Testicular cancer

The Function of the Testes and Complications Associated with Testicular Cancer

The testes (or testicles) are the male reproductive glands located in the scrotum. Their primary functions include producing sperm (spermatogenesis) and synthesizing the hormone testosterone, which regulates male reproductive development and secondary sexual characteristics. Any disease affecting the testes can disrupt fertility, hormone balance, and overall reproductive health.

Testicular cancer primarily affects young and middle-aged men and is one of the most treatable cancers when diagnosed early. However, if left undiagnosed or untreated, it may lead to infertility, hormonal imbalances, and metastasis to organs such as the lungs, brain, and abdomen. The psychological and emotional impacts—especially in younger men—are also significant. Raising awareness through education, self-examination practices, and regular checkups is key to early detection and prevention of complications.

Categories Associated With Primary and Secondary Testicular Tumours

Testicular tumours are classified as either primary (originating within the testes) or secondary (metastases from other sites):

Primary Testicular Cancer:

These tumours originate in the testicular tissue. They are broadly divided into:

  • Germ Cell Tumours (GCTs): Account for over 90% of testicular cancers.
    • Seminomas: Slow-growing, usually in men aged 25–45.
    • Non-Seminomas: More aggressive; includes embryonal carcinoma, yolk sac tumour, choriocarcinoma, and teratoma.
  • Non-Germ Cell Tumours:
    • Sex Cord-Stromal Tumours: Less common, including Leydig cell and Sertoli cell tumours.
    • Lymphoma: The most common testicular cancer in older men (above 60).

Secondary (Metastatic) Testicular Cancer:

Rarely, cancers from other organs (prostate, kidney, or lymphomas) may metastasize to the testes.

Risk factors include:

  • Undescended testicle (cryptorchidism)
  • Family or personal history of testicular cancer
  • Infertility
  • Klinefelter’s syndrome
  • HIV infection
  • Caucasian ethnicity (higher risk)
  • Environmental exposures (endocrine disruptors)

Signs and Symptoms of Testicular Cancer

Most men discover testicular cancer themselves, often through self-examination. Common signs include:

  • A painless lump or swelling in either testicle
  • Heaviness or aching in the lower abdomen or scrotum
  • Sudden fluid collection in the scrotum
  • Pain or discomfort in a testicle or scrotum
  • Breast tenderness or enlargement (gynecomastia)
  • Lower back pain (if metastasised to lymph nodes)
  • Shortness of breath, cough, or chest pain (if metastasised to the lungs)

Many cases are asymptomatic in early stages, highlighting the importance of self-awareness and regular checkups.

Diagnosis of Testicular Cancer

A stepwise diagnostic approach includes:

Clinical Evaluation:

History of symptoms, physical exam of the testicles and abdomen by a urologist.

Laboratory Tests:

  • Tumour Markers:
    • Alpha-fetoprotein (AFP)
    • Beta-human chorionic gonadotropin (β-hCG)
    • Lactate dehydrogenase (LDH)

These are key in diagnosis, monitoring, and prognosis.

Imaging Studies:

  • Scrotal Ultrasound: First-line test for identifying intratesticular masses
  • CT Scan (Chest, Abdomen, Pelvis): To evaluate for metastases
  • MRI: Occasionally used for more detailed imaging

Surgical Diagnosis:

  • Radical Inguinal Orchiectomy: The Entire testicle is surgically removed for histological diagnosis (biopsy is typically avoided to prevent cancer spread).

Staging:

Staging (I–III) is based on tumour size, lymph node involvement, and distant metastases.

Best Treatment for Testicular Cancer

Treatment is highly effective and individualised based on tumour type, stage, and patient condition. The main treatment strategies are:

A. Traditional Treatments

B. Advanced and Alternative Treatments

C. Traditional Treatment for Testicular Cancer

1. Surgical Procedures

  • Radical Inguinal Orchiectomy: Removal of the affected testicle is the first step in most cases.
  • Retroperitoneal Lymph Node Dissection (RPLND): Removal of abdominal lymph nodes if metastasis is suspected or confirmed.

2. External Beam Radiation Therapy

  • Primarily used for seminomas, which are radiation-sensitive.
  • Typically applied to the para-aortic lymph nodes.
  • Side effects may include fatigue, nausea, and infertility (depending on the radiation field).

3. Systemic Chemotherapy

  • Commonly used drugs include cisplatin, etoposide, and bleomycin (BEP regimen).
  • Especially effective for non-seminomatous germ cell tumours and advanced seminomas.
  • Side effects include fatigue, hair loss, nausea, and temporary infertility.

B. Advanced Treatments for Testicular Cancer

New therapies are emerging that offer better targeting and reduced side effects, especially in refractory or relapsed cases:

1. Microinvasive Therapies and Surgeries

  • Laparoscopic RPLND:
  • A minimally invasive approach for lymph node dissection with reduced recovery time and complications.
  • Cryoablation or Radiofrequency Ablation:
  • Rarely used in testicular cancer but may be explored in metastatic foci not amenable to conventional therapy.

2. Targeted Therapies

  • Though not yet standard for most testicular tumours, targeted treatments aimed at specific pathways (e.g., angiogenesis, mTOR inhibition) are being explored in clinical trials for chemoresistant cases.

3. High-Dose Chemotherapy with Stem Cell Transplant (HDCT + SCT)

  • In cases of relapse or resistance, high-dose chemotherapy followed by autologous stem cell transplant can be life-saving.

4. Immunotherapy and Biologics

  • Limited application currently, but trials are underway to assess the use of checkpoint inhibitors in platinum-resistant germ cell tumours.

Prevention and Lifestyle Management

While testicular cancer is not always preventable, early detection and healthy practices help reduce risk and complications:

  • Monthly self-examinations (especially in men with known risk factors)
  • Regular health checkups
  • Prompt medical evaluation of any lump or discomfort in the testicles
  • Avoidance of environmental toxins (e.g., endocrine disruptors)
  • Sperm banking before chemotherapy or radiation, to preserve fertility

Raising awareness in schools and among young adults is vital for early intervention.

Prognosis and Survival Rates

Testicular cancer is among the most treatable cancers, especially when diagnosed early. The overall 5-year survival rate exceeds 95%. For stage I, the cure rate is nearly 100%. Even advanced-stage cases respond well to chemotherapy and surgery, with survival rates of 70–80% or higher. Ongoing surveillance post-treatment is essential to monitor for recurrence or late side effects.

Conclusion

Testicular cancer, though relatively rare, predominantly affects young and middle-aged men. Its impact extends beyond physical symptoms to affect emotional and reproductive health. However, with high survival rates and excellent treatment outcomes, early detection through awareness and self-examination is crucial. Advances in surgery, chemotherapy, and emerging therapies continue to improve survival and quality of life for affected individuals. A proactive, informed approach helps reduce the global burden and stigma associated with testicular cancer.