Testicular Cancer

Testicular Cancer

Testicular Cancer

What is Testicular Cancer?

Testicles

Testicles are part of the male reproductive system. The testicles are 2 egg-shaped glands located inside the scrotum. The scrotum is a sac of loose skin that hangs beneath the base of the penis.

Functions:

  • They synthesize male hormones such as testosterone.
  • They make sperm.

Testicular Cancer

The growth of uncontrolled mutated cells in the testicles is called esticular Cancer. Almost all Testicular Cancers start in the germ cells. Compared with other types of Cancer, Testicular Cancer is rare and is highly treatable even when Cancer has spread beyond the Testicle.

Types of Testicular Cancer

  • Seminomas: Though this cancer is malignant, it is highly curable if detected at an early stage. Seminomas also have a good prognosis with patients stage I to stage IIB having a 5 year survival rate of 98% to 92%. These are very sensitive to radiation. Generally, it occurs in the age group 30-50 years.

    Types
    • Classical Seminoma: More than 95% of seminomas are classical. These usually occur in men between 25 and 45.
    • Spermatocytic Seminoma: This rare type of seminoma tends to occur in older men. The average age of men diagnosed with spermatocytic seminoma is about 65. Spermatocytic tumors tend to grow more slowly and are less likely to spread to other parts of the body.
  • Nonseminomas: They tend to grow and spread more quickly than seminomas. A testicular tumor that contains both seminoma and nonseminoma cells are treated as a nonseminoma. They are more likely to affect between teenage to early 40s. They grow and spread rapidly and possibly faster than seminomas.

    Types
    • Embryonal Carcinoma: Pure embryonal carcinomas occur only 3% to 4% of the time. This type of non-seminoma tends to grow rapidly and spread outside the testicle.
    • Yolk sac Carcinoma: This is the most common form of testicular cancer in children (especially in infants), but pure yolk sac carcinomas are rare in adults. When they occur in children, these tumors usually are treated successfully.
    • Choriocarcinoma: This is a very rare and aggressive type of Testicular Cancer in adults. Pure choriocarcinoma is likely to spread rapidly to distant organs of the body, including the lungs, bones, and brain.
    • Teratoma: Pure teratomas of the testicles are rare and do not increase AFP (alpha-fetoprotein)or HCG (human chorionic gonadotropin) levels. More often, teratomas are seen as parts of mixed germ cell tumors. They are further classified as:
      • Mature teratomas are tumors formed by cells similar to cells of adult tissues. They rarely spread to nearby tissues and distant parts of the body. They can usually be cured with surgery, but some come back (recur) after treatment.
      • Immature teratomas are less well-developed cancers with cells that look like those of an early embryo. This type is more likely than mature teratomas to grow into surrounding tissues, to spread outside the testicle, and recur years after treatment.
      • Teratomas with somatic type malignancy are very rare Cancers.

Occurrence Rate of Testicular Cancer in India

Testicular Cancer is a rare tumor type accounting for 1% of malignancies in men. India had the lowest incidence of 0.5 per 100,000 men. Testicular Cancer is increasing in incidence in many countries; however, mortality rates remain low and most men are cured. An in-depth understanding of the risks and long-term side effects of treatment are important in prognosis.

Anatomy of Testicular Cancer

Testicular CancerTesticular Cancer

What are the general symptoms of Testicular Cancer?

Detection of testicular cancer at an early stage is aided by the following symptoms:

  • A lump or enlargement in either testicle.
  • A feeling of heaviness in the scrotum.
  • 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.
  • Back pain.
What are the general causes of Testicular Cancer?

The exact causes of testicular cancer are yet not confirmed. However, there are a few factors that considerably increase the chances of getting the disease. Some of the risk factors are discussed below.

An undescended testicle (cryptorchidism):

The testicles usually develop inside the abdomen of the fetus and they descend into the scrotum before birth. Sometimes the testicle remains in the abdomen. In other cases, the testicle starts to descend but remains stuck in the groin area. Cryptorchidism with at least one testicle is found to the extent of 3% in prematurely born babies.

Undescended testicles continue moving down into the scrotum during the child’s first year of life. If the testicle has not descended by the time a child is a year old, it probably won’t go down on its own.

Males with cryptorchidism are several times more likely to get Testicular Cancer than those with normally descended testicles. In 90% of the cases, the undescended testis is confined to inguinal canal. It can be rectified through surgery.

Abnormal testicle development or Carcinoma in situ:

Carcinoma in situ (CIS) means that there are abnormal cells in the testicle. It isn't Cancer. There is no lump and usually no other symptoms.

These abnormal cells are completely contained. Unlike cancer cells, they can't spread, if left untreated CIS develops into cancer in about half (50%) the men who have it.

CIS is most often found when a man has a testicular biopsy to check for infertility. It can be treated by removing the testicle to prevent testicular cancer from developing.

Family history: If family members have had testicular cancer, you may have an increased risk.

Age: Testicular Cancer affects teens and younger men, particularly those between ages 20 and 35. However, it can occur at any age.

Race: Testicular Cancer is more common in white men than in black men. It is 4 to 5 times more in white man than that of black men or Asian-American men.

HIV or AIDS: Some evidence has shown that men infected with the human immunodeficiency virus (HIV), particularly those with AIDS, are at increased risk.

Injury to the testicles: Severe injury to the testicles can also cause Testicular Cancer.

Hypospadias: A congenital condition in males in which the opening of the urethra is on the underside of the penis.

Can Testicular Cancer be prevented?

Many cases ofTesticular Cancer have no known factors. Also, the known factors of Testicular Cancer are natural and beyond one’s control. So it becomes quite impossible to prevent most cases of Testicular Cancer.

