Testicular Cancer

Testicular cancer is often diagnosed following the development of a swelling or painless lump on one or both testicles (testes). Mostly surgical, treatment often leads to complete cure in most cases. Earlier the tumor is detected better is the prognosis.

The testes have two distinct functions: secretion of testosterone (the male hormone), and the production of sperm. In general, there are two main types: seminomatous and non-seminomatous. They respond to therapies differently; the seminomatous tumors being particularly sensitive to radiotherapy.

Statistics

Testicular cancer accounts for 1 to 2% of cancers in men, and 3.5% in urological tumors. It is the most frequent tumor in young men, rare before 15 years and after 50 years. The risk is higher in HIV-positive patients. The tumor is bilateral in 1-2% of cases. Semenoma is the most common germ cell tumor in primary bilateral testicular cancers, but malignant lymphoma is the most common bilateral testicular tumor. After curing the primary cancer, the risk of having a relapse on the opposite testis is 2-5% in the next 25 years.

Testicular Cancer Symptoms

Symptoms of testicular cancer often include pain, swelling, discomfort at the level of a testicle. Most patients experience these signs. Although they are not specific to cancer and may have other causes, they are the symptoms that cause people to seek for medical care.

Signs at the testicle level

In the vast majority of cases, cancer is asymptomatic; it is suspected by the discovery of a palpable mass on the testicle. This mass does not regress over time. It is hard to touch and most often painless.

Occasionally, the discovery of the cancer occurs by chance during an ultrasound examination performed for a fertility disorder or testicular trauma. Other testicular cancer symptoms that may manifest include feeling of heaviness in the testicles, discomfort or a pain that persist over time. The diseased testicle as a whole can swell and increase in volume, sometimes suddenly.

Other signs     

Other signs, although very rare, can evoke the development of cancer. Among these signs include gynecomastia, swelling of the breast tissue in boys or men, which tends to appear quickly. This disorder is caused by the secretion of a hormone called human chorionic gonadotropin (hCG) by the tumor.

Gynecomastia is commonly present in adolescence without being linked to cancer. But medical attention is recommended in case of a gynecomastia that appears briskly.

Sometimes the development of cancer causes pain in the back or on the side, difficulty breathing. Other testicular cancer symptoms include a mass in the abdomen.

The Diagnosis

In general, a physician starts the diagnosis by palpation of the bursa. Cancer of the testicle is most often diagnosed as a result of the appearance of a hard and irregular mass. But the discovery of the mass is not enough to confirm the disease. Further medical exams are needed to determine the exact nature of the tumor and whether it is cancerous or not. If this is the case, it is necessary to assess the cancer precisely: size, localized or metastasized (spread to other parts of the body).

The time spent on these various examinations and the expectation of the results may seem long. However, these procedures are essential to confirm the diagnosis and establish a treatment adapted to the situation of the patient.

Initial Exams – The first stage of a testicular cancer diagnosis and initial assessment include a consultation during which a health professional asks the patient about personal and family history, previous cancer or cryptorchidism (absence of one or both testes from the scrotum) for instance. The physician may also perform a clinical examination which usually consists of palpation of both testicles. He will then prescribe an ultrasound.

Ultrasound – This is an imaging exam performed systematically. It allows exploration of the affected testicle and assessment of the size of the tumor. The second testicle is also examined to confirm that there is no tumoral mass present.

Blood Test – According to the results of the ultrasound, blood sample is taken to measure markers of testicular cancer: AFP, total hCG and LDH. Analyzing of these markers is important. Markers are substances in the blood; their concentration makes it possible for health professionals to determine the evolution of a particular disease. They are systematically measured at the time of diagnosis and are used to assess prognosis. Their evolution is observed throughout the treatments and during the follow-up or Active Surveillance (see below for info). It is this evolution over time that helps in particular to evaluate the possible presence of metastases after the surgery and helps to determine the stage of the cancer.

Testicular Cancer Treatment

Surgical Therapy – Orchidectomy, removal of the diseased testicle through surgery, is the initial testicular cancer treatment, regardless of the type of tumors, and even in the case of metastasis. The surgical procedure consists of removing the testicle in which the tumor has developed and the tissues in the vicinity to which it has been able to spread.

Chemoradiotherapy – often there are complementary treatments.  Two additional complementary therapies after or for the removal of the testis may be necessary, alone or in combination: chemotherapy, based on one or more anticancer drugs; radiotherapy which consists in targeting the lymph nodes of the abdomen with rays.

Lymphadenectomy – also called lymph node dissection, lymphadenectomy may also be performed to make it possible to remove, by a second surgical operation, the lymph nodes likely to be affected by cancer cells.

In some cases, active monitoring may be performed after the testicular cancer treatment. This option consists of seeing an oncologist regularly and attentively without undergoing any therapy such as chemotherapy, radiotherapy or cleansing of the lymph nodes of the abdomen.

Active Surveillance

A surveillance strategy may be proposed in some cases, once the tumor has been removed and the cancer markers have returned to normal rates; this is active surveillance.

Active monitoring includes several assessment options, scheduled at regular intervals. It is under coordinated management between the oncologist and the medical team in charge of the case.

Each assessment includes a consultation during which the doctor performs palpation of the remaining testis and the scrotum. It also assesses overall health of the patient. Medical imaging techniques are also performed during the surveillance period: an ultrasound scan of the scrotum and a scan of the thorax to the bottom of the pelvis (thoraco-abdomino-pelvic CT scan).

A blood sample is also taken to measure the rates of the tumor markers and follow their evolution over time. The results of all these exams allow a medical doctor to confirm that there is no development or progression of the cancer.

What happens if cancer development is suspected?

During one of these surveillance exams, the development of cancer cells can be suspected.

Treatment with radiotherapy or chemotherapy is then systematically started to kill the pertinent cancerous cells. This complementary treatment is effective in more than 95% of cases.