Testicular cancer is a type of cancer that develops in the testicles, which are the male reproductive glands located inside the scrotum. The testicles are responsible for producing sperm and testosterone, the primary male sex hormone. Testicular cancer typically begins in the germ cells, which are the cells that produce sperm. However, it can also develop in other types of cells within the testicles, such as the supportive tissues or hormone-producing cells.
Testicular cancer is relatively rare compared to other types of cancer, accounting for only around 1% of all cancers in men. However, it is the most common cancer in young men between the ages of 15 and 35. While it can occur at any age, it is most frequently diagnosed during this period. Testicular cancer is highly treatable, especially when detected early. However, prompt diagnosis and treatment are essential for the best possible outcome.
Types of testicular cancer
Testicular cancer primarily manifests in two main types: germ cell tumors and non-germ cell tumors.
a. Germ cell tumors
Germ cell tumors originate from the germ cells within the testicles, which are responsible for producing sperm. They constitute the majority of testicular cancer cases and are further divided into subtypes:
- Seminomas: Seminomas are a type of germ cell tumor that typically occurs in men between their late twenties and early forties. These tumors tend to grow slowly and are highly treatable, even in advanced stages. Seminomas are usually confined to the testicle and have a good prognosis.
- Non-seminomas: Non-seminomas encompass several subtypes, including embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, teratoma, and mixed germ cell tumors. Non-seminomas are often more aggressive than seminomas and may spread more quickly. They are typically diagnosed in younger men and may require more intensive treatment.
b. Non-germ cell tumors
Non-germ cell tumors develop from the supportive and hormone-producing tissues within the testicles, rather than from the germ cells themselves. While less common than germ cell tumors, they still represent a subset of testicular cancers. Examples of non-germ cell tumors include:
- Leydig cell tumors: Leydig cell tumors arise from the Leydig cells, which produce testosterone in the testicles. These tumors are usually benign (non-cancerous) but can occasionally be malignant.
- Sertoli cell tumors: Sertoli cell tumors develop from the Sertoli cells, which provide support and nourishment to the sperm-producing cells. Like Leydig cell tumors, Sertoli cell tumors are typically benign but can be malignant in some cases.
Causes of testicular cancer
The exact cause of testicular cancer is not fully understood, but several risk factors have been identified that may increase the likelihood of developing the disease. These risk factors include:
a. Undescended testicle (Cryptorchidism)
Men who were born with one or both testicles that did not descend into the scrotum (cryptorchidism) have a higher risk of developing testicular cancer. It is believed that the abnormal position of the testicle increases the likelihood of malignant transformation.
b. Family history
Having a family history of testicular cancer increases the risk of developing the disease. Men with a father or brother who has had testicular cancer are at higher risk compared to those without a family history. However, the majority of cases of testicular cancer occur in men without a family history of the disease.
c. Genetic factors
Certain genetic conditions, such as Klinefelter syndrome, may increase the risk of testicular cancer. Klinefelter syndrome is a chromosomal disorder in which males are born with an extra X chromosome (XXY instead of XY). Other genetic abnormalities may also contribute to an increased risk of testicular cancer.
d. HIV infection
Some studies have suggested a link between HIV infection and an increased risk of testicular cancer. The weakened immune system associated with HIV/AIDS may contribute to the development of certain types of cancer, including testicular cancer.
e. Environmental factors
Exposure to certain environmental factors may play a role in the development of testicular cancer, although the evidence is not conclusive. Some studies have suggested a possible link between exposure to pesticides, chemicals, or environmental toxins and an increased risk of testicular cancer. However, more research is needed to establish a clear causal relationship.
f. Testicular trauma or injury
There is limited evidence to suggest that trauma or injury to the testicles may increase the risk of testicular cancer. However, the association between testicular trauma and cancer development is not well-established, and more research is needed to clarify this relationship.
Symptoms of testicular cancer
Testicular cancer often presents with noticeable symptoms, although some cases may be asymptomatic and only detected during routine physical examinations or screenings. It’s important for men to be aware of the following potential symptoms of testicular cancer.
a. Lump or swelling in the testicle
The most common symptom of testicular cancer is the presence of a painless lump or swelling in one of the testicles. This lump may feel like a small, hard mass or a larger, softer swelling. It’s essential for men to regularly perform testicular self-examinations to detect any changes in the size, shape, or consistency of the testicles.
b. Pain or discomfort
While testicular cancer is often painless, some men may experience a dull ache or discomfort in the affected testicle or scrotum. This discomfort may be constant or intermittent and may radiate to the lower abdomen or groin area.
