What Is Testicular Cancer

Overview

Testicular cancer is a cancer that affects one or both testicles  also known as testes. It is generally not very common and it usually affects men or any person with testicles, between the ages of 15 and 50. 

Testis are part of the male reproductive system located inside the scrotum - the skin pouch underneath the base of the penis. Testis are glands that produce sperm and the hormone testosterone. 

In about 95% of cases, cancer starts with germ cell changes.² Germ cells are cells that produce sperm. 

Types of testicular cancer

As already mentioned, most testicular cancer cases are due to changes in the germ cells. There are two types of germ cell tumors namely:

1. Seminomas - Seminomas tend to grow slowly. While in some cases your lymph nodes may become involved, they are usually restricted to the testis. Seminomas can be classical. About 95% of seminomas or spermatocytic arerare types that affects older patients

2. Non-Seminomas - Non-Seminomas are the commonest type of testicular cancer. Theyy are more aggressive, grow quickly, and can spread to other body parts. They usually affect men in their late teens to early 30s. Non Seminomas are separated into four types:embryonal carcinoma,yolk sac carcinoma, choriocarcinoma, and teratoma

Stages of testicular cancer

Testicular cancer can be staged using different methods, but in the UK, doctors usually use a numerical staging system. The stage of cancer is determined by a physical examination, test and scan results, and the analysis of tissue extracted during surgery. Tumor markers in the blood are also assessed, as cancer cells can increase their production.

The S stage is used to determine the levels of tumor markers in your blood, where:

• S0 indicates normal levels
• S1 indicates a slight increase
• S2 indicates a moderate increase
• S3 indicates a significant increase in the markers

Stage 0: Germ Cell Neoplasia: Germ cell neoplasia in situ (GCNIS) refers to the presence of anomalous cells within the testicle, which is also known as stage 0. These cells appear unusual when observed under a microscope, but they are confined solely to the seminiferous tubules, which are small tubes inside the testicle. GCNIS has not spread to other regions of the testicle, does not cause any symptoms, and is not considered cancer. However, if left untreated, it has the potential to develop into invasive cancer.

Stage 1: The initial phase of testicular cancer is referred to as "Stage 1", where the cancer is confined solely to the testis and has not spread to other organs or nearby lymph nodes. Stage 1 is categorized into two groups, Stage 1A and 1B, depending on the tumor size. Additionally, Stage 1S denotes that after surgery, there are increased levels of markers in your blood.

• Stage 1A: Cancer is localized in the testis and has not grown into nearby blood vessels or lymph nodes. Tumor markers are normal (S0)
• Stage 1B: Cancer has extended outside the testicle and into adjacent structures but has not spread to distant organs or lymph nodes. Tumor markers are normal (S0)
• Stage 1S: The suspected spread of cancer beyond the testicle with an elevation in at least one tumor marker level (S1, S2, or S3)

Stage 2: Stage 2 testicular cancer occurs when cancerous cells spread from the testicle to nearby lymph nodes in the abdomen or pelvis. It is divided into 2A, 2B, and 2C, depending on the number and size of affected lymph nodes. Tumor marker levels may be normal or slightly elevated (S0 or S1), and cancer may have grown into neighboring structures but not yet spread to distant organs. 

• Stage 2A means up to 5 lymph nodes are affected and are less than 2 cm in size
• Stage 2B involves larger nodes or infiltration of the lymph node's covering
• Stage 2C means at least one node is larger than 5 cm

Stage 3: Stage 3 testicular cancer indicates that cancer has spread to the lymph nodes or other organs. It is divided into three sub-stages —3A, 3B, and 3C —depending on where cancer has spread  and the level of tumour markers in the blood. In all stage 3 cancers, cancer may have spread outside the testicle into nearby structures. 

• Stage 3A means cancer has spread to distant lymph nodes or the lungs with normal or slightly raised tumour marker levels
• Stage 3B indicates cancer has spread to nearby lymph nodes and the lungs or distant lymph nodes, with moderately high tumour marker levels
• Stage 3C is when cancer has spread to another organ, such as the liver or brain, and tumour markers can be at any level

Causes of testicular cancer

The exact causes of testicular cancer remain unknown. However, some risk factors can increase your likelihood of developing testicular cancer. You can check the Risk Factors section discussed later in this article. 

