Testicular Cancer

What is testicular cancer?

Testicular cancer is cancer of testicles, which are male reproductive organs that hang below the penis in a sac called Scrotum.

How serious is the problem of testicular cancer?

Testicular tumors are the most common malignancy in the young male aged between 15-34 years. The germ cell tumors are the most common testicular tumor. The treatment of testis cancer has improved dramatically over the last 25 years, with cure rates approaching as high as 95% in early stage of germ cell tumor this success in treatment is the result of multimodality therapy that may include Cisplatinum- based chemotherapy, surgery and radiotherapy.

What are the types of testicular Cancers?

Testicular cancers are categorized into 2 groups.

1. Seminoma,br> 2. Non-seminoma.

They both originate from Germ cells, which are the cells present in the testis with potential to grow and develop into larger numbers of different tissues and organs in the fetus. Nearly 50% of these tumors are pure seminomas.
Non-seminomatous tumors are faster growing than seminomatous tumors and have a higher tendency to spread to other parts of the body. The serum tumor markers such as α-feto protein, B-HCG can help in differentiating these 2 categories of tumors as treatment option in early stage may differ.

What leads to testicular cancer?

1. Your sibling has testicular cancer.
2. Testis is formed inside the abdomen and it then descends to the skin pouch under the male organ (Penis) called Scrotum before birth. If it fails to descend into the sac, then it is called undescended testis. All parents should feel for the testicles in a male newborn if there is no pediatrician available at the time of birth of a baby, which is very common in our country.
3. If you have a cancer in one testis then other testis stands a chance of developing cancer again. Best way to look for the development of testicular cancer is do self-examination every day while taking a bath, where one needs to see for change in the size of the testis.

What are the symptoms of testicular cancer?

Early cancers may not produce any symptoms. If you have an undescended testis or one of your sibling has suffered from testicular cancer then you should meet Urologist.

Warning signs for testicular cancers are
1. Painless enlargement of the testis
2. Feeling of heaviness in the sac
3. Appearance of men boobs

What are the lab tests to diagnose testicular cancer?

1. Clinical examination is the best test: You should see a doctor if you have increase in the size (one is bigger than other) of the testis. More often than not, increase in the size is misdiagnosed as hydrocele and one should insist in getting an ultrasonography of the sac to see for the testicular cancer. You can see in above picture that a surgeon treated this patient with the diagnosis of hydrocele without getting one ultrasound done, and knife went through the cancer and resulted in such complication.

2. Ultrasonography of the testicles: This is a very important test available widely. It can pick up small lesions even before the enlargement of the testicles. It can also identify calcifications in the testicles, which may have some significance in follow up.

3. Blood test: There are tumor markers like Alpha Feto Protein (AFP) or Human Chorionic Gonadotropin (HCG), which are raised in some testicular tumors.

4. CT scan: Contrast enhanced CT scan is useful to stage the cancer and plan a treatment. The testicular cancer spreads to lymph nodes present in the back side of the abdomen along the side of the vertebral column. These lymph nodes are second station to the spread of cancer once it leaves the testicle. Many young patients with large mass in this area are misdiagnosed as other abdominal cancers when a simple clinical examination of the scrotum is ignored.

5. X-ray Chest: It is done to stage the cancer as testicular cancer goes to the lungs quite commonly. CT chest can also be considered depending upon clinical situation.

6. PET CT: PET CT is not useful in initial diagnosis but rather it is done in patients with Seminoma, who have received chemotherapy and have a residual mass in the abdomen.

What is the treatment for testicular cancer?

Your urologist will stage the cancer and stratify the risk category before instituting the treatment. The first and the foremost treatment option is to get the affected testis removed, which is called high orchiectomy or radical orchiectomy.
Once the pathology report is available then the need for further therapy is decided depending upon stage and pathological type of the cancer. Broadly, radiation and chemotherapy are the 2 mainstay of treatment. Though both the types of testicular tumors are very sensitive to chemotherapy, seminomatous tumors responds better to radiation therapy than non-seminomatous tumors in early stage.
Some patients with non-seminoma tumors with small size lymph nodes in the back of the abdomen, may require removal of those lymph nodes by surgery called retroperitoneal lymph node dissection (RPLND). This can also be done with laparoscopy or robot assistance.

Radiotherapy:

Radiation uses X-rays to kill cancer cells. The goal of radiation for testicular cancer is to kill cancer cells that have spread to lymph nodes.

Chemotherapy:

It is given in patients with large lymph nodal metastasis in the back of the abdomen. Most of the tumors respond to chemotherapy and they disappear completely but some may shrink to smaller size, which can be taken out by surgery called retroperitoneal lymph node dissection (RPLND).

What is the role of laparoscopy and Robotic surgery?

Main role of surgery in testicular tumor after an initial removal of the testis (radical orchiectomy) is in removing lymph nodes in the back of the abdomen. This can be achieved by open surgery after giving a very large incision in the middle of the belly (as shown in the picture) or by Laparoscopy or Robot assistance; where in the incision would not be that long and recovery would be faster than those having open surgery.

How is life after being diagnosed with Testicular cancer?

Testicular cancer is one of the most responsive cancers to chemotherapy With combination of treatment like surgery, chemotherapy and radiation, one can live almost a normal life.

Will I lose my potency?

Testicular cancer may affect fertility for a while but it does not affect your sexual performance.

Should I get my sperms preserved?

1. As testicular cancer involves younger men, removal of one testis does not affect their ability to father a child.
2. If cancer is occurring in solitary testis, which requires it’s removal or if a you are planned for chemotherapy, then sperms can be preserved in sperm bank for future.