Testicular cancer is the most common malignancy in men aged 15-35 years. It has an incidence of approximately 6 in 100,000 men, and is slightly more common in men who had an undescended testis. The tumours are bilateral in 2% of affected men.
Are there different types of testicular tumours?
Testicular cancer is generally divided into two types:
Germ Cell tumours.
Non-Germ Cell tumours.
90-95% of all testicular tumours are germ cell tumours.
Germ Cell Tumours are further divided into the following categories:
Seminoma – the most common – 40%.
Teratocarcinoma – 25-30%.
Embryonal carcinoma – 20-25%.
Teratoma – 5-10%.
Choriocarcinoma – 1%.
Yolk sac tumours – more common in children.
Of course, many testicular tumours comprise a mixture of the different types and are known as Mixed Germ Cell Tumours.
What are the symptoms?
Most men present with a painless lump in their testis. They usually discover it unexpectedly, often in the shower. Occasionally, the mass is noticed after trauma to the testis – it is not thought that the trauma causes the tumour, rather that it was the incident that brought the already present tumour to light.
Occasionally, a man may experience some of the following:
Dull ache in the testis.
Heaviness in the lower abdomen.
Acute sharp pain – that is often suspected to be “torsion” (twisting) of the testis.
Swelling in the scrotum – a “reactive” hydrocele.
The last three only occur if the tumour has spread to other parts of the body.
What tests are needed?
An ultrasound is usually the first test performed. It readily conforms the present of the tumour and excludes other problems in the scrotum.
Apart from general blood tests – Full Blood Count (FBC); renal & liver function tests, there are a number of specific blood tests that are performed if testicular cancer is present. They are:
ß-HCG – Beta Human Chorionic Gonadotropin.
AFP – Alpha Foetoprotein.
LDH – Lactate dehydrogenase.
These are helpful in deciding best treatment options, as well as providing a method of monitoring response to therapy.
An abdomino-pelvic and chest CT scans are essential to the assessment of a man with testicular cancer. The lymph drainage of the testes is to abdominal lymph nodes near the kidney (not locally in the groin) and these can only be assessed in this fashion.
Occasionally other scans such as bone, cerebral etc. are required depending on the individual man’s needs.
How is it treated?
For the majority of men the only treatment that is required is the removal of the affected testis. This is a straightforward procedure with a quick recovery time.
Retro-peritoneal Lymph Node Dissection (RPLND)
Some men will require the draining lymph nodes to be removed as well as the offending testis. It is usually done when the pathology of the cancer is known and spread to the lymph nodes has occurred. This is major surgery and much discussion will be had with your treating doctors before proceeding.
Some men will require chemotherapy. The need for this depends on both the type of testicular cancer and where it has spread in the body.
This is usually only offered to some men with particular presentations of seminoma.
Testicular cancer is one of the most treatable of cancers. There is more than a 95% cure rate – even if the cancer has spread quite widely through the body.
Remember Lance Armstrong (despite his recent fall from grace) had metastatic testicular cancer that had spread to his brain and spine before being treated. He went on to win seven Tour de France events.