Testicular cancer

SATYENDRA PERSAUD

I recently learnt of a friend with testicular cancer and another who was worried about a lump in the testicle and I thought this would be a good topic to review today.

Testicular cancer refers to cancer of the testicles, commonly called the “balls” or “seeds”. It most commonly affects younger men aged 15-44. If caught early it is curable and men can survive with a single testicle. Any man can get testicular cancer but certain groups are at higher risk such as men with a family history of the disease or who have a history of an undescended testicle (a testicle which hasn’t dropped into the sac).

What are the symptoms of testicular cancer?

Cancer of the testes may present as a mass in the testicle or as pain – a dull ache or heaviness in the scrotum. Advanced cases may note a large swelling of the testicle or may have symptoms as a result of cancer spread including back pain or shortness of breath.

What happens if there is a suspicion of testicular cancer?

If you have a lump in the testicle or a suspicion of cancer, you should see a urologist who will take a history and examine you thoroughly. A testicular ultrasound is usually requested urgently as this is very useful and is good at detecting growths in the testicle. Other problems may mimic tumours including infection, hernias and hydroceles (fluid in the scrotum). If a mass is confirmed you will require blood tests and a CT scan of your tummy and chest. There are certain chemicals in the blood which may be raised in testicular cancers depending on the type of testicular tumour- these are called tumour markers. The tumour markers your doctor will request include AFP, B-HCG and LDH and these may need to be repeated after surgery. Certain illnesses and even marijuana use may cause a false elevation of these markers.

How is testicular cancer treated?

The first step in treatment is to remove the tumour. While in rare cases only the tumour may be removed, most commonly the entire testicle will be removed. This is done through an incision in the groin and is usually a straightforward operation with a fast recovery time. The pathologist will look at the tumour under the microscope and will be able to tell us what type of testicular tumour it is – this is very important and will be one of the factors which will determine treatment. Men can have a normal life with one testicle but a small percentage will require hormone replacement. You may also consider having a prosthesis or false testicle placed for a more natural feel.

If the cancer has not spread beyond the testicle, observation may be an option in certain tumours and in well motivated patients and this should be discussed with your urologist. Observation requires frequent blood tests and imaging as a few cases may recur later on. Chemotherapy, radiation or surgery are all options and especially so if the cancer has spread beyond the testicle. The decision on which one is best will be made based on the type of tumour, stage of the tumour, surgeon skill and patient wishes. Surgery to clear lymph nodes in the abdomen is technically demanding and should be done by surgeons with experience in this area.

Testicular self-examination

Following a shower or warm bath is the best time for a self-exam. The scrotum (sac) is examined while standing and this only takes a few moments. You should check each testicle, rolling it between the thumb and forefingers making sure the firmness of the testicle is the same throughout. Lumps are not normal nor is pain. Lumps should raise suspicion even if they are not painful. Checking yourself once per month is a good idea. If you feel a lump, seek help immediately!

Satyendra Persaud MBBS DM(Urol) FCCS FRCS (Eng) Lecturer in Urology/DM Urology Coordinator University of the West Indies St Augustine, Trinidad and Tobago