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Understanding Testicular Cancer

  • 10 May 2024
  • 3 mins

What is Testicular Cancer?

Testicular cancer is one of the most prevalent forms of cancer diagnosed in young men, especially those between 20 to 40 years old. According to urologist Dr. Png Keng Siang, testicular cancer occurs in approximately 1 in 250 males and account for 1-2% of all cancers in men.

“It is not a cancer most people talk about. However, it does occur in the younger age group, among men in their 20s to 40s,” Dr. Png states. “So, for men in this group, we are always reminding them to be aware of this rare cancer.”

Testicular cancer happens when germ cells in the testes become cancerous, clumping together to form a tumor. Germ cells are primitive cells that normally mature to become cells that make sperm, an important factor in sexual reproduction.

There are two types of testicular cancer that can arise from germ cells, seminoma and non-seminoma.

Seminoma: Slow-growing cancer that primarily affects those in their 40s to 50s. It responds better to radiation and chemotherapy.

Non-Seminoma: Develops more quickly than seminoma cancers and mainly affects people in their teens, 20s and 30s. It can be less responsive to radiation and chemotherapy treatments. There are four subtypes of non-seminoma cancers – embryonal carcinoma, yolk sac carcinoma, choriocarcinoma and teratoma.

Some testicular cancer tumors can contain both seminoma and non-seminoma cells.

There are also rare testicular cancers that do not arise from germ cells, such as Leydig cell tumors which form from the Leydig cell that produces testosterone and Sertoli cell tumors which come from Sertoli cells that help support normal sperm growth.
 

Signs and Symptoms

Some common signs and symptoms you may notice include:

  • Painless swelling or lump in one of the testes: The swelling or lump may be the size of a pea, or even larger.
  • Changes in the size or shape of the testicle: One testicle may look different from the other.
  • A feeling of heaviness in your scrotum
  • Dull ache in your groin or lower abdomen that may come and go

In cases of advanced cancer, other symptoms may be present. For example, if the cancer has spread to the lungs, you may experience shortness of breath.

“A lump in the testes will be the most common presenting complaint [among men with testicular cancer],” Dr. Png says.

“Typically, the man will go to his GP or polyclinic doctor with complaints of discomfort. It may even not be pain, but just an uncomfortable feeling in the testes. His primary care doctor then feels a lump and refers it to me. Or, sometimes the man themselves, or even their partners, may discover a mass in the testes.”

Dr. Png advises you to see a doctor if you notice any changes such as a lump or firmness in your testicle. As there are many different possible causes for lumps within the scrotum, your doctor will be able to determine if the lump in your testicle may be cancerous.
 

Risk Factors

There is no definite cause for testicular cancer but there have been some risk factors identified which could increase your chances of developing testicular cancer:

Undescended Testicle: Undescended testicles (Cryptochidism) is the most significant risk of testicular cancer, with studies reporting that boys with cryptorchidism are 3 times more likely to develop testicular cancer in their lifetime. Cryptochidism happens when boys are born with their testicles inside their abdomen. They tend to descend into the scrotum by the time they are one year old, but in some boys, the testicles do not descend.

“Testes that have been in an abnormal position are more prone to undergoing cancerous changes because they were in an unusual environment while they were in the fetus or even when they become adult,” Dr. Png says. “That’s why, even if the patient had undergone a surgery at birth or as a baby to bring the testes down to the scrotum, they are still at risk of having testes cancer down the road.”

An orchiopexy can be carried out to move the testicle into the correct position inside the scrotum.

Age: Unlike most cancers that affect older men, testicular cancer most commonly affect men between ages 20 to 40. This can come as a shock to many, as youth is not typically associated with a risk of cancer.

“A very unique characteristic of testicular cancer is that these patients are usually in the peak of their reproductive life, their careers, their family life. So, when this diagnosis hits them, they’re usually in a shock as cancers tend to occur in older men or older patients,” Dr. Png says.

Genetics & Family History: If your biological father or brother had testicular cancer, your likelihood of developing it will increase.
 

Treatment Methods

If you are diagnosed with testicular cancer, your doctor will recommend a treatment plan for you based on the type of testicular cancer you have and the stage of your testicular cancer. Chemotherapy, radiotherapy and surgery are the 3 main methods of treatment for testicular cancer.

Regardless of which stage of testicular cancer you are diagnosed with, orchiectomy is often the first treatment option given. It involves surgically removing the affected testicle, or in some cases if the cancer is detected early enough, only the affected portion of the testes is removed instead of the entire testicle.

Thereafter, chemotherapy may be given to help prevent the cancer from returning. Radiotherapy is also sometimes recommended. With radiation therapy, the treatment offered is what is known as adjuvant or neoadjuvant treatment and is usually offered before or after surgery depending on the stage of the patient’s testicular cancer.
 

Testicular Self-Exam

According to Dr. Png, there have been instances of early testicular cancer not causing pain as it can be a silent, growing tumor. Hence, it is important to periodically perform a testicular self-exam at home.

“Just like how women perform breast self-examination,” Dr. Png says. “Men, especially young men, as soon as they enter their teenage years or young adulthood, should be taught and be aware of how to perform a testicular self-examination.”

You can perform a testicular self-exam at home, healthcare providers suggest performing it monthly to regularly check on your testicles and to notice any changes as soon as possible.

Here’s how you can perform a testicular self-exam at home:

  1. Perform the self-exam after a warm shower or bath as your skin will be more relaxed, making it easier to feel for anything unusual.
  2. Place your index and middle fingers underneath the testicle with your thumb on top, then roll each testicle between your thumb and fingers.
  3. Familiarise yourself with what is normal for your testicles and feel for any lumps. These lumps can be pea-sized or larger, and are often painless. Each testicle should also remain generally the same size.

Do consult your doctor as soon as possible if you notice a lump, swelling or any changes to your testicles. The lump might not be cancerous but it is still worth checking out. Testicular cancer is highly curable if detected early.

Contributed by

Dr. Png Keng Siang
Urologist
FeM Surgery @ Farrer