Testicular | Chris O'Brien Lifehouse

This information has been prepared to help you understand more about testicular cancer.

Many men feel understandably shocked and upset when they are told they have testicular cancer. This information is intended to help you understand the diagnosis and treatment of this type of cancer.

We cannot advise you about the best treatment for you. You need to discuss this with your doctors. However, we hope this information will answer some of your questions and help you think about the questions you want to ask your doctors or other health carers.

The testicles

The testicles (also called testes or a testis, if referring to one) are part of the male reproductive system. These two small, egg-shaped glands sit behind the penis in a pouch of skin called the scrotum.

The tube that runs from the each testicle to the penis is called the spermatic cord. It contains blood vessels, nerves, lymph vessels and a tube called the vans deferens, which carries sperm towards the penis.

The testicles have two main functions:

  • to make and store sperm; and
  • to produce testosterone (the male sex hormone).

Testosterone promotes the development of male sex characteristics such as a deep voice, facial hair and muscles

There are many lymph nodes (glands) and vessels in the area around the testicles and in the abdomen. These nodes and vessels play an important role in resisting and fighting disease (immunity). They drain fluid from the tissues back into the bloodstream.

What is testicular cancer?

Cancer that develops in a testicle is called testicular cancer. Usually only one testicle is affected, but in some cases, both testicles are affected

Most testicular cancers start in the cells that develop into sperm, called germ cells.

Types of testicular cancer

The most common tumours that form in the testicles are called germ cell tumours. Germ cell tumours can be divided into two categories

Seminoma: usually occurs in men aged between 25 and 50 years, but also occurs in men over 60.

Non-seminoma: more common in younger men, usually in their 20s. Non-seminoma is made up of other sub-types of testicular cancer that are grouped together, including:

  • choriocarcinoma
  • embryonal carcinoma
  • teratoma
  • yolk sac tumour

Sometimes a testicular cancer can be a mix of seminoma and non-seminoma cells or a combination of the different types of non-seminoma.

How common is it?

If you would like to read any facts or statistics about testicular cancer, please refer to the Cancer Institute NSW website:

http://www.cancerinstitute.org.au/cancer-in-nsw/cancer-facts/testicular-cancer

Causes

The exact causes of testicular cancer are unknown, however some factors will increase your risk of developing it:

  • Undescended testicles – by birth or within the first year of life, testicles usually move down into the scrotum. If the testicles don’t descend by themselves, doctors can perform an operation to bring them down. While this procedure reduces your risk of developing testicular cancer, your risk is still higher than men who were born with descended testicles.
  • Personal history – about 2-3% of men who previously had testicular cancer later develop cancer in the other testicle.
  • Family history – if your father or brother has had testicular cancer you are slightly more at risk. You may wish to discuss screening options with a genetic counsellor and/or urologist.
  • Human immunodeficiency virus (HIV) – there is some evidence HIV may increase your risk.
  • Some congenital defects – men born with hypospadias (an abnormality of the penis) are about twice as likely to develop testicular cancer.

There is no known link between testicular cancer and injury to the testicles, sporting strains, hot baths, wearing tight clothes, sexual activity or having a vasectomy.

Symptoms

Some men do not experience any symptoms of testicular cancer. Others may notice one of more symptoms, including:

  • swelling or lump in the testicle (usually painless)
  • a feeling of heaviness in the scrotum
  • change in the size or shape of the testicle (e.g. hardness or swelling)
  • a feeling of unevenness
  • pain or ache in the lower abdomen, testicle or scrotum
  • enlargement or tenderness of the breast tissue
  • back pain
  • stomach-aches

These symptoms are common to several conditions, such as cysts, which are harmless lumps. However, if you notice any of these symptoms you should see your doctor. Your doctor will be able to arrange further tests.

Diagnosis

Initial examination

In most cases your GP will conduct the first examinations to diagnose testicular cancer. You GP will check the testicle and scrotum for lumps or swelling while wearing a rubber glove. If your GP notices any suspicious lumps you will probably be referred to a urologist for further tests. Urologists are doctors who specialise in the urinary and male reproductive systems.

Further tests

If you are referred to a urologist, they will arrange some further tests. You may have one or more of the following tests or procedures:

Ultrasound

A scan that uses soundwaves to build up pictures of your organs. A gel is spread over your scrotum and a device called a transducer is moved over the area for a few minutes. The transducer sends out soundwaves that echo when they encounter something dense, such as an organ or tumour. A computer can then create a picture using the echoes.

