Testicular Cancer

Testicles or testes are a part of the male reproductive organs. Behind the penis, at its base, is a sac-like structure, called the scrotum, which holds two testicles on each side. The testis (singular) is responsible for the production of sperm and testosterone.

Testicular cancer originates in either a single or both of the testicles. More than often, the start in the sperm-producing germ cells of the organ.

There are the following types of testicular cancers depending upon the growth, nature and location of existence.

Germ Cell Tumour: Majority of the testicular cancer cases (90% of them, as suggested by research) start in the germ cells of the testes. These cells are responsible for producing sperms. There are generally a few types of germ cell tumours. These are:

Seminomas: seminomas are slow growing tumours. They do not metastasize quickly. Seminomas can increase the levels of Human Chorionic Gonadotrophin or HCG in the blood. This hormone (HCG) is, therefore, considered a marker for testicular cancer and is used for diagnosis and screening. Seminomas can be further divided into two subtypes. These are:

• Classical (or typical) seminomas
• Spermatocytic seminomas

Non seminomas: These cancers are more commonly seen in males in late teens. These can be further divided into 4 subtypes. Non-seminoma cancers are either of these subtypes or a combination of these. These are:

• Embryonal carcinoma
• Yolk sac carcinoma
• Choriocarcinoma
• Teratoma

Carcinoma In Situ: Carcinoma in situ is also known as Intratubular germ cell neoplasia. This is a noninvasive disease in the germ cells, which may or may not develop into cancer. In testicular in situ carcinoma, the structure of the germ cells appear abnormal, when seen under a microscope. The name intratubular germ cell neoplasia comes from the seminiferous tubules, the tubes where sperms are produced.

Stromal tumours: Stroma are the supportive and hormone producing cells of the testicles. The tumours that originate here are called the gonadal stromal tumours. They account for 5% of adult testicular cancer. They are of two types:

• Leydig Cell tumours
• Sertoli Cell tumours

Secondary testicular cancers: Secondary testicular cancers are the ones that start in other body parts and spread to the testicular tissue.

Symptoms of testicular cancer include the following signs:

• A lump in the testicles
• Enlargement of the testicles
• Abdominal pains
• Pain in the groin
• Fluid collection in the scrotum
• Pain in the discomfort
• Back pain

Pain and discomfort in the scrotum, groin and surrounding areas, without in any external injury is not common and should be checked immediately. If you are experiencing any of these signs and symptoms, we suggest that you get yourself checked immediately.

The screening and diagnosis of testicular cancer can include the following tests and procedures:

Physical Examination: A complete examination of the body to check for any signs of infection, lumps, lesions, or any unusual signs in the body, especially the scrotum and testicles is done.

Medical History: A complete medical history of the patients and the family, their diseases, medications and treatment regimens will also be taken by our specialist.

Serum tumour marker test: The serum tumour marker test is a blood test to measure the amount of certain substances (chemicals and hormones) released by organs, tissues or cancerous cells in the body. These substances are linked to tumour cells and cancers and are called tumour markers. There are the following types of tumour markers that can be used to detect testicular cancers:

• Alpha fetoprotein or AFP
• Beta human chorionic gonadotrophin (beta HCG)

Inguinal orchiectomy: Once the tumour markers are tested, a procedure called Inguinal orchiectomy is performed to remove the testicle. It is a type of biopsy. This is done by making a small incision in the groin area. The testicle tissue is then viewed under a microscope to check for cancer cells and their type. This procedure will help in determining the future course of action for the treatment of cancer.

Imaging tests:

• Ultrasound: High energy sound waves are used to create images of the human body, organs and tissues with the help of echoes. These echoes form a sonogram, which gives a view of the tissues. Other imaging tests that can be used are:
• X- Ray
• MRI
• PET Scan

A few risk factors and causes that are known for testicular cancer are:

• An undescended testicle: When a male fetus is growing in the womb, the testicles develop outside the scrotal sac and then transcend into the scrotum before birth. In a few cases, the testicles are not able to transcend. This increases the risk of testicular cancer. Although the testes are moved into the scrotal sac surgically, the risk does not fade away. This condition is also called cryptorchidism. However, a large percentage of a male who has testicular cancer do not have a history of undescended testicles.
• Abnormal testicle development: Conditions such as Klinefelter’s syndrome may cause the testicles to develop abnormally, putting the individual at a higher risk of testicular cancer.
• Family History: If an immediate family member has developed cancer, it increases the risk of cancer.
• Age: Although, testicular cancer can occur at any age, but is more commonly seen in men between the ages of 15 and 35.

Based on the screening and diagnosis, which confirms the type, stage and origin of cancer, a single or a combination of treatments will be recommended by our specialists. These treatments will also be based on an individual’s persona and family medical history. The commonly used treatments are:

Surgery: Surgery might be suggested to remove either one or both of the testicles, entirely. A few surrounding lymph nodes and healthy tissue may also be removed as a preventive measure to stop cancer from spreading any further.

Radiation Therapy: Radiation therapy is the use of high energy rays to kill cancerous cells. These radiations can be both- internal or external. In external radiation, a machine is made to target the radiations directly at the cancerous area. In internal radiation, a small seed or device filled with radioactive substances is placed in the cancerous area. This allows the radiations to target the cancer cells locally. This treatment is more common in treating seminomas.

Chemotherapy: Chemotherapy is the use of drugs and medicines to kill the cancer cells. It is a type of systemic treatment. Systemic treatment is one where the cells that have travelled to other body parts can also be killed. Chemotherapy drugs can be taken either orally or through the IV route. The medicine travels through the bloodstream.

In advanced stages of cancer, stem cell treatments may be suggested along with chemotherapy to administer healthy cells in the body.

There is no particular way to prevent testicular cancer. However, regular screenings, if a person is at high risk, can prevent any complications.