Testicular Cancer

It usually occurs in males below the age of 35, but rarely before puberty (age range: 15-44 y.o). Almost all cases of testicular cancer originate from germ cells (cells that produce sperm). There are two main types of testicular cancer (according to the type of cells inducing cancer): Seminomas and Nonseminomas. Both these types have the same incidence rate (50%). 

Which are the predispository factors for Testicular Cancer? 

Known risk factors for the development of testicular cancer are the following:

• Race. Caucasian males of Northern Europe present the highest rate of testicular cancer. Some genetic or environmental factors are probably involved.

• Family history. Brothers and sons of patients with testicular cancer present high risk for developing the disease. 

• Cryptorchidism (undescended testicles). Testes develop in the abdominal region and normally move down to the scrotum before birth. Some babies are born withe either the one testicle  or both testicles not having descended to the normal position. According to studies, there is a slightly higher risk for testicular cancer in males who had cryptorchidism, particularly when there is delay in  surgical treatment cryptorchidism. 

 • Infertility. Some studies have demonstrated that infertile males have a slightly higer risk for developing testicular cancer. 

• HIV infection (AIDS). Males suffering from AIDS also present high risk for cancer of testicles and other organs. 

What are the symptoms of Testicular Cancer?

In most cases, the first symptom is a palpable painless scleral mass (lump) on the testicle. In some cases, this lump may be painful. It should be known that there are also various other diseases presenting the same symptoms. In rare cases when cancer has spread, there may occur symptoms from other parts of the body; for example, pain in the back or abdomen, loss of body weight or dyspnea. 

How is Testicular Cancer diagnosed?

The physician will initially perform a clinical examination to check whether there is any palpable induration on the testes. Then, further screening tests have to be done, such as: 

  • Testicular Ultrasound. U/S can help easily clarify whether the palpable induration is due to something solid, such as cancer, or to some benign vesicle simply containing fluid. 
  • Blood testing. Testicular cancer often produces some substances that can be detected in the blood, the so-called 'tumor markers'. Blood testing measures the following tumor markers: AFP (Alpha-Fetoprotein), β-hCG (Human Chorionic Gonadotropin) and LDH (Lactase Dehydrogenase). Increase of one or more markers confirm the diagnosis of testicular cancer. Yet, there are cases of  testicular cancer in which the above blood markers appear to be at normal levels. Hence, a negative result does not necessarily exclude cancer. 

How is Testicular Cancer staged?

Once testicular cancer has been diagnosed, there are further screening tests to be done for evaluating whether it has spread. These tests include plain chest X-rays, CT scan and probably MRI. This is the process of staging and aims at identifying:

  • whether cancer has spread to lymphnodes in the abdominal region.
  • whether cancer has spread to other areas of the body, such as the lung.

What is the treatment of Testicular Cancer?

Once testicular cancer is confirmed with the above screening tests, the physician will recommend surgical removal of the afflicted testis (orchiectomy).

Surgery

Surgical treatment is recommended in all cases and aims at removing the testis afflicted with cancer. If cancer is in an early stage and has not spread, surgery alone can be therapeutic. However, if cancer has spread further, there may be need for adjunctive radiotherapy or chemotherapy and revision surgery for removing any potential residual tumor masses in the abdomen. 

Οrchiectomy and Infertility

It should be known that removal of one testis while the other one is normal, does not affect sexual activity or fertility. Fertility may be affected in case you undergo adjunctive chemotherapy or radiotherapy. Your therapist physician will inform you and suggest to make a sperm deposit to the sperm bank. Yet, in many patients fertility comes back to normal one year after the completion of chemotherapy/radiotherapy. 

Chemotherapy

Chemotherapy is cancer therapy by administering anti-cancer agents to eliminate ('kill') cancer cells or to prevent their proliferation. Your physician will tell you whether you belong to the group of patients  to undergo chemotherapy. The duration and type of therapeutic program depends on the type and stage of cancer at the time of diagnosis. 

Radiotherapy

Radiotherapy is a treatment using radiation to destroy cancer cells. Your physician will tell you whether your case is indicated for radiotherapy. 

Follow-up after therapy

After a successful therapy, regular follow-up is necessary so as to detect timely any potentially occurring cancer recurrence. Follow-up includes clinical examination, blood tests (to check tumor markers. Also, chest X-ray or CT scan may be required for confirming there is no relapse. 

What is the prognosis of Testicular Cancer?

The prognosis is usually very good. Thanks to the advancement of  chemotherapy, testicular cancer is today curable in more than 95% of cases. If it is diagnosed and treated early, its cure is taken for granted. But even when it has spread to other parts of the body, there are many chances that it can be cured, more than in other types of cancer. 

Learn about prevention of testicular cancer and self-examination!