c. Changes in testicular size or shape
Testicular cancer can cause changes in the size or shape of the affected testicle. Men may notice that one testicle feels larger or heavier than the other, or that the affected testicle has become irregularly shaped or distorted.
d. Feeling of heaviness in the scrotum
Some men with testicular cancer may experience a sensation of heaviness, pressure, or fullness in the scrotum. This feeling may be accompanied by a sense of discomfort or unease.
e. Pain or discomfort in the lower abdomen or groin
In some cases, testicular cancer may cause pain or discomfort in the lower abdomen or groin area. This pain may be mild or moderate and may be aggravated by physical activity or prolonged periods of sitting or standing.
f. Breast enlargement or tenderness
Certain types of testicular cancer, such as germ cell tumors, can produce hormones that may cause breast enlargement or tenderness in men. This condition, known as gynecomastia, may occur in conjunction with other symptoms of testicular cancer.
Stages of testicular cancer
Testicular cancer staging is crucial for determining the extent of the disease and guiding treatment decisions. The staging system commonly used for testicular cancer is the TNM system, which assesses the primary tumor (T), nearby lymph nodes (N), and distant metastasis (M).
Stage 0 (Carcinoma in situ)
Cancer cells are confined to the innermost layer of tissue within the testicle and have not spread beyond the testicle. At this stage, the cancer is considered non-invasive and has not yet developed into a tumor. Carcinoma in situ is often detected incidentally during biopsies performed for other reasons and has an excellent prognosis with close observation.
Stage I
Cancer is confined to the testicle and may involve the epididymis or spermatic cord but has not spread to nearby lymph nodes or distant organs. Stage I is further divided into two sub-stages:
- Stage IA: Cancer is limited to the testicle and does not involve the blood vessels or lymphatic vessels. The tumor is smaller than 2 centimeters (cm) in size.
- Stage IB: Cancer has spread to blood vessels, lymphatic vessels, or both, within the testicle. The tumor may be larger than 2 cm in size but has not spread to nearby lymph nodes or distant organs.
Stage II
Cancer has spread to nearby lymph nodes in the abdomen or pelvis but has not spread to distant organs. Stage II is further divided into two sub-stages:
- Stage IIA: Cancer has spread to lymph nodes in the abdomen, pelvis, or both, but the largest lymph node containing cancer is less than 2 cm in size.
- Stage IIB: Cancer has spread to lymph nodes in the abdomen, pelvis, or both, and the largest lymph node containing cancer is 2 cm or larger in size.
Stage III
Cancer has spread to distant organs, such as the lungs, liver, or brain, and may also involve nearby lymph nodes. Stage III is further divided into two sub-stages:
- Stage IIIA: Cancer has spread to distant lymph nodes or to organs beyond the abdomen and pelvis, such as the lungs.
- Stage IIIB: Cancer has spread extensively to distant organs, such as the liver or brain, and may also involve nearby lymph nodes.
Prevention of testicular cancer
Preventing testicular cancer entirely is not always possible due to factors such as genetics and developmental abnormalities. However, there are measures individuals can take to reduce their risk and promote early detection.
a. Perform regular Testicular Self-Exams (TSE)
Men should become familiar with the size, shape, and texture of their testicles and perform monthly TSEs. A TSE involves gently feeling each testicle between the fingers and thumbs to detect any changes, such as lumps or swelling. Any abnormalities should be promptly reported to a healthcare provider.
b. Address risk factors
Men with known risk factors for testicular cancer, such as a family history of the disease or a personal history of undescended testicles (cryptorchidism), should discuss their risk with a healthcare provider. Regular screenings or surveillance may be recommended for individuals with elevated risk.
c. Protect against HIV
Some studies suggest a link between HIV infection and an increased risk of testicular cancer. Practicing safe sex, using condoms, and avoiding high-risk behaviors can help reduce the risk of HIV infection and potentially lower the risk of testicular cancer in certain individuals.
d. Maintain a healthy lifestyle
Adopting healthy habits, such as eating a balanced diet, maintaining a healthy weight, and engaging in regular physical activity, may help reduce the risk of cancer overall. A diet rich in fruits, vegetables, whole grains, and lean proteins provides essential nutrients and antioxidants that support overall health and may lower cancer risk.
e. Avoid exposure to environmental toxins
While the evidence is limited, some studies suggest a possible link between exposure to certain environmental toxins, such as pesticides or chemicals, and an increased risk of testicular cancer. Minimizing exposure to potential carcinogens in the workplace, home, or environment may help reduce the risk of cancer.
f. Regular medical check-ups
Routine medical check-ups allow healthcare providers to monitor overall health and detect any abnormalities or changes that may warrant further evaluation. Men should discuss their risk factors for testicular cancer with a healthcare provider and adhere to recommended screening guidelines.
