Testicular cancer – symptoms, diagnosis and treatment

Testicles are the egg shaped balls that can be seen under the penis. In most men, there will be two and some may have only one. Both the testicles may not be of same size, one can be a little larger and it is normal. Testicles are an important part of male reproductive system. They produce the important male hormone ‘testosterone’ and also produce ‘sperms’ that are necessary to reproduce.

Some men may find a small bump or lump on their testicles and this can range anything from a harmless pimple or cyst to a cancer tumour that may grow silently. Lumps on the testes can form at any age but most of the time, cancerous tumours are seen in men who are in the range of 15 to 45 years of age. Testicular cancer is rare and can be cured. It is always advised that you keep checking your testes regularly to look for any abnormalities and when you find one, you must immediately see a good sexologist near you for a diagnosis.

Simple anatomy of testicles or scrotum

Before you do a self test, you need to understand what you can expect in your scrotum (the bag that holds the testicles) when you touch it. Scrotum mainly consists of 2 things:

1. 2 small egg shaped balls 
2. Few connecting tubes behind the balls that move up into the groin. 

The skin on the testicles is highly folded when you stretch it to hold a testicle, you should feel the soft balls inside. They should be pain on their surface without any lumps or bumps. The tubes running behind them are called epididymitis. They nurture the sperms until they are mature and carry them outside the body during ejaculation. Try placing the ball between your thumb and index finger and move your hand across the ball to see if you feel any bumpy surface. If you feel anything, don’t panic and keep testing it everyday for a week. If you continue feeling it, see a doctor to know if it is normal or if there is something else going on.

Testicular cancer symptoms

1. A lump that is usually painless in most of the cases.
2. Swollen testicles – this again may or may not be painful and sometimes, it may feel heavy
3. Slight pain in the testicles (kind of pulling sensation)
4. Changes in the chest (breast area), they may be tender to touch.

There can be other reasons other than testicular cancer that can cause similar symptoms such as epididymitis (inflammation of epididymitis), testicular torsion (twisting of testicles that needs a surgery to correct), inguinal hernia (descending of intestines into the groin on into the scrotum), hydrocele (accumulation of fluids in the testicles) etc.

What causes testicular cancer?

1. Hereditary – If your father or brother has/had it, you may be at risk of developing it.
2. If you were born with undescended testicles (cryptorchidism)
3. Abnormal cells in the testicle called Germ Cell Neoplasia In-Situ (GCNIS)

If you think you belong to any of these risk categories, make sure you get your testicles tested regularly (at least go for an annual health check plan to be on the safer side).

Diagnosis

Self Test

1. Test your testicles every week (if not everyday) and look for any lumps on it. In most cases, lumps won’t go unnoticed.
2. Check the epididymitis too once you are done checking your balls.

Diagnosis by a doctor

If you think that there are some cysts or lumps in your scrotum, please see a doctor. Your doctor will then start with a physical examination of your testicles. Since they are experts in the area, he/she can easily detect if it is just a superficial cyst or pimple that will go away or something more concerning.

For further confirmation (if they too find any bump or lump on the testes), he/she may ask for a testicular ultrasound. This gives them a picture of the testicles and also the lump that’s present on it. Scans or x-rays of your chest area may be required. This is done to see if the cancer has metastasized (spread from its original place to other parts of the body). 

Blood tests and serum tumour marker tests may also be performed to look for proteins and hormones that might be present confirming the existence of cancer. In case of metastasized cancer, other parts of the body may also be tested with an MRI or other imaging tests before beginning the treatment.

Seminomas and Non-Seminomas

90% of the cancer tumours start in the germ cells. Germ cells are those from which the sperms are produced. There are two types of Germ Cell Tumours – seminomas or non-seminomas.

• Seminoma – This is the most common type of testicular cancer that grows slowly and can be treated easily with chemotherapy and radiation. 
• Non Seminoma – This type of cells grow more quickly and don’t respond to chemotherapy or radiation treatment like the seminomas. Multiple surgeries might be needed as your doctor continues to remove the growing tumour.

Treatment of testicular cancer

Observation

After treating the testicular cancer that is in the initial stages, you will be put under observation by your urologist. Regular blood tests and tumour marker tests will be performed to check on the growth of the tumour. If your doctor sees that there are signs of the tumour growing, further treatment or surgery may be recommended.

Surgery

• Orchiectomy – removal of one of both testicles completely. This is the most preferred solution, especially in cases when the tumour continues to grow even after initial intervention and treatment. Depending on the location and spread of the cancer cells, one or both testicles might be removed. You will be put on hormone therapy to maintain the necessary testosterone in the body.  If you are worried about the look of your scrotum, artificial testicles may be inserted (procedure called testis prosthesis).
• TSS (Testis Sparing Surgery) – In this case, only the tissue on the testis that is affected is removed instead of the entire testicle(s). This is recommended only when the lump is benign (non cancerous).  TSS is not recommended when the cancerous tumour is present on only one testicle.
• Retroperitoneal Lymph Node Dissection (RPLND) – The procedure involves removing the abdominal lymph nodes to prevent recurrence of testicular cancer. The surgery is performed by making an incision that extends from below the breastbone to the area just below the navel.
• Radiation Therapy – High energy radiation that is capable of killing cancer cells is targeted at the tumour in the scrotum. Radiation therapy is done in case of seminoma-cell cancer as non-seminoma cancer cells don’t respond well to radiation therapy.
• Chemotherapy – Chemotherapy is usually performed when the cancer cells have moved / spread to surrounding organs in the body. The drug that is injected kills the cancer cells and has its side effects.

Conclusion

Not just the testicles, you need to be very mindful of your body at all times. You need to keep checking your body parts and watch out for any abnormalities and symptoms. Some diseases may not show up symptoms until it’s too late but they would have given you a hint that you might usually ignore. The sooner you see a good doctor, the easier it would be to treat any disease.