Signs and symptoms of testicular cancer

Testicular cancer may not always present symptoms. However, when symptoms do arise, they can include: 

1. Testicular pain
2. Swelling
3. the presence of a lump in the testicle
4. Lower back or abdominal pain 
5. Enlargement of breast tissue 

In pre-pubescent individuals with testicles, symptoms may also include voice changes and facial and body hair growth. 

In the later stages of the disease, you may experience: 

1. Chest pain and/or cough and/or shortness of breath
2. Confusion
3. Abdominal pain
4. Headaches
5. Lower back pain from cancer spreading to lymph nodes in the back of the abdomen

If you experience any of these symptoms, it's important to make an appointment with your doctor.

Management and treatment for testicular cancer

Testicular cancer treatment depends on cancer's stage and can involve surgery, radiation therapy, and chemotherapy. Surgery may involve removing the testicles and nearby lymph nodes to determine cancer's stage.¹

Radiation therapy uses high-energy rays to kill cancer cells, and chemotherapy uses medication to do the same. Chemotherapy is systemic and can treat cancer cells that have spread. In advanced cases, high-dose chemotherapy may be followed by a stem cell transplant. The survival rate for testicular cancer depends on the stage of cancer.

Diagnosis of testicular cancer

Your doctor may use several tests to diagnose testicular cancer, including a physical exam, an ultrasound, and tumor marker tests. If cancer is suspected, surgery may be recommended to remove the tumor for biopsy. Further tests, such as CT scans, will be done to determine the extent of cancer and its stage. 

Testicular cancer has three stages, with Stage 3 being the most advanced, and is categorized by the expected response to treatment.

Risk factors of testicular cancer

The likelihood of developing cancer is influenced by various factors, such as lifestyle choices like smoking and diet, as well as genetic and environmental factors. These factors are known as "risk factors." Although the exact causes of most testicular cancers are not known. Certainn risk factors may increase the likelihood of developing the condition. However, having one or more risk factors does not necessarily mean that an individual will get testicular cancer, as it is a rare disease and the risk is generally low.

The below listed puts you at risk of testicular cancer: 

1. Undescended testicles (Cryptorchidism)
2. Germ cell neoplasia in situ (GCNIS): previously known as carcinoma in situ (CIS), refers to the presence of abnormal cells in the testicle. It is not cancer and usually doesn't cause any symptoms. However, if left untreated, it can lead to cancer within 5 years in about 50% of cases
3. Family history: Increased risk of developing testicular cancer if the father or brother has it too
4. Previous testicular cancer 
5. Abnormality of the penis or urethra (Hypospadias) 
6. AIDS or HIV 
7. Ethnic background: White men are at a higher risk than men with an ethnic background

FAQs

How common is testicular cancer? 

Testicular cancer is not a very common cancer, with around 2.3k men being diagnosed each year in the UK.

Can testicular cancer be cured? 

Yes, testicular cancer can often be cured, especially if it is detected early and treated promptly. The treatment options for testicular cancer depend on the stage of the cancer and other factors, such as the type of  cancer, the patient'sage and overall health, and whether cancer has spread to other parts of the body. The prognosis for testicular cancer is generally good, with a five-year survival rate of over 95% for men whose cancer has not spread beyond the testicles.

How can I prevent testicular cancer? 

There is no guaranteed way to prevent testicular cancer, but there are some things that may help reduce the risk of developing the disease: 

1. Perform regular test exams 
2. Be aware of risk factors such as age and family history
3. Maintain a healthy lifestyle 
4. Protect your testicles when exercising

When should I see a doctor? 

It's important to note that regular self-examination and early detection are keys to successful treatment outcomes, so it's recommended you perform monthly testicular self-exams and seek medical attention promptly if you notice any abnormalities or changes in your testicles.

Summary

Testicular cancer is a relatively rare type of cancer that forms in the testicles. It typically affects younger men. Cancer may cause symptoms such as pain, swelling, or lumps in the testicles. With early detection and treatment, testicular cancer can often be cured.