Diagnosis of testicular cancer
The diagnosis of testicular cancer typically involves a combination of medical history review, physical examination, imaging tests, and laboratory tests
a. Medical history and physical examination
A healthcare provider will begin by taking a thorough medical history, including any symptoms experienced and any relevant risk factors, such as family history or previous testicular conditions. A physical examination will be performed to assess the testicles, scrotum, and groin area for any abnormalities, such as lumps, swelling, or changes in size or texture.
b. Ultrasound imaging
If a lump or abnormality is detected during the physical examination, the next step is often to perform an ultrasound of the scrotum. Ultrasound imaging uses high-frequency sound waves to create detailed images of the testicles and surrounding tissues. This imaging test can help determine the size, location, and characteristics of any masses or abnormalities within the testicles.
c. Blood tests
Blood tests may be used to measure levels of certain tumor markers that are often elevated in men with testicular cancer. The most commonly measured tumor markers for testicular cancer include:
- Alpha-fetoprotein (AFP): Elevated levels of AFP may indicate the presence of certain types of testicular cancer, such as non-seminomatous germ cell tumors.
- Beta-human chorionic gonadotropin (β-hCG): Elevated levels of β-hCG may be present in both seminomatous and non-seminomatous germ cell tumors.
- Lactate dehydrogenase (LDH): LDH levels may be elevated in various types of cancers, including testicular cancer. However, LDH is not as specific to testicular cancer as AFP and β-hCG.
These blood tests help healthcare providers assess the type of testicular cancer, monitor the response to treatment, and detect any recurrence of the disease.
d. Biopsy
In some cases, a biopsy may be performed to confirm the presence of cancer cells. A biopsy involves removing a small sample of tissue from the testicle for examination under a microscope by a pathologist. However, biopsies are not commonly performed for testicular cancer due to the risk of spreading cancer cells. Instead, the diagnosis is often based on imaging tests, blood tests, and the presence of characteristic symptoms.
e. Imaging studies
Additional imaging studies, such as computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, or positron emission tomography (PET) scans, may be performed to evaluate the extent of the disease and determine if cancer has spread to other parts of the body, such as nearby lymph nodes or distant organs, such as the abdomen, pelvis, or chest.
f. Consultation with a specialist
Depending on the findings of the diagnostic tests, the patient may be referred to a urologist, oncologist, or other specialists for further evaluation and management. A multidisciplinary team approach involving various healthcare professionals is often employed to develop a comprehensive treatment plan tailored to the individual needs of the patient.
Treatment of testicular cancer
The treatment of testicular cancer typically involves a multidisciplinary approach and depends on several factors, including the type and stage of cancer, the patient’s overall health, and personal preferences.
a. Surgery (Orchiectomy)
The primary treatment for testicular cancer is surgical removal of the affected testicle, a procedure called orchiectomy. During orchiectomy, the entire testicle containing the tumor is removed through an incision in the groin. In most cases, only one testicle is affected, and removal of the affected testicle does not affect fertility or the ability to have an erection or orgasm. However, if both testicles are affected, hormonal therapy may be needed to replace testosterone.
b. Chemotherapy
Chemotherapy involves the use of powerful drugs to kill cancer cells or stop them from growing and dividing. Chemotherapy is often used after surgery to destroy any remaining cancer cells or to treat cancers that have spread beyond the testicle. The specific chemotherapy drugs and treatment regimen depend on the type and stage of cancer. Common chemotherapy drugs used to treat testicular cancer include cisplatin, etoposide, and bleomycin.
c. Radiation therapy
Radiation therapy uses high-energy rays, such as X-rays or protons, to kill cancer cells or shrink tumors. It may be used in some cases to treat seminomas, particularly if the cancer has spread to nearby lymph nodes. However, radiation therapy is less commonly used than surgery or chemotherapy for the treatment of testicular cancer.
d. Stem cell transplantation
In some cases, high-dose chemotherapy may be used to treat testicular cancer. High-dose chemotherapy kills cancer cells but also destroys healthy blood-forming stem cells in the bone marrow. To restore healthy bone marrow function, a stem cell transplant may be performed. Stem cells may be collected from the patient’s own blood (autologous transplant) or from a donor (allogeneic transplant) and then infused into the patient’s bloodstream after chemotherapy.
Conclusion
Testicular cancer is a significant health concern that primarily affects younger men but can occur at any age. Despite its rarity compared to other cancers, testicular cancer requires prompt diagnosis and appropriate treatment for optimal outcomes. By staying informed and proactive about their health, men can reduce their risk of testicular cancer and improve their chances of successful treatment and long-term survival.
