Testicular cancer

Introduction

The testicles produce sperm and testosterone. Testosterone is a hormone that plays a role in the development of a man’s reproductive organs and characteristics specific to men.

Testicular cancer develops when the testicle(s) normal cells become abnormal and start growing uncontrollably, forming a tumour or mass. The exact reason why a cell becomes cancerous is unclear. Testicular cancer accounts for 1% of all male cancers and according to GLOBOCAN statistics for South Africa, the incidence is 218 cases per year. It is one of the most common cancers in men aged 15 - 44 years and rarely occurs before puberty. ^[1,2,3,4]

Most types of testicular cancer develop in the sperm-producing cells known as germ cells and are referred to as germ cell tumours. Germ cell testicular cancers are divided into two main types:

1. Seminomas (about half of cases) occur most commonly in men aged 25 - 55 years.
2. Non-seminomas, usually affect men aged 15 - 35 years. These tend to grow and spread more quickly.

Risk for developing testicular cancer

• Family history: brothers and sons of affected men have an increased risk.
• Race: white men are about five times more likely to get testicular cancer.
• Undescended testicles (testes): increased risk.
• Infertility: men with fertility problems have an increased risk.
• HIV/AIDS: increased risk.

What are the testicular cancer symptoms?

Typical signs of cancer in its initial stage

• Painless (or painful) swelling or lump in/on the testicle
• Change in the size or shape of the testicle
• A feeling of heaviness in the testicle or the scrotum
• A twinge in the groin
• Pain and discomfort in a testicle or in the scrotum

Typical signs of cancer in an advanced stage 

If the cancer is found at a more advanced stage and has spread to other parts of the body, then various other symptoms can develop:

• Back pain
• Chest pain, coughing and difficulty breathing
• Enlarged abdominal lymph nodes
• Enlarged or painful breast tissue

Testicular self-examination (TSE)

The testicular self-examination (TSE) is an easy way to check your own testicles for any unusual lumps or bumps which can be the first sign of testicular cancer. It is important to do a TSE every month so that you become familiar with the normal size and shape of your testicles. This will make it easier for you to notice any changes that may occur in the future.

Contact your doctor if you notice any of the following

• Change in the size of your testicles
• Swelling, lumps or pain in the testicles 
• Change in the colour of your scrotum
• Pain in your groin

These changes do not necessarily mean you have cancer, but they should be checked by your doctor.

Diagnosis

Physical examination

A doctor will feel the testicles for any sign of swelling, tenderness, or hardening. They may also feel the abdomen, neck, upper chest, armpits, and groin for evidence of enlarged lymph nodes.

Ultrasound

A testicular ultrasound test uses sound waves to create an image of the testicles. This test can show the presence and size of a mass. 

Blood tests

Blood tests can be done to determine the levels of tumour markers in the blood. Tumour markers are substances that occur normally in the blood, but the levels may be elevated in certain situations, including testicular cancer. 

Biopsy

A biopsy is the removal of a small amount of tissue for examination under a microscope. This may be done to determine whether cancer is present or not.

Surgery

If testicular cancer is suspected, a surgeon may perform a procedure in which the entire testicle is removed through an incision in the groin. The testis is then examined to determine if it is cancerous and which type of cancer.

Treatment options

Treatment includes surgery, chemotherapy, and/or radiation therapy. The final choice of treatment depends on the patient’s specific situation.

Surgery

The removal of the affected testis may be used to make a diagnosis of cancer, and in doing so, is also a treatment option.

Chemotherapy

Chemotherapy is the use of anti-cancer medications that destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body.

Radiation therapy

Radiation therapy is also referred to as radiotherapy. High-energy rays are used to kill cancer cells and shrink tumours.

Consult with your healthcare professional if you have any questions.

#FafChallenge:

#FafChallenge: Don’t faf this up. Be ballsy enough to check your crown jewels in the #FafChallenge.

REFERENCES

1. Testicular Cancer - Introduction. Available at: https://www.cancer.net/cancer-types/ testicular-cancer/view-all.
2. Tidy, C. Testicular Cancer - Patient UK. Available at: https://patient.info/health/ scrotal-lumps-pain-and-swelling/testicular-cancer. 
3. South Africa GLOBOCAN Statistics 2018 Fact Sheet. Available at: http://gco.iarc.fr/today/data/factsheets/populations/710-south-africa-fact-sheets.pdf. 
4. Herbst, M. Cancer Association of South Africa ( CANSA ) Fact Sheet on Testicular Cancer. 1–11 (2013). Available at: https://www.cansa.org.za/files/2017/11/Fact-Sheet-Testicular-Cancer-NCR-2013-web-November-2017.pdf. 
5. Testicular Cancer Facts. 1–16 Available at: http://www.love-your-nuts.com/tcFacts.html. 
6. Surviving Cancer. Available at: http://www.can-sir.org.za/wp-content/uploads/2013/04/What-is-Testicular-Cancer