Testicular Cancer

Testicular cancer involves a malignant tumor that starts in the cells of a testicle and can spread, or metastasize, to other parts of the body. Cells in a testicle sometimes change and no longer grow or behave normally. In some cases, these changes to testicle cells cause cancer.

More than 90 percent of all testicular cancers are germ cell tumors – the cells that make sperm. The two germ cell tumors that develop in the testicles are seminomas and non-seminomas.

Causes of Testicular Cancer

The cause of this testicular cancer is unknown. Testicular cancer mainly affects young men between the ages of 20 and 39. It is also more common in men with abnormal testicle development or a family history of testicular cancer. We know that men born with an undescended or partly descended testicle are five times more likely to develop testicular cancer.

Other research has suggested that there may be a hereditary factor involved and that if you have a father or brother who has developed the disease, you are at an increased risk. Any genetic or developmental abnormality, such as an extra chromosome at birth, can also put you at greater risk of developing testicular cancer.

Being young, Caucasian, and having a family history of testicular cancer are also risk factors for testicular cancer.

Signs and Symptoms of Testicular Cancer

The first sign of testicular cancer is usually a swelling of one of the testicles or a pea-sized hard lump on the front or side of a testicle. Other signs to look out for are a sudden collection of fluid in the scrotum, enlargement or tenderness of the breasts, and occasionally a dull ache or, even more seldom, acute pain in the abdomen or groin.

Testicular cancer may not cause any signs or symptoms in its early stages because the tumor is very small. Symptoms often appear once cancer grows into surrounding tissues and structures. Other health conditions can cause the same symptoms as testicular cancer. See your doctor if you have these symptoms:

• Painless lump in the testicle
• Swelling of the testicle
• Pain or a dull ache in the testicle or scrotum
• Feeling of heaviness in the scrotum or abdomen
• A buildup of fluid in the scrotum
• Enlarged lymph nodes in the neck
• Pain in the back or abdomen
• Trouble breathing or shortness of breath
• Cough, sometimes with blood (called hemoptysis)
• Chest pain and/or swelling
• Trouble swallowing
• A buildup of fluid around the lungs (pleural effusion) or in the abdomen (ascites)
• Weight loss
• Breast soreness or growth (gynecomastia)
• Signs of puberty in boys at an earlier age than expected, such as the voice getting deeper and the growth of facial and body hair
• Infertility

If you observe these symptoms, seeking medical treatment as soon as possible is essential. However, each symptom doesn’t necessarily point to testicular cancer. In conjunction with one another, however, the likelihood increases.

Sometimes, just one symptom is enough to warrant a doctor’s visit. For instance, an athlete may suffer pain in the abdomen or back, but that doesn’t automatically mean they have testicular cancer. On the other hand, if you notice a difference in your testicles, take precautionary measures and seek medical attention. It doesn’t need to be a lump or an enlargement of the testes to be considered a red flag.

Of course, you should seek medical attention for any unusual or unresolved pain in the lower back, groin, stomach, or scrotum.

Diagnosing Testicular Cancer

Testicular cancer can be a difficult diagnosis because there is no way to avoid it, prevent it, or monitor its initial development. While some doctors may advise you to be vigilant with self-examination, others say it will likely have no bearing on the ultimate detection and diagnosis of testicular cancer.

Like any cancer, testicular cancer should be diagnosed and treated as early as possible for the best outcome. If you notice any of the symptoms and signs described above, see a urologist as soon as possible.

How to Detect Testicular Cancer

Just as women are reminded throughout their adult lives to check their breasts for lumps, men must be vigilant in checking their testicles for signs of lumps or growth that could point to testicular cancer. Changes to the shape and presence of lumps may indicate an issue. Still, it’s important not to panic without a doctor’s screening and extensive imaging, as not even a lump means cancer, and not every change in your testicles is problematic.

Even people without known risk factors can still be affected by testicular cancer. All adult-aged men should check their testicles regularly regardless of risk factors.

Self-Screening

You can detect testicular cancer by doing a monthly testicular self-exam. To perform a self-exam, follow these steps:

• Do the exam after a warm shower or bath. The warmth relaxes the skin of the scrotum, making it easier to feel anything unusual.
• Use both hands to examine each testicle. Place your index and middle fingers underneath the testicle and your thumbs on top. Roll the testicle between your thumbs and fingers. (It’s normal for testicles to be different sizes.)
• As you feel the testicle, you may notice a cord-like structure on top and at the back of the testicle. This structure is called the epididymis. It stores and transports sperm. Please do not confuse it with a lump.
• Feel for any lumps. Lumps can be pea-size or larger and are often painless.
• Also, check for any change in size, shape, or consistency of the tests.
  On top of regular self-screenings, you should get a physical exam from your primary care physician at least once yearly. The earlier the cancer is caught, the more can be done to treat it.

If you start noticing changes in your testicles or symptoms that you believe may be troublesome, consult your doctor or urologist immediately.

Treating Testicular Cancer

The good news is that testicular cancer is highly treatable when caught early or if it has spread beyond the testicles. Your healthcare team will create a treatment plan based on your needs and may include a combination of different treatments. When deciding which treatments to offer for testicular cancer, your healthcare team will consider:

• The type of germ cell tumor (seminoma or non-seminoma)
• The stage of cancer
• The risk of recurrence
• Your wish to have children (fertility)
• Your personal preferences

Surgery for Testicular Cancer

The following types of surgery can be used to treat testicular cancer:

• Radical inguinal orchiectomy removes the testicle and spermatic cord: It is usually the first treatment for testicular cancer, and it is done to confirm the diagnosis.
• Retroperitoneal lymph node dissection (RPLND) This is the surgery to remove lymph nodes at the back of the abdomen (retroperitoneum). If the lymph nodes on the same side of the body as the tumor are removed, it is called ipsilateral RPLND. If the lymph nodes on both sides of the retroperitoneum are removed, it is called bilateral RPLND. This surgery may be done at the same time as the radical inguinal orchiectomy or later. RPLND can be part of the treatment for the early stages of testicular cancer. It can also be used to treat advanced testicular cancer after chemotherapy.
• Salvage surgery: This surgery removes cancer that remains after orchiectomy and chemotherapy. It may be done when testicular cancer doesn’t wholly respond to chemotherapy after an orchiectomy. Salvage surgery may include a bilateral RPLND.

Prevention of Testicular Cancer

Not enough is known about the causes of testicular cancer to suggest ways of preventing it. However, recent research has shown that if undescended testicles are corrected before a boy is ten years old, his risk of developing testicular cancer drops to an average of 1-in-450 before age 50.

If you think that you may have testicular cancer symptoms or have a family history of testicular cancer, call Charlotte Men’s Health for an appointment with Dr. Richard Natale at (704) 786-5131 or request an appointment online.