Overview

What is Testicular Cancer?

The testes comprise primitive cells that mature to become cells that make spermatozoa or sperm that are important in sexual reproduction. There are also supporting cells that make enzymes and other fluid that enable the sperm to function properly. These primitive cells may become cancerous. These tumours are called testicular germ cell cancers.

How common is Testicular Cancer?

Testicular cancer represents about only 1-2 % of all cancers in males, but is one of the most common cancers in young men.

Age of Onset

It occurs predominantly in males aged 20 - 40 years.

Causes and Risks

Males who have a history of undescended testes (testes that did not descend to lie in the scrotum during development) have a much higher chance of developing testicular cancer. Other risk factors include history of testicular cancer in the other testis and family history of testicular cancer.

Symptoms

Symptoms and Signs of Testicular Cancer

Typically, patients present to their doctor with a painless lump in one or both testes. Occasionally, there may be a heavy or aching sensation in the testes. In advanced cancer, other symptoms may be present, for example, if cancer has spread to the lungs, there may be shortness of breath.

Diagnosis

Diagnostic Tests

Ultrasonography of the testes will locate and delineate the size of the testicular lump.

Blood tests are taken for tumour markers comprising of alpha-fetoprotein (AFP) and beta-human chorionic gonadotrophin (HCG), and lactate dehydrogenase (LDH). CT scan of the chest, abdomen, pelvis and occasionally, the brain, is also performed to find out the extent of cancer.

Testicular cancers may be seminomas or non-seminomatous germ cell tumours, depending on what cell type is found at examination of the cancer under the microscope. An orchidectomy (removal of the testis) or biopsy is done to obtain the diagnosis.

Treatment Options

Treatment of Testicular Cancer

Orchidectomy is performed to remove the affected testis if the cancer is localized. If there is advanced cancer, this may be done after chemotherapy in order to shrink the tumour first. Following surgery for early testicular cancer, chemotherapy or radiotherapy may be required to reduce the risk of recurrence. Chemotherapy is used if there is advanced cancer involving other organs such as the lungs or liver1. Side effects of chemotherapy which are injected into veins include temporary nausea and vomiting, mouth ulcers, hair loss, loss of appetite and tiredness.

Prognosis of Testicular Cancer

Clinical examinations, scans and pathology reports all help the medical team decide what is the stage of the germ cell tumor. The appropriate course of treatment may then be recommended. The treatment strategy will vary from person to person. Prognosis of testicular cancer is generally very good. It depends on the extent of the disease, the state of health of the individual as well as response to treatment. With appropriate treatment, cure rates of up to 80% have been reported even for patients with advanced testicular germ cell tumor. Patients with early stage testicular cancer have reported cure rates of more than 95% with appropriate treatment. Close monitoring of blood markers together with radiological assessment is essential to detect early recurrence of cancer.

Frequently Asked Questions

I have had a lump in my testis for a while. It is not painful.

Testicular cancer is usually not painful. If there is a lump seek early medical attention. Although it may not be cancerous, it is better to have it checked.

I have only one testis.

Normally, two testes are formed in the embryo, which descend before birth to lie in the scrotum. Occasionally one or both testes do not descend. There is a higher chance of cancer developing in undescended testes; therefore it is advisable to seek early medical attention. Surgery may be required to bring the testis back into the scrotum.

Will cancer treatment for testicular cancer affect my ability to have children in the future and how can that be mitigated?

Yes, fertility will be affected by chemotherapy and as such your physician will likely refer you to a reproductive clinic for cryopreservation of your sperm to be used at a later stage post treatment should the need arise.  

References

1. Williams SD, Birch R, Einhorn LH, et al. Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med 1987; 316:1435.
2. Oliver RT, Mead GM, Rustin GJ, et al. Randomized Trial of Carboplatin Versus Radiotherapy for Stage I Seminoma: Mature Results on Relapse and Contralateral Testis Cancer Rates in MRC TE19/EORTC 30982 Study. J Clin Oncol 2011; 29:957.