Testicular Cancer

What Is Testicular Cancer?

This is a malignant tumour of the testicles.

The testicles (also called the testes or gonads) are the male sex glands, situated in a scrotal sac outside the body and are responsible for secreting both sperm and male sex hormone.

Sperm are constantly manufactured from 'germ' cells in the testes - cancer occurs when the development of these cells goes out of control.

These cancers are classified as two different microscopic types - teratomas and seminomas - and are one of the commonest cancers in young men between the ages of 15 and 35.

What Causes Testicular Cancer?

This remains unclear, and it accounts for only 1 per cent of all cancers in men, with some 1500 cases diagnosed each year in the UK. The risk is higher in men where a testicle has not descended properly into the scrotum in childhood (an 'undescended testicle'), but no link has been proved between testicular injury and cancer.

What Are The Signs And Symptoms?

There Are A Number Of Possible Symptoms;

1. A painless lump in either testicle.
2. An enlarged testicle.
3. A feeling of 'heaviness' in the scrotum.
4. A dull ache in the groin or lower abdomen.
5. Fluid collecting in the scrotum.
6. Pain or discomfort in the scrotum for no obvious reason.

With any of these symptoms, if they last more than a week or two your GP should examine you since testicular cancer is readily curable if caught early enough.

Will I have any tests or investigations?

After your doctor has examined you, a specialist will probably arrange the following tests;

• A chest X-ray and sometimes a body (CT) scan.

• Blood tests. These will include looking for specific proteins in the blood, or 'tumour markers', released by testicular cancer. There are two types - human chorionic gonadotrophin (HCG) which is produced by seminomas and teratomas, and alphafetoprotein (AFP), produced only by teratomas.

• A testicle biopsy. Here, surgeons remove the testicle completely - a procedure known as inguinal orchidectomy - and examine it under a microscope. This allows for the type of cancer to be determined and a treatment plan commenced. Seminomas make up about 40% of all cases of testicular cancer.

What Treatment Might I Need?

If there is any doubt at all about cancer being present, the treatment is simple - surgical removal of the testicle. This orchidectomy needs a general anaesthetic and 1 to 2 nights in hospital with around a fortnight's convalescence. Analysis of the testicle takes 7 to 10 days usually before the diagnosis is known exactly.

The surgeon is then able to say whether it is a teratoma or a seminoma and whether any cancer has spread outside the testicle. If it has, then X-ray treatment (radiotherapy) is especially effective against seminomas, and chemotherapy (anti-cancer drugs) are used - often in combination.

What Course Will The Illness Follow?

This depends on the stage the cancer has reached and whether it has spread to other parts of the body. Regular monitoring by a specialist is the rule here, and in general patients are checked and have their tumour markers measured regularly for the first two years after treatment. Testicular cancer very rarely recurs after a disease-free period of 3 years, with check-ups being needed then every 6 to 12 months.

It is important that men learn to examine their testicles regularly since testicular self-examination or TSE every month will pick up any new lumps or tumours. Patients who have been treated for cancer in one testicle have about a 1 per cent chance of developing it in the other, usually as a new disease rather than spread from the first one, so TSE is very important here and any unusual findings reported to your doctor.

Can I Do Anything To Help Myself?

TSE involves knowing how your testes feel normally so that any change can be recognised. The best way to do this is in a warm bath when the testicles are loose and their surrounding muscles relaxed. Most men find their left testicle hangs lower than their right one, and it is not unusual for one to be larger than the other.

Support the scrotum in the palm of the hand and feel their weight and normal size. Then, roll each testicle between thumb and forefinger, checking for any lumps or hardness. Most testicles should have the firm consistency of a ripe plum - hardness like wood should not be present. This procedure should be done every month.

Tell Your Doctor

1. Do you usually examine your testicles regularly?
2. When did you first notice any symptoms?
3. Have you ever had any testicle problems in the past?
4. Do you have any urinary problems or symptoms?
5. Are one or both testicles involved?

Ask Your Doctor

1. Will this affect my sexual performance?
2. Will I have any problems with my fertility?
3. Will I need any kind of artificial testicle after surgery?
4. Am I able to be sterilised in the future?
5. What are the side-effects of any treatment?

Useful Contacts

Macmillan Cancer Relief
Address: 89 Albert Embankment, London, SE1 7UQ
Telephone: 020 7840 7840
Fax: 020 7840 7841
Website: www.macmillan.org.uk

Wessex Cancer Trust
Address: Suite 9a Fairways House, Mount Pleasant Road, Southampton
Telephone: 023 8067 2200
Website: wessexcancer.org.uk

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