The testicles are two small egg-shaped glands, held in a sac below the penis (the scrotum). This is where sperm form and mature. Sperm moves from the testicles into the vas deferens (a tube behind the testicles) and out the urethra when ejaculated. The testicles also make male hormones like testosterone. Testosterone controls the sex drive and starts the growth of muscle, bone and body hair. Healthy testicles have a firm, slightly spongy feel and the firmness should be the same throughout. The size of both testicles should be about the same, though one may be larger than the other.
Testicular cancer occurs when cells in the testicle grow to form a tumor. More than 90 percent of testicular cancers begin in the germ cells, which produce sperm. There are two types of germ cell cancers (GCTs); seminoma and non-seminomas. Seminoma grows slowly and respond very well to radiation and chemotherapy. Non-seminoma grows more quickly and can be less responsive to treatments. There are also rare testicular cancers that don’t form in the germ cells such as Leydig cell tumors that form from the Leydig cells that produce testosterone and Sertoli cell tumors that form from the Sertoli cells that support normal sperm growth.
The type of testicular cancer cell found, symptoms and other factors guide treatment.
- A painless lump in the testicle, which is the most common sign
- Swelling of the testicle, with or without pain
- A feeling of weight in the testicles
- A dull ache or pain in the testicle, scrotum or groin
- Back pain
- Tenderness or changes in the male breast tissue
Causes
- Family history
- Undescended testicles
- GCNIS: These are odd cells in the testicle called germ cell neoplasia in situ (GCNIS) and they are typically found during an infertility test.
- Personal history of testicular cancer
- Hypospadias which is opening of the urethra on the underside of the penis.
- Cannabis use
- Intersex variations such as partial androgen insensitivity syndrome
- Testicular Self-Exam. This is done when one checks the testicles for any changes or abnormalities. It is of great value to know what feels normal, so as to notice any changes when they occur. The best time to do a monthly testicular self-exam is after a warm bath or shower, while standing, when the scrotum is relaxed. It may help to do it in front of the mirror, so as to see and feel what you are doing. The steps are:
- Look for swelling in the scrotum
- Gently feel the scrotal sac to find a testicle
- Check each testicle one at a time by firmly and gently rolling it between the thumb and fingers of both hands to feel the whole surface. It is normal for one testicle to be slightly larger than the other
- Feel along the underside of the scrotum to find the epididymis that sits at the back of the testicle. It should feel like a little bunch of tightly curled tubes.
- Perform on the other testicle.
- Testicular Ultrasound
- Serum Tumour Marker Test
Stages
Testicular Cancer is grouped into the following stages:
- Stage 0: This is called Germ Cell Neoplasia in Situ (GCNIS). This is not yet cancer, but a warning that cancer could grow. This is found in the seminal tubules and nowhere else.
- Stage I (IA, IB, IS): Cancer is found only in the testicle, has not spread to nearby lymph nodes or anywhere else in the body.
- Stage II (IIA, IIB, IIC): Cancer has spread to one or more lymph nodes in the belly (often the first site of testicular cancer spread). It has not spread to other parts of the body.
- Stage III (IIIA, IIIB, IIIC): Cancