Testicular Cancer

Types of Testicular Cancer

Testicular cancer is classified into two main types:

1. Seminoma
2. Non-seminoma

Both originate from germ cells, which have the potential to develop into various tissues and organs. Seminomas account for nearly 50% of these tumors. Non-seminomas tend to grow more rapidly and have a higher likelihood of spreading. Tumor markers such as α-fetoprotein (AFP) and beta-human chorionic gonadotropin (B-HCG) help differentiate these two types, as their treatment approaches may vary.

Causes of Testicular Cancer

Factors that may increase the risk include:

1. A family history of testicular cancer
2. Undescended testis – Normally, testicles descend from the abdomen into the scrotum before birth. If this fails to happen, it increases the risk of testicular cancer. Parents should ensure their newborn son’s testicles are in place.
3. Having cancer in one testicle increases the risk of developing cancer in the other. Regular self-examinations during bathing can help detect changes in size or abnormalities.

Symptoms of Testicular Cancer

Early stages may not present symptoms, but warning signs include:

• Painless swelling or enlargement of a testicle
• A feeling of heaviness in the scrotum
• Development of enlarged breasts (gynecomastia)

Diagnosis of Testicular Cancer

1. Clinical Examination – Any increase in testicle size should prompt a visit to a doctor. Testicular cancer is sometimes misdiagnosed as hydrocele; an ultrasound can help differentiate the two.
2. Ultrasound of the Testicles – A widely available test that can detect small lesions and calcifications.
3. Blood Tests – Tumor markers like AFP and HCG can indicate the presence of testicular cancer.
4. CT Scan – A contrast-enhanced CT scan helps stage the cancer by assessing lymph node involvement in the abdomen.
5. Chest X-ray – Since testicular cancer often spreads to the lungs, a chest X-ray or CT scan may be needed.
6. PET-CT – Not typically used for initial diagnosis but may be helpful in evaluating residual masses after chemotherapy in seminoma cases.

Treatment for Testicular Cancer

Treatment depends on cancer staging and risk stratification. The primary treatment is radical orchiectomy (surgical removal of the affected testicle). Further therapy is determined based on pathology results and staging.

• Radiotherapy – Effective for early-stage seminomas, using X-rays to target cancer cells in lymph nodes.
• Chemotherapy – Used in cases with large lymph node metastases. Many tumors shrink significantly with chemotherapy, though some may require additional surgery.
• Retroperitoneal Lymph Node Dissection (RPLND) – Some non-seminoma cases require surgical removal of affected lymph nodes, which can be done through open surgery, laparoscopy, or robotic-assisted techniques.

Role of Laparoscopic and Robotic Surgery

After radical orchiectomy, surgery may be needed to remove lymph nodes in the abdomen. Traditional open surgery requires a large incision, whereas laparoscopy or robotic-assisted techniques offer less invasive options with quicker recovery times.

Life After Testicular Cancer

Testicular cancer responds well to treatment, and with the right combination of surgery, chemotherapy, and radiotherapy, most patients can lead normal lives.

Fertility and Potency Concerns

• Testicular cancer may temporarily affect fertility but does not impact sexual function.
• Sperm preservation is advisable for those undergoing chemotherapy or surgery on a solitary testicle, allowing future options for fatherhood.

With early detection and proper treatment, testicular cancer is highly curable, providing patients with hope and the ability to lead fulfilling lives.