What is testicular cancer?

Testicular cancer starts in the cells of a testicle. The testicles are part of a man's reproductive system. They are the two egg-shaped organs found in the sac of loose skin (scrotum) at the base of the penis. The testicles are held in the scrotum by the spermatic cord. The spermatic cord contains the ductus deferens, some lymph nodes, veins and nerves.

Testicles make the male sex hormone testosterone and sperm. Sperm begins to form in "germ" cells inside the testicles. Most testicular cancers start in the germ cells and are called germ cell tumors.

There are two main types of grem cell tumors. -- seminomas and non-seminomas. Each type grows differently and is treated differently. Both types can be treated successfully.

1. Causes testicular cancer

There is no single cause of testicular cancer but some factors seem to increase the risk of developing it:

• Delayed descent of the testicles (if not corrected early)
• Age - particularly between 15 and 49
• Family or personal history of testicular cancer
• Abnormal development of the testicle
• Some men develop testicular cancer without any of these risk factors.

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2. Early Detection:

All men, from the time they are 15 years old, should learn how to perform testicular self-examination (TSE). This is a simple, pain-free way to check what is normal for your testicles so that you will notice any changes. And you should do it regularly. Early detection of testicular cancer can make a difference in the treatment of the disease.

How to check your testicles
The best time to check your testicles is just after you've had a bath or shower, when the muscles in the scrotum are relaxed, making it easier for you to feel any lumps, growths or tenderness.

See your doctor if you have:

• a lump on the testicle
• a painful testicle
• a feeling of heaviness or dragging in the lower abdomen or scrotum
• a dull ache in the lower abdomen and groin

Have regular medical checkups with your doctor that include a testicular examination.

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3. Signs and Symptoms

The most common signs and symptoms of testicular cancer include: 

• painless lump on a testicle
• swelling of a testicle or change in the way it feels
• pain or discomfort in a testicle or in the scrotum
• feeling of heaviness or aching in the lower abdomen (stomach area) or scrotum

Other health problems can cause some of the same symptoms. Testing is needed to make a diagnosis. 

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4. Diagnosis

After taking your medical history and completing a physical examination, your doctor may suspect you have testicular cancer. 

To confirm the diagnosis, your doctor will arrange special tests. These tests may also be used to “stage” the cancer. You may have one or more of the following tests.

Imaging studies
Imaging studies allow tissues, organs and bones to be looked at in more detail. Using x-rays, ultrasounds, CT scans, MRIs or bone scans, your healthcare team can get a picture of the size of the tumour and see if it has spread. These tests are usually painless and do not require an anesthetic (freezing). 

If your doctor suspects that you have testicular cancer, you may have anultrasound. An ultrasound examination uses sound waves to make pictures of your testicles and scrotum. The doctor will look for anything abnormal in the pictures.

Blood tests
Blood is taken and studied to see if the different types of blood cells are normal in number and appearance. The results show how well your organs are working and may suggest whether or not you have cancer. Blood tests can also show if there are levels of certain substances in your blood that are higher than normal. Some substances (called tumour markers) are linked to certain types of cancer. For testicular cancer, there are three tumour markers:

• AFP (alpha-fetoprotein)
• b-HCG (beta-human chorionic gonadotropin)
• LDH (lactate dehydrogenase)

Orchiectomy and biopsy
A biopsy is usually necessary to make a definite diagnosis of cancer. Cells are removed from the body and checked under a microscope. If the cells are cancerous, they may be studied further to see how fast they are growing.

There are many ways to do a biopsy. For testicular cancer, it is usual to remove the entire testicle. This surgery is called an orchiectomy (ororchidectomy).

The surgery is done under a general anesthetic (you will be unconscious). You can usually go home from the hospital the next day. With the healthy testicle that is left, you’ll still be able to have an erection and you will be able to have children.

Cells from the removed testicle are checked under a microscope. If the cells are cancerous, they may be studied further to see what type of cancer it is and how fast the cells are growing. If the cancer has not spread beyond the testicle, this may be the only treatment you need.

Further testing
Your doctor may order more tests to find out if the cancer has spread and to help plan your treatment. 

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5. Staging

Once a definite diagnosis of cancer has been made and your healthcare team has gathered the information it needs, the cancer will be given a stage.

The cancer stage describes the tumor size and tells whether it has spread beyond the place where it started to grow.

For testicular cancer, there are four stages.

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6. Treatment For Testicular Cancer

Some procedure can cause permanent infertility
Before you undergo any procedure, talk to your doctor about sperm banking (freezing sperm before treatment for use in the future). If you have radiation treatment, chemotherapy or certain types of surgery, you may not be able to have children. Sperm banking allows you to decide later whether or not you want to have children. Young men don’t often think about having a family when they are facing a diagnosis and treatment for testicular cancer. Sperm banking gives you and your future partner important options.

Surgery
Surgery is the main treatment for testicular cancer. The surgeon removes the entire testicle (orchiectomy). The lymph nodes near the kidneys are often removed as well. Surgery is done under general anesthetic.
If the cancer has not spread and all of it was removed with the testicle, surgery may be the only treatment you need. It is uncommon for cancer to affect both testicles at the same time, so the healthy testicle remains.
After surgery. you may have some pain or nausea, or you may not feel like eating. These side effects are temporary and can be controlled.
Having one testicle removed will not make you impotent (unable to have an erection) or make you sterile (unable to father children). As long as the remaining testicle is healthy, you will still be able to have a normal erection and usually still be able to produce sperm.