Ultrasounds are painless and take approximately 15 minutes.

Blood Tests

Blood tests may be conducted to check your general health and how well organs (such as your kidneys) are working.

Tumour markers

Some types of testicular cancer produce chemicals that are released into the blood. These chemicals are often described as tumour markers, as they are produced at much higher levels when cancer is present.

If your blood test shows an elevated level of these chemicals, you may have testicular cancer. However, other factors may also cause your tumour markers to rise, such as liver or blood diseases.

Raised tumour markers are more common in non-seminoma and mixed tumours than in seminomas. It is also possible to have testicular cancer without having raised tumour markers.

If you are diagnosed with testicular cancer, you will have regular blood tests to monitor levels of tumour markers. Tumour markers will decrease if your treatment is successful and increase if the cancer is active. Blood test for tumour markers will continue throughout treatment and remission.

Orchidectomy (removal of the testicle)

None of the tests described above can provide a definitive diagnosis of testicular cancer. The only way this can be done is the surgical removal of the affected testicle.

Most other types of cancer are diagnosed by removing a small piece of tissue from the tumour (biopsy). There is a small risk that, by cutting through the scrotum to biopsy the testicle, the cancer cells will spread.

Instead, the urologist will remove your whole testicle in an operation called an orchidectomy or orchiectomy. In cases where both testicles are affected, your urologist may decide to remove both of them (bilateral orchidectomy). However, this procedure will affect your fertility, so you should discuss it with your doctor.

An orchidectomy is usually done under a general anaesthetic. A cut (or incision) is made in the groin and the testicle is pulled up and out of the scrotum and removed through the incision. The tissue removed during surgery is sent to a specialist (a pathologist) who examines the cells under a microscope and provides information about the suspected cancer.

 

Imaging tests

If the ultrasound, blood tests and/or the removal of the testicle show you have testicular cancer, other tests will be carried out. The tests will show the extent of the cancer in your body and if it has spread to other parts of the body. You may have one or more of these tests before an orchidectomy.

CT scan

A CT (computerised tomography) scan is a procedure that uses X-ray beams to compile many pictures of the body. CT scans are useful for checking whether or not cancer has spread to other organs and tissues.

You may have an injection of a special dye into your veins before the scan. The dye will help to make the picture clearer. You will be asked to lie still on a table while the CT scanner, which is large and round like a doughnut, slowly moves around you. A CT scan is painless and takes about 30-40 minutes.

Chest X-ray

A chest X-ray may be used to see whether cancer has spread to your lungs or lymph nodes in the chest. It only takes a few minutes and is painless and safe.

PET scan

A PET (positron emission tomography) scan highlights abnormal tissues in the body. This type of scan is not available in all hospitals and is not commonly used for testicular cancer. However, some doctors will use a PET scan after treatment if your tumour markers are elevated or if they are not sure of the full extent of your cancer.

Prior to the scan, you will be injected with a glucose solution containing a small amount of radioactive material. After the solution has circulated throughout your body you will undergo a full body scan.

Stages of testicular cancer

The removal of the testicle and the results of the other tests will tell the doctor how far your cancer has spread (the stage). Your treatment will depend on the stage of your cancer.

Stage 1 – the cancer is found only in the testicle.
Stage 2 – the cancer has spread to the lymph nodes in the abdomen or pelvis
Stage 3 – the cancer has spread beyond the lymph nodes to other areas of the body such as the lungs, liver or brain.

Prognosis

Prognosis means the expected outcome of a disease. Of all the solid organ tumours, testicular cancer is the most curable. If the cancer is found when it is still in the testicle (Stage 1), 97% of men are cancer-free after treatment. In most other cases, tumours can be controlled or shrunk with treatment.

You can discuss your prognosis with your doctor, who will consider factors such as your test result, the type of testicular cancer you have, the stage of cancer and other factors such as age, fitness and medical history. However, it is not possible for anyone to give you an accurate prediction on the course of your illness.

Which health professionals will I see?

You will be cared for by a range of health professionals who specialise in different aspects of your treatment. Health professionals who may care for you include:

  • General practitioner (GP) – arranges the first tests to investigate your symptoms
  • Urologist – a surgeon who specialises in treating diseases of the urinary system and the male reproductive system
  • Medical oncologist – prescribes and coordinates the course of chemotherapy
  • Radiation oncologist – prescribes and coordinates the course of radiotherapy
  • Nurses – help administer drugs, including chemotherapy, and provide care, information and support through all stages of your treatment
  • Cancer care coordinator/cancer nurse coordinator – supports patients and families throughout treatment and liaises with other staff to help organise care.
  • Endocrinologist – specialises in restoring the normal balance of hormones in the body (e.g. prescribing hormone replacement therapy for men who have had both testicles removed)
  • Anaesthetist – administers an anaesthetic before an operation so you lose consciousness and don’t feel any pain.
  • Dietician – recommends an eating plan to follow while you are in treatment and recovery.
  • Social worker, physiotherapist, clinical psychologist and occupational therapist – link you to support services and help you with any emotional, physical or practical problems.

