Testicular Cancer

What are the risks for developing testicular cancer?

  • The main risk factor is a history of an undescended testicle. The higher the testis was located, the greater the risk.  Even after surgery to relocate the testis to the scrotum, the risk exists which is why testicular self examination is required for these patients.
  • Other less common risk factors include:
    • Family history of testicular cancer
    • Past history of testicular cancer in the opposite testicle
    • HIV infection
    • Some chromosomal/ genetic conditions
    • ITGCN – intratubular germ cell neoplasia- this is a premalignant condition that may be detected during a testicular biopsy

What are the symptoms of testicular cancer?

  • A testicular lump/mass is the most common presenting symptom
  • Other symptoms may include:
    • Hydrocele – fluid collection surrounding the testicle
    • Testicular pain – if the tumour has bled
    • Breast enlargement
    • Abdominal distension
    • Back pain
    • Weight loss

If testicular cancer is suspected, what tests will be required?

  • A scrotal/testicular ultrasound is the most useful investigation when a testicular lump is detected.  This will usually provide enough information as to wether a testicular cancer is suspected.
  • Blood tests: baseline blood tests as well as specific testicular tumour markers
  • Staging x-rays – CT scan of chest/abdomen and pelvis will check for spread beyond the testicle (metastasis)

What is the treatment for testicular cancer?

  • If a testicular cancer is suspected, a radical orchidectomy (surgical removal of the entire testicle and spermatic cord) will be required.  This is performed via an inguinal (groin) incision.
  • The testicle will then be sent for analysis to confirm the presence of cancer as well as the specific type of cancer.

What are the different types of testicular cancer and how does this effect treatment required?

  • There are several different types of testicular cancer which will determine what if any additional treatment is required other than orchidectomy.
  • Germ cell tumours are the most common type of testicular cancers.  These tend to effect younger aged males most frequently (usually 20-40 years of age). There are 2 main types of germ cell tumours:
    • Seminoma is the most common germ cell tumour.  If the tumour is confined to the testicle/scrotum (stage 1), then additional treatment may be required to reduce the risk of recurrence.  Chemotherapy or radiotherapy may be required, however close surveillance may be sufficient in selected low risk cases.
    • Non seminomatous germ cell tumour: includes several subtypes (teratoma, yolk sac, embryonal & choriocarcinoma).  In addition to orchidectomy, for stage 1 tumours chemotherapy may be required to reduce the chance of relapse, however in selected low risk cases surveillance may be sufficient
    • Lymphoma – is the most common type of testicular cancer in men over 50.  In addition to orchidectomy, chemotherapy will be required to complete treatment.

What additional treatment is required for tumours that have spread beyond the testicle/scrotum?

  • In most cases for both seminoma and non seminoma, 2 or 3 courses of chemotherapy will be required.
  • Occasionally, a course of radiotherapy will be used for seminoma tumours
  • If there are residual tumours remaining after chemotherapy detected on CT scan, then surgical removal may be required.  These cases are often complex and require individualised treatment which will be discussed at oncology multidisciplinary meetings