages of testicular cancer is the surgical removal of the affected testicle, known as a radical inguinal orchiectomy. In some cases, removal of nearby lymph nodes (retroperitoneal lymph node dissection) may be necessary.
2. Radiation Therapy: Mainly used for seminomas, radiation therapy involves targeting cancer cells with high-energy rays to destroy them.
3. Chemotherapy: Used for both seminomas and non-seminomas, chemotherapy involves the use of drugs to kill cancer cells. It is particularly effective for advanced stages or when cancer has spread.
4. Surveillance: For early-stage cancers, active surveillance with regular follow-ups may be an option, allowing for prompt treatment if cancer recurs.
5. Stem Cell Transplant: In rare cases, high-dose chemotherapy followed by a stem cell transplant may be used for recurrent or resistant testicular cancer.

Prognosis

Testicular cancer has one of the highest cure rates of all cancers, especially when detected early. The overall 5-year survival rate exceeds 95%, with even higher rates for early-stage cancers. Regular follow-ups and monitoring are essential to detect any recurrence early and to manage long-term side effects of treatment.

Conclusion

Testicular cancer, while rare, is a serious condition that primarily affects young men. Awareness of symptoms and risk factors, combined with early detection and advances in treatment, contribute to high survival rates. Men should perform regular self-examinations and seek medical attention for any abnormalities, ensuring timely diagnosis and treatment. With appropriate care, the prognosis for testicular cancer remains excellent.