What is testicular cancer and what are the symptoms?

An integral part of the male reproductive system, the testicles are contained within the scrotum and produce male hormones such as testosterone as well as sperm. They play an important role in the development of masculine characteristics such as a deep voice, beard growth, muscle develop and the ability to have an erection, all of which are driven in some way by the production of testosterone.

Some men may experience no symptoms at all, but there are a number of recognisable signs that could suggest testicular cancer is present. The most recurrent symptom of testicular cancer is a hard lump either on the outside or inside of the testicle. This is usually a hard lump of tissue distinguishable from the rest of the testicle, and is very rarely painful.
Testicular Cancer Similarly, you may notice swelling or enlargement of the testicle rather than a lump. If the testicular cancer is causing pain it may also be accompanied by a dull ache or a feeling of heaviness. This can also cause discomfort in the abdomen area. In rare cases testicular cancer can cause abnormal growth of the male breasts, which is due to the cancer producing high-levels of hormones. The breasts may also feel sore and sensitive.

If you are experiencing any of these symptoms then you should be assessed by a doctor or specialist as soon as possible. There could be a number of underlying causes for the symptoms, many of them non-cancerous. Swelling in the testicle could be down to a torsion, whereby the testicle becomes twisted inside the scrotum and restricts the blood supply. Injury and infection can also cause the testicle to swell, whilst inguinal hernias are often mistaken for lumps on the testicle.

How is testicular cancer diagnosed?

Self-examination is one of the first and most important steps in any diagnosis, and specialists recommend that men perform a testicular self-exam at least once a month to closely monitor any signs of testicular cancer.

It is relatively easy to carry out a testicular self-exam by feeling the testicles during a shower or bath (when the skin has softened). You should roll the testicles gently with your fingers, looking for any abnormal lumps or changes in shape. Only by examining them regularly can you properly monitor if anything changes in the testicles. You should also be aware that the scrotum contains a range of blood vessels and connective tissues, which many men often confuse for an abnormal growth.
Oncology consultation

If you do find anything different, are experiencing pain or are unsure about any changes you feel in the testicles, you should consult a health provider as soon as you can. They can perform a range of physical examinations in the testicle area, the groin and the abdomen, and will ask a series of questions about your symptoms. If anything suspicious is found you will likely be sent for further tests. This will usually involve an ultrasound scan, which can pick up any tumour or growth on the testicle. Blood tests can also help diagnose testicular cancer by highlighting whether there are any high levels of certain proteins in the blood which may indicate that cancer is present.

A biopsy may also be carried out, which involves the surgical removal of part of the tumour. This sample is then sent for analysis to confirm the presence of cancerous cells. Many surgeons are reluctant to perform a biopsy for testicular cancer as the surgery itself risks spreading the cancer further, and it is usually only carried out when a definitive diagnosis cannot be obtained from the ultrasound and blood tests.

What causes testicular cancer?

There is no agreed consensus for what exactly causes testicular cancer. It can develop in men of all ages, ethnicities, professions and lifestyles. There are, however, a range of risk factors which make some men more likely to develop testicular cancer.

Men are more likely to develop testicular cancer if they:

  • Have a family history of testicular cancer
  • Have an undescended testicle, which occurs at birth when one or both of the testicles do not move from the abdomen into the scrotum.
  • Are white – men of white ethnicity are around four times more likely to develop testicular cancer than black or asian men, though the exact reason for this is unknown.
  • Are HIV positive
  • Are in bad physical shape. Studies suggest that men who are physically active are less likely to develop testicular cancer.

How is testicular cancer treated?

Surgery

Surgical removal of the testicle is typically the first and most-effective method of treating testicular cancer. Removal of the affected testicle almost always takes place no matter what stage of progression the cancer is at and regardless of whether it has spread further. This is mainly to ensure that all cancerous cells are removed from the scrotum area.

The procedure itself is known as radical inguinal orchiectomy. The surgeon begins by making a small incision just above the scrotum, and the testicle can be detached from the spermatic cord which attaches it to the abdomen. Both the cord and the surrounding blood vessels are tied up by the surgeon at this stage of the procedure to prevent the possibility of cancerous cells being spread.

In some cases it may be necessary to remove the lymph nodes located behind the abdomen, depending how far the cancer has spread. This procedure is far more complex than radical inguinal orchiectomy and must be carried out by an experienced specialist. Known as retroperitoneal lymph node dissection, the surgery can be performed laparoscopically, meaning the incisions are minimal and laparoscopic tools are used to complete the operation. Traditional surgical methods may also be used, which results in larger incisions and a longer recovery time.

There are a number of possible side-effects to a surgical testicle removal besides the usual risks associated with surgery. Many men worry that having a testicle removed will result in issues with sexual function, but if only one testicle is removed you should have no long-term problems with erections or ejaculation. Sex drive also tends to remain at the same level as before the surgery, whilst hormone production is unaffected.

On the other hand, if both testicles need to be removed then there will be consequences in terms of sexual function and hormone production. Without testicles you will also become infertile, but it is possible to have sperm frozen before they are removed. Testosterone production will cease once both testicles are removed and this can lead to a lack of sex drive and loss of sexual function, as well as fatigue, muscle wastage and low mood. This can be countered with the use of testosterone patches or injections, which are able to stabilise levels of testosterone.

Appearance is another concern for men who have a testicle removed. Some may feel self-conscious about how the scrotum looks without one testicle, or are embarrassed by the surgical scar. Prosthetic testicles are often provided, which look natural once place inside the scrotum. The prosthetic can also restore a natural weight balance to the scrotum.

Radiotherapy

If the cancer has spread from the testicles to the surrounding lymph nodes, your oncologist may recommend radiotherapy. This uses high-intensity rays to to kill the cancerous cells and prevent them from reproducing further. Radiotherapy will often be used after a testicle is surgically removed, particularly when the surgeon deems operating upon the lymph nodes too risky.

Radiotherapy itself is relatively painless but does bring a number of adverse side-effects, the most common being fatigue and nausea.

Chemotherapy

Another method of destroying any cancer cells that may have been left behind after a testicle removal is chemotherapy. In treating testicular cancer, chemotherapy usually involves in the injection of a drug through a vein, which travels round the body and attacks the cancerous cells. Like radiotherapy, chemotherapy is an option when the cancer has spread to the nearby lymph nodes. In can also be used if there is a risk of the cancer coming back even after the testicle has been removed.

Chemotherapy is given in cycles which last around 3 to 4 weeks. Alongside cancerous cells, chemo will also damage healthy cells in the body, which leads to a range of side-effects, the extent of which depends on the strength of the dosage. These may include nausea, hair loss, fatigue, loss of appetite and diarrhea.

After Treatment

Once your treatment is completed you will need to be closely monitored for any signs that the cancer may have returned. You will be expected to undergo a series of regular check-ups and your cancer care team may wish to carry out blood tests, x-rays or CT scans to ensure the cancer hasn’t spread in the meantime.

How much does testicular cancer treatment cost?

Getting a precise quote for testicular cancer treatment can be difficult. The final cost is dependant upon the type of cancer you have, the stage it is at, whether it has spread and the treatment method you choose to have. There are also additional costs such as aftercare and medication to consider. Speaking in detail with a cancer care team about the type of care you need is the best way to build an accurate picture of how much your treatment will cost.

 

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