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TESTICULAR CANCER

 

What are the risks for developing testicular cancer?

  • Undescended testicle (most common) – testicle not in scrotum at birth. Even if surgery to relocate the testis into the scrotum is performed, there is still a risk 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

  • May be associated with infertility

  • 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?

  • Testicular lump/mass (most common)

 

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

 

How is testicular cancer diagnosed?

  • Scrotal/testicular ultrasound: to identify the tumour and differentiate from other scrotal/testicular lumps and swellings

  • Blood tests (including testicular tumour markers)

  • Staging scans: CT of chest/abdomen/pelvis to look for spread (metastases)

 

How is testicular cancer treated?

  • Radical orchidectomy: surgical removal of the entire testicle and spermatic cord will be required.  This is performed via a groin incision, like for a hernia.

    • The testicle is sent for analysis to confirm the presence of cancer as well as the specific type of cancer.

  • After removal of the testicle adjuvant treatment with chemotherapy may be offered to reduce the risk of recurrence or you may be followed up with regular surveillance scans

 

What are the different types of testicular cancer and does this affect treatment?

 

  1. Germ cell tumours

  • Most common type of testicular cancers

  • These affect younger men (usually 20-40 years of age)

 

There are 2 main types of germ cell tumours:

  • Seminoma: most common

  • Non seminomatous germ cell tumour: includes several subtypes (teratoma, yolk sac, embryonal & choriocarcinoma)

 

For both of these, if they are confined to the testis (Stage 1), treatment options after orchidectomy include surveillance or adjuvant chemotherapy.

 

  1. Lymphoma

  • Most common type of testicular cancer in men over 50

  • In addition to orchidectomy, chemotherapy will be required to complete treatment

 

  1. Stromal tumours

  • Rare tumours that can produce hormones

  • Majority are benign (10% are malignant) and orchidectomy is usually the only treatment

 

What treatment is required if the cancer has spread?

  • For both seminoma and non-seminoma, 3 courses of chemotherapy will be required.

  • If there are residual tumours detected on a follow-up CT scan after chemotherapy, surgical removal may be required.  These cases are often complex and require individualised treatment.