Conditions > Testicular cancer

Testicular cancer

Clinical picture

When cells in a testicle show unbridled growth, this phenomenon is known as testicular cancer or testes carcinoma. Testicular cancer is a relatively aggressive cancer type that grows fast and spreads rapidly. Despite these facts, it is also one of the more treatable cancers.

The testicles or testes form part of the male reproductive organs and are found within the scrotum together with the epididymis. The testes produce sperm cells and male hormones. Testicular cancer generally originates within the cells that produce the sperm.

Two types of tumour are distinguished:

Seminoma: These tumours originate in the centre of the testicle, where sperm is produced. This type of tumour affects half of all testicular cancer patients.
Non-seminoma: This is a blanket term to describe all tumours that are not seminomas. Specifically: embryonal carcinoma, teratoma, choriocarcinoma or a combination.

In Belgium, around 360 men are diagnosed annually with testicular cancer. Usually these men are younger than 50 years old. Most tumours are discovered during an early stage. The 5-year survival rate for men diagnosed during stage I is 100%. But even patients who are diagnosed in stage III still have an 89% chance of being alive after five years.

Symptoms

Testicular cancer is often detected at an early stage. Symptoms include:

swelling or hardening of the testicle, sometimes painful
distinct testicular lump
a heavy feeling in the lower abdomen or testicle
pain in the lower back or abdomen, which can indicate the cancer has spread
swelling of nipples or breast glands, sometimes painful
being short of breath, coughing, sometimes with blood
fatigue
unexplained weight loss

Cause

There is no known cause for testicular cancer. However, certain risk factors can be identified. These include:

having undergone surgery during or after puberty in order to resolve an undescended testicle (triples the chance of getting testicular cancer)
having one or two undescended testicles during adulthood (multiplies the chance of testicular cancer six fold)
a history of testicular cancer
having an atrophied testicle
having relatives with a history of testicular cancer
infertility
sedentary lifestyle
prolonged use of cannabis

Diagnosis

A GP will conduct a physical exam, and possibly prescribe antibiotics at first, since the symptoms of testicular cancer and an inflammation are very similar. Only when the antibiotics have no effect, the patient may be referred to a urologist. He will perform blood tests, but possibly also an ultrasound and even orchiectomy; the removal of the testicle. This procedure is performed frequently, in order to stop the cancer from spreading. After diagnosis, an MRI scan, a CT scan or bone scan may be in order.

The tumour is graded in accordance to the following three stages:

Stage I: There is a tumour in the testicle but no spreading has occurred
Stage II: The tumour has spread to nearby lymph nodes
Stage III: Tumorous cells have spread to other organs and tissues. Metastases are mostly found in the lungs and lymph nodes

The differentiation of the tumour is an important factor in establishing a prognosis and treatment. This can be determined on the basis of a biopsy. A biopsy involves the removal of a small bit of tissue that can be examined under a microscope. Differentiation determines the degree of mutation in the cancerous cells.

Treatment

Common treatments for testicular cancer are surgery, radiotherapy, chemotherapy and lymph node surgery, or a combination of one or more of these treatments. An orchiectomy is not only part of diagnostics but also the start of treatment.

If the tumour is of the seminoma type, there are multiple options. This can involve regular check-ups, or surgery, followed by chemotherapy and radiation. In stage III, only chemotherapy is recommended. A cancer that develops according the combination type is treated the same way as a non-seminoma cancer.