Regular examination and treating cryptorchidism might reduce the chances of occurrence of Testicular Cancer.

What are the stages of Testicular Cancer?

Testicular Cancer can be staged as:

  • T refers to the spread of Cancer cells to tissues next to the testicle.
  • N describes the spread of Cancer cells to regional lymph nodes.
  • M indicates whether the Cancer has metastasized.
  • S indicates the serum levels of tumor markers that are made by some Testicular Cancers.

These stages are explained in details below:

T suffixed with a numerical or letter indicates the size and location of the tumor.

  • TX: The primary tumor cannot be assessed.
  • T0: There is no prominent evidence indicating a primary tumor.
  • Tis: Carcinoma in situ i.e. non-invasive cancer cells are detected in the testicles.
  • T1: The tumor has not spread beyond the testicle. The cancer might have grown through the inner layer surrounding the testicle, but it has not reached the outer layer covering the testicle.
  • T2: The cancer has spread to blood or lymph vessels near the tumor, or the tunica vaginalis.
  • T3: The tumor is growing into the spermatic cord which contains blood vessels, lymph vessels, nerves, and the vas deferens.
  • T4: The tumor is growing into the skin surrounding the testicles.

N stands for lymph nodes. Lymph is a fluid that flows from different tissues and organs of the body and eventually drains into the bloodstream. N indicated the size of the cancer cells and its size in the lymph node.

  • NX: Regional lymph nodes cannot be assessed.
  • N0: The mutated cells did not spread to regional lymph nodes.
  • N1: The Cancer has spread to at least one lymph node, but the size is limited to 2 cm.
  • N2: The Cancer has spread to at least one lymph node and the size ranges between 2 cm to 5 cm.
  • N3: The Cancer has spread to at least one lymph node that is larger than 5 cm.

M indicates if the cancer cells have spread to distant cells of the body.

  • MX: Distant metastasis cannot be evaluated.
  • M0: The disease has not metastasized to distant parts of the body.
  • M1: There is atleast 1 distant metastasis present in the body.
  • M1a: The tumor has metastasized to distant lymph nodes or to the lung.
  • M1b: The tumor has metastasized to other organs, such as the liver, brain, or bone.

S indicates the level of serum makers.

  • SX: Tumor marker levels are not available, or the tests have not been done.
  • S0: Tumor marker levels are normal.
  • S1: At least 1 tumor marker level is above normal.
  • S2: At least 1 tumor marker level is substantially above normal.
  • S3: 1 or more tumor marker level is very highly elevated.
Survival rates of Testicular Cancer?

Survival rates indicate an average outcome of a large number of people who had the disease, but they cannot precisely predict the expectancy of any particular case. Multiple factors may affect a person's outlook; however, the survival rate of testicular cancer is quite high.

Stage 5 year Survival Rate
Localized 99%
Regional 96%
Distant 73%

Here,

Localized means the cancer is still only in the testicle.

Regional means that the cancer has spread to nearby lymph nodes or tissues

Distant means that the cancer has spread to organs or lymph nodes away from the tumor.

Can Testicular Cancer be detected early?
  • Physical exam and history: The testicles are physically examined to check for lumps, swelling or pain. A history of the patient's health habits, past illnesses and treatments are also taken in account.
  • Ultrasound exam: High-energy sound waves are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
  • Serum tumor marker test: It is a procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. The following tumor markers are used to detect Testicular Cancer:
    • Alpha-fetoprotein (AFP).
    • Beta-human chorionic gonadotropin (β-hCG).
  • Inguinal orchiectomy: A tissue sample from the testicle is then viewed under a microscope to check for cancer cells. If cancer is found, the cell type seminoma or nonseminoma is determined in order to help plan treatment.
  • Biopsy: Biopsy is the removal of a small amount of tissue for examination under a microscope.
What are the Treatments available?

Depending on the type, stage of the cancer and other factors, treatment options for testicular cancer can include

  • Surgery
    • Surgery to remove the complete testicles is the primary treatment option for nearly all stages and types of testicular cancer. An incision in the groin is made and the entire testicle is extracted through the opening.
    • Surgery to remove nearby lymph nodes: An incision is made in the abdomen. Generally, extensive care is taken to avoid damaging nerves surrounding the lymph nodes but in some cases, it might be unavoidable.
  • Radiation therapy: Radiation therapy uses high-powered energy beams, such as gamma rays or X-rays, to kill Cancer cells. However, radiation therapy has got a few side effects as well that may include fatigue, as well as skin redness and irritation in your abdominal and groin areas. Radiation therapy is also likely to cause infertility.
  • Chemotherapy (chemo): Chemotherapy treatment uses drugs to kill Cancer cells. Chemotherapy drugs travel throughout your body to kill Cancer cells that may have migrated from the original tumor. Chemotherapy is also likely to cause infertility, which can be permanent.
  • High-dose chemotherapy and stem cell transplant: A stem cell transplant is a highly effective treatment for Testicular Cancer.
Is there curative treatment for Testicular Cancer?

Testicular Cancer is highly treatable, even when cancer has spread beyond the testicle. The most common method to treat Testicular Cancer is through surgery.

How frequently should one visit doctor for early diagnosis?

In case of experiencing any of the mentioned symptoms or having a prior or familial history of testicular cancer, a physical examination by a doctor is highly recommended.

How can I as a patient know it early?

Being aware of the signs and symptoms will definitely help a patient to suspect the disease. In some cases, men discover Testicular Cancer themselves, either unintentionally or while doing a testicular self-examination to check for lumps. In other cases, your doctor may detect a lump during a routine physical exam.

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