Testicle Cancer
Testicular cancer is a disease of younger men. Testicular cancer is most frequently seen in men ages 20 to 34. Young men should be advised to do regular self examination of the testicles to monitor for any changes in size, shape or discomfort within the testicle. Men with a history of an undescended testicle or a family history of testicular cancer should be particularly careful about self examination.
Most testicular cancers can be cured, even if diagnosed at an advanced stage.
How to do a testicular self exam
Once a month (or so)
Easily done in the shower
Feel one testicle, then the other.
The testicle should feel smooth and round. You should not feel and hard, lumpy, or very tender areas.
The epididymis is on the back of the testicle and should feel soft without nodules.
If you feel anything funny, call a doctor.
Voila! You are done. Get on with your life until next month.
The two main types of testicular cancers are seminomas and “mixed” germ cell tumors. These 2 types grow and spread differently and are often treated differently. Nonseminomas tend to grow and spread more quickly than seminomas. Seminomas are more sensitive to radiation as a form of treatment
Diagnosis of a a testicular cancer usually happens when a man feels a change in his testicles and makes an appointment for consulatation. Many testicular masses are easy to feel as hard, sometimes tender mass by the time a patient comes to the office. When we feel a mass that is suspicious we confirm the mass by scrotal ultrasound. We also draw blood for the tumor markers (AFP, HCG, LDH) that can help us differentiate whether the cancer is a pure seminoma or a mixed germ cell cancer. Tumor marker levels also help determine the clinical stage of cancer at presentation.
The next step in treatment is to remove the affected testicle. Surgery to remove the testicle (radical inguinal orchiectomy) is critical for initial diagnosis and staging. The testicle and its spermatic cord are sent to pathology to determine the subtype of cancer and the clinical stage.
A simple way to think about testicle cancer stages breaks down below:
Stage I: Confined to the testicle (and epididymis and cord without lymph node involvement), normal or mildly elevated tumor markers.
Stage II: Spread to lymph nodes (IIA <2 cm, IIB >2 cm), elevated tumor markers (AFP, hCG).
Stage III: Spread to distant organs (e.g., lungs, liver, brain), significant elevation in tumor markers.
Treatment for Testicle Cancer Involves:
Surveillance is closely following a patient's condition without giving any adjuvant (additional) treatment after initial removal of the testicle unless there are changes in test results. Surveillance is employed in early stage prostate cancer and exams and tests are given on a regular schedule to check for cancer recurrence or progression.
Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. Chemotherapy drugs enter the bloodstream and reach cancer cells throughout the body (systemic chemotherapy).
Surgery for testicle cancer most commonly would be a retroperitoneal lymph node dissection (RPLND), removal of the affected lymph nodes along the main blood vessels (aorta and vena cava) in the abdomen.
What option? When?
Stage I (Confined to the Testicle):
Seminoma: Orchiectomy followed by surveillance, carboplatin chemotherapy, or radiotherapy.
Non-seminoma: Orchiectomy, followed by surveillance or chemotherapy.
Stage II (Spread to Lymph Nodes):
Seminoma: Orchiectomy, followed by chemotherapy or radiotherapy.
Non-seminoma: Orchiectomy, followed by chemotherapy or RPLND (Retroperitoneal Lymph Node Dissection) if the tumor markers are normal and lymph nodes are small.
Stage III (Distant Spread):
Chemotherapybased on the risk group classification (good, intermediate, or poor).
Surgery (e.g., RPLND for residual disease) or radiotherapy may also be used depending on the organ involved.