Testicular Cancer

Testicular cancer is a malignancy that develops in the testicles, part of the male reproductive system. It presents mainly in males aged 20 to 34 and is highly treatable, with a five-year survival rate of approximately 95% in the United States. However, treatment may result in infertility.

Signs and Symptoms

One of the first signs of testicular cancer is often a lump or swelling in the testes.

The U.S. Preventive Services Task Force recommends against routine screening for testicular cancer in asymptomatic males, but the American Cancer Society suggests monthly self-exams for those with a family history of cancer. Symptoms may include:

• A lump in one testis, which may or may not be painful.
• Sharp pain or a dull ache in the lower abdomen or scrotum.
• A feeling of "heaviness" in the scrotum.
• Firmness of the testicle.
• Breast enlargement (gynecomastia) due to hormonal effects.
• Low back pain, indicating possible spread to lymph nodes.

If the cancer spreads to other organs, symptoms may also include shortness of breath, cough, coughing up blood due to lung metastasis, and a lump in the neck from lymph node metastasis.

Causes

A major risk factor is cryptorchidism (undescended testicles). Other risk factors include inguinal hernias, Klinefelter syndrome, and mumps orchitis. Physical activity is associated with decreased risk, while sedentary lifestyle increases risk. Higher rates of testicular cancer in Western nations have been linked to cannabis use.

Diagnosis

Diagnosis typically begins with the detection of a lump or mass in the testicle. Imaging studies like scrotal ultrasound, blood tests for tumour markers (e.g., alpha-fetoprotein, human chorionic gonadotropin), and CT scans to locate metastases are employed.

Inguinal orchiectomy, the surgical removal of the testicle, is preferred over biopsy to prevent the spread of cancer cells. Post-surgery, the tumour is staged according to the TNM Classification of Malignant Tumours.

Treatment

Surgery

The primary treatment is the surgical removal of the affected testicle (orchiectomy). In cases of non-seminomas, retroperitoneal lymph node dissection (RPLND) may be performed to remove lymph nodes in the lower abdomen.

Adjuvant Treatment

Adjuvant treatment with chemotherapy or radiotherapy is often recommended to eliminate any remaining cancer cells. The choice depends on the tumour's histology and stage. Surveillance with periodic CT scans and blood tests may be an alternative to adjuvant treatment in less advanced cases.

Radiation Therapy

Radiation therapy is mainly used for stage II seminomas or as adjuvant therapy for stage I seminomas. However, it is ineffective against non-seminomas.

Chemotherapy

For advanced non-seminomas, chemotherapy protocols such as Bleomycin-Etoposide-Cisplatin (BEP) are standard. For seminomas, adjuvant chemotherapy with carboplatin is increasingly used due to fewer long-term side effects compared to radiation therapy.

Prognosis

Testicular cancer has a high cure rate, with more than 95% of cases cured and around 80% for metastatic disease. Surveillance is very important for detecting relapses early, particularly for stage I cancers. Sperm banking may be advised for those undergoing treatments that may affect fertility.

Psychological Factors

The psychological impact of testicular cancer and its treatments can be profound. Issues such as diminished masculinity, altered sexual identity, and body image concerns can lead to anxiety and depression. Fear of recurrence is common, affecting one-third of survivors significantly. However, many survivors also report personal growth and positive lifestyle changes post-recovery.

Epidemiology

Testicular cancer is most common in men aged 15–40 years, with the highest prevalence in the U.S. and Europe. Incidence has doubled since the 1960s, particularly in Scandinavia, Germany, and New Zealand. In the UK, approximately 2,000 cases are diagnosed annually, with less than 1% of cancer deaths in men attributed to testicular cancer.

Other Animals

Testicular tumours also occur in other animals, such as horses, where they include interstitial cell tumours and teratomas.

---

Self-assessment MCQs (single best answer)

What age group is primarily affected by testicular cancer?

Which of the following is NOT a common symptom of testicular cancer?

What is the major risk factor for developing testicular cancer?

Which diagnostic method is preferred to prevent the spread of cancer cells in testicular cancer?

Which treatment is NOT typically used for non-seminomas?

What is the standard chemotherapy protocol for advanced non-seminomas?

What percentage of testicular cancer cases are cured in the United States?

Which of the following is a psychological issue commonly faced by testicular cancer survivors?

Which organisation recommends monthly self-exams for those with a family history of testicular cancer?

In the UK, how many cases of testicular cancer are diagnosed annually?