Treatment

If you are diagnosed with testicular cancer you may have chemotherapy, radiotherapy or surgery, or a combination of treatments.

Before you have any type of treatment for your cancer you should consider the impact it may have on your fertility. You may be able to undergo a type of treatment that does not affect your fertility or your doctor may advise you to bank sperm before treatment.

Surgery

Several different surgical procedures are used for the treatment of testicular cancer. The type of surgery that you undergo will depend on the stage of your cancer (how far it has spread).

Orchidectomy

If the cancer was found only in the testicle, an orchidectomy may be the only treatment you need. Only about 2-3% of men who have had cancer in one testicle develop cancer in the other testicle.

An orchidectomy (or orchiectomy) is a procedure conducted by your urologist to remove your whole testicle. In cases where both testicles are affected, your urologist may decide to remove both of them (bilateral orchidectomy). However, this procedure will affect your fertility.

An orchidectomy is usually done under a general anaesthetic. A cut (or incision) is made in the groin and the testicle is pulled up and out of the scrotum and removed through the incision. The tissue removed during surgery is sent to a specialist (a pathologist) who examines the cells under a microscope.

If it is determined that the cancer was completely removed along with your testicle, you may not need further treatment. Instead, your doctor may recommend a surveillance policy, in which you are monitored with regular blood tests, chest X-rays and CT scans. These tests will show if the cancer is still present (residual cancer) or if it returns.

Lymphadenectomy (removal of lymph nodes)

If the cancer has spread to the lymph nodes (or lymph glands) in your abdomen, you may have an operation to remove them. This is called a retroperitoneal lymph node dissection or lymphadenectomy.

Men with non-seminoma may have a lymphadenectomy to prevent the cancer from spreading. Men with seminoma don’t usually have this procedure because the cancer cells in their lymph nodes can be destroyed with radiotherapy or chemotherapy.

 

Chemotherapy

Chemotherapy uses drugs to kill or slow the growth of cancer cells. These drugs are called cytotoxic. Chemotherapy kills rapidly dividing cells such as cancer cells.
Chemotherapy may be given alongside radiotherapy if there is a moderate risk of the cancer spreading or returning, or as the primary treatment if the cancer has spread or is life threatening.

Chemotherapy drugs are given by an injection into the vein (intravenously) and by injection into a muscle (intramuscularly). You will probably have to visit the hospital or treatment centre daily (as an outpatient) to have your treatment. Your treatment will be given in cycle that includes a period in which you receive the drugs and a period (approximately 21 days) of rest.
Chemotherapy is usually a very successful treatment for testicular cancer.

Radiotherapy

Radiotherapy uses X-rays to kill cancer cells or injure them so they cannot multiply. Radiotherapy is commonly used to treat seminomas after surgery. It is used to prevent the cancer coming back or to destroy any cancer cells that may have spread to the lymph nodes in the abdomen.
Treatment is carefully planned to make sure all cancer cells are destroyed with as little harm as possible to your normal tissue. The doctor or radiation therapist may mark your skin with special ink or marker pens to make sure   the radiation is directed at the same place on your body each time.

During radiotherapy, you will lie under a machine called a linear accelerator, which shoots X-ray beams at the cancer. The unaffected testis is covered with lead to preserve fertility. Each treatment only takes a few minutes once started, but the whole process may take a few hours (including seeing your radiation oncologist, having blood tests and setting up the machine).
You will probably have treatment from Monday to Friday for approximately 2-4 weeks. Usually you will be treated as an outpatient.

For more information about testicular cancer treatments, including side effects, you may like to visit the Cancer Council NSW website:
http://www.cancercouncil.com.au/testicular-cancer/treatment/

Palliative treatment

Palliative treatment helps improve your quality of life by alleviating symptoms of cancer, without trying to cure the disease.
Often treatment is concerned with pain relief and stopping the spread of cancer, but it can also involve the management of other physical and emotional problems. Treatment may include radiotherapy, chemotherapy or other medications.

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