Watchful waiting
Watchful waiting is an option for some men with testicular cancer and begins after surgery (orchiectomy). Watchful waiting (also called active surveillance) means your healthcare team will watch you closely. You would be treated with chemotherapy, radiation therapy or both only if signs and symptoms of cancer appear or change.
The schedule of watchful waiting follow-up visits will be different for each person, but you might visit your doctor every 1 to 2 months for the first year. Blood tests, chest x-rays and CT scans of your abdomen will be done on a regular basis during your follow-up visits.
Watchful waiting can continue for many years. If treatment is needed at any point, research has shown that it is still as effective as treatment offered right after surgery.

Radiation therapy
In external beam radiation therapy, a large machine is used to carefully aim a beam of radiation at the tumour. The radiation damages the cells in the path of the beam – normal cells as well as cancer cells. Radiation therapy is sometimes used to treat seminomas after surgery. Radiation can help prevent the cancer from coming back or destroy cancer cells that may have spread beyond the testicle. During radiation therapy, the remaining healthy testicle is shielded to protect it from damage.
Radiation side effects will be different depending on what part of the body receives the radiation. You may feel more tired than usual, have some diarrhea or notice changes to the skin (it may be red or tender) where the treatment was given

Side effects of radiation therapy

Many treatments for cancer can have side effects but it’s hard to know if and when they might happen to you. Side effects from radiation therapy vary from person to person, depending on:

• the amount of radiation
• the part of your body being treated
• your treatment schedule
• your general physical health
• other medications you are taking

Some people think that having side effects means that the radiation is working and not having them means that it’s not. Side effects are caused by damage to healthy cells during treatment. They are different from person to person and are not a sign of whether the treatment is working or not.

General side effects

Side effects that are possible with radiation therapy to any area of the body are often called general side effects. They may include:

• anxiety or depression
• changes in appetite
• fatigue
• skin changes in the treatment area
• changes in sleep patterns
• hair loss in the treatment area

Feelings about sexuality can also be affected during treatment.

As radiation therapy affects everyone in different ways, it is difficult to predict exactly how you will react to treatment. You may not have side effects at all, or only a few mild ones during your treatment. But being aware of possible side effects can help you cope with any problems that arise.

Your radiation therapy team is there to help you manage any side effects you have from treatments. Ask them about ways to reduce side effects or make them easier to deal with. If you notice any unexpected side effects or symptoms, talk to your radiation therapy team.

How long do side effects last?

It takes time for healthy cells to recover from the effects of radiation therapy, so side effects may continue even after treatment is over. Some may continue for weeks or months after your treatment. Other side effects, such as infertility, might be permanent.

Last modified on:  08 February 2010

Side effects of chemotherapy

All medicines can have side effects but it’s hard to know if and when they might happen to you. This is especially true when it comes to chemotherapy treatments for cancer. A certain drug may make one person sick to their stomach while someone else might just feel queasy or may feel nothing at all.

Your healthcare team will explain which side effects to report right away, and which ones can wait until your next appointment. If you notice any unexpected side effects or symptoms, talk to your healthcare team. They will suggest ways to deal with them. It may also be possible to change your treatment schedule or alter your medications to manage them. There may also be other medications that can help.

When are side effects most likely to happen and when will they go away?

Side effects can happen any time during your treatment. Some may happen during treatment, immediately after or a few days later. Some may continue after treatment is over, because it takes time for healthy cells to recover from the effects of chemotherapy drugs. Side effects can vary, depending on your treatment schedule, the drugs you are taking or how your body reacts to the treatment.

Side effects will gradually disappear when treatment is over, depending on the types of drugs you were taking and your general physical health. Some side effects may be permanent.

Last modified on:  09 December 2009

Relieving pain

Living with cancer and being treated for it doesn’t have to mean living with pain. You can play an important role in managing your pain by recognizing that you have it and asking your healthcare team for help. The way you feel pain is unique and it can be treated according to your specific needs.

You may have many concerns about taking medications to control pain. Some people believe that in order to live with dignity they must face their disease and bear the pain. Perhaps you’re concerned about how pain medicines might affect your body or whether they might change your personality in some way. You may worry that medications won’t work when you really need them if you start using them early in your treatment.

If you are in pain, it is important to talk to your healthcare team about your concerns. Your healthcare team is there to help you. You don’t have to face pain alone.

Last modified on:  09 December 2009

Coping with cancer
Whether you are newly diagnosed, in active treatment, or are caring for someone with cancer, you will probably need to deal with many day-to-day issues, make tough decisions, and cope with a range of emotions.

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7. After Treatment

Follow-up care helps you and your healthcare team monitor your progress and your recovery from treatment. At first, your follow-up care may be managed by one of the specialists from your healthcare team. Later on it may be managed by your family doctor.

The schedule of follow-up visits is different for each person. You might see your doctor more often in the first year after treatment, and less often after that.

Self-image and sexuality
It is natural to be concerned about the effects of testicular cancer and its treatment on your sexuality. Your doctor can tell you about possible side effects. You may be worried about being intimate with a partner or that you may be rejected. It may help to talk about these feelings with someone you trust. Your doctor can also refer you to specialists and counsellors who can help you with the emotional side effects of testicular cancer treatment.
If you have had a testicle removed, you may wish to talk to your doctor about reconstructive surgery to help restore the appearance of the testicle. This is called a testicular prosthesis or implant. The prosthesis is filled with saline and matches the look and feel of the other testicle. It is surgically implanted in the scrotum.
The end of cancer treatment may bring mixed emotions. You may be glad the treatments are over and look forward to returning to your normal activities. But you could feel anxious as well. If you are worried about your treatment ending, talk to your healthcare team. They are there to help you through this transition period.

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Much of the context above courtesy of the Canadian Cancer Society (http://www.cancer.ca) March, 2010