testicular-cancer head pic

Testicular Cancer

You wouldn’t be alone if you associated cancer with people over 30 or with little kids. Especially testicular or prostate cancer that’s just for old dudes right? Well, cancer isn’t that picky. Testicular cancer is in fact the most common cancer in men between the ages of 15 and 35. It’s often overlooked or not discussed as it’s a little awkward, I mean who wants to discuss their balls with their Dad or their Mum? This is a shame. With early detection testicular cancer is one of the most curable cancers out there and a little fiddling down below could quite literally save your life (despite what they may tell you in Sunday school). But this is what we are here for to discuss the “undiscussable” and help you avoid a possibly embarrassing conversation with your Dad.

+   What is Testicular Cancer?

Testicles

To answer the question what is testicular cancer, I’m going to answer the obvious first: What is a testicle? Testes (the plural of testicle) are those small, smooth ellipsoids - think 3D oval - that hang out in that loose bag of skin under your penis we call the scrotum. They are responsible for producing sperm and male hormones.

Cancer

Now, what is cancer? Your body’s cells grow and divide in your body every day, replacing old cells with new healthy ones in an orderly, organized way. Sometimes however, cells grow abnormally and don’t follow orders getting out of control, rapidly dividing and creating new cells even when they aren’t needed. These unnecessary new cells then form tumors. Cancer can happen in any part of your body and in many different cell types. In testicular cancer the cancer grows from germ cells (the cells that make sperm) forming a tumor in your testicle. In most cases of testicular cancer the tumor only grows in and affects one testicle.

If you do get testicular cancer, there is a chance it will spread to other parts of your body. Cancer cells in your testicle may break away and get into your lymph nodes or blood stream. When testicular cancer spreads it tends to first spread to the lymph nodes in the abdomen (stage II) and then further in your body to places like your lungs, brain, bones and liver (stage III). The good news is that even stage III testicular cancer is pretty responsive to chemotherapy.

Types

There are two types of cancer. In both the cancer grows out of the germ cells (sperm cells):

Seminoma – This is a slower growing form of testicular cancer that tends to more commonly affect men between the ages of 30 and 40. It is extremely responsive to radiation treatment.

Non-Seminoma – This is more common in younger guys and it grows fairly quickly. There are a few different types of tumor in non-seminoma cases including: choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumor. Nonseminomas are sensitive to radiation therapy, but not as sensitive as seminomas are. Chemotherapy is often very effective for nonseminomas, even if the cancer has spread.

+   Causes and Risk Factors

The smart guys still haven’t really worked out what causes testicular cancer but they have identified some risk factors:

  • History of cancer (in particular testicular cancer) in your family
  • History of an undescended testicle
    • Just before you are born your testes descend out of your belly to the outside of your body. In some cases this doesn’t happen and one or both may need to be surgically brought down from your belly.
  • Abnormal testicle development
  • Klinefelter Syndrome
    • A genetic disease in which boys are born with an extra X chromosome (it effects about 1 in 1000 men)
  • HIV infection
  • Exposure to certain chemicals

+   Symptoms

Unfortunately, testicular cancer is fairly symptom free. Often there may not even be pain and the first sign of something wrong is when a self-exam or an exam by your doctor shows a tumor. This is why it’s a good idea to regularly do a self check (see our guide). If you do get symptoms you may notice one of the following:

  • Pain and discomfort in the testicle
  • Feeling of heaviness in the scrotum (the loose bag of skin under your penis)
  • Pain in the lower back or abdomen
  • Enlargement of a testicle or a change in how it feels
  • A lump (this may be on inside or the outside of your testicle)
  • Swelling or a collection of fluid in your scrotum
  • In some cases you may notice an excess growth of breast tissue which is medically known as gynecomastia (use it to impress your doctor next visit). This also occurs normally in some adolescent boys who don’t have testicular cancer

+   Treatment

First things first, if you think you have a tumor your doctor will probably start out by ultra sounding your testicles - just like the ultra sounds they use to check out babies. This will give your doctor some idea about the size and placement of the tumor. They may also order blood tests to look for tumor markers and check other parts of your body to see if the cancer may have spread. They use this is to help stage the cancer:

  • Stage I
    Cancer not spread past the testicle
  • Stage II
    When cancer has spread to the lymph nodes in the abdomen
  • Stage III
    When cancer has spread past the abdomen to the brain, liver, lungs or bones
  • Once they have a better idea of what’s going on:
    • If a tumor is present and they think it may be cancer it is likely they will suggest surgical removal of the testicle affected (orchiectomy). They will then send part of the tumor off to a lab where they will decide what kind of cancer it is - seminoma or nonseminoma (see above)
      • The testicle is often replaced by a prosthetic (fake) testicle, that looks and feels pretty much exactly the same as the real thing
      • Rarely both testes may be removed 
    • If the cancer has spread past the testicle to the lymph nodes in the abdomen they will probably remove these at the same time they remove the testicle
    • If the cancer hasn’t spread outside the testicle you and your doctors may not pursue any more treatment after surgery. If this is the case you will probably need to go to regular check-ups and it’s really important you follow up. Otherwise you may need to undergo radiation or chemotherapy in order to prevent the cancer coming back
  • Radiation therapy
    • Radiation is used kill specifically targeted cells, to prevent cancer from recurring
    • This is an extremely effective form of treatment for seminoma
  • Chemotherapy
    • Chemotherapy is a type of medicine that targets cancer cells that may have spread elsewhere in your body or any that may be left behind at the sight of the original tumor
    • It’s a very effective treatment for nonseminoma even when the cancer has spread

+   Complications

There are a number of complications that stem from both having testicular cancer and from the treatment of cancer

  • Cancer may spread to other parts of your body
  • Risks of surgery
    • Surgery to remove your testicle is fairly straightforward and doesn’t hold too many complication but all surgeries carry some risk and will involve some pain
  • Infertility
    • If both testicles are removed
    • Chemotherapy and radiation can both cause infertility
    • If you want to have kids in the future, don’t freak out about this. It sucks but you can talk with your doctor about preserving sperm for use later
  • Chemotherapy
    • Chemotherapy has a number of side effects from nausea to hair loss to more permanent lung damage. The type of complications will depend on the type of chemotherapy drugs you are put on

+   Self-Exam

You should regularly perform this exam. Partly so you can become more familiar with your testicles and therefore be more aware of any changes that might indicate a tumor or other problem. It’s best to do this exam after a shower or bath. The heat from the water will help to relax your scrotum making it easier to feel anything unusual.

  • 1. Stand in front of a mirror Look for any swelling on the skin of the scrotum
  • 2. Examine each testicle with both hands
    • Place the index and middle fingers under the testicle while placing your thumbs on the top
  • 3. Gently roll the testicle between the thumbs and the fingers.
    • Remember that the testicles are usually smooth, oval shaped and somewhat firm
    • It's normal for one testicle to be slightly larger than the other
    • Also, the cord leading upward from the top of the testicle (epididymis) is a normal part of the scrotum

(Mayo Clinic explanation of self exam)

You should regularly perform this exam can become more familiar with your testicles and aware of any changes that might be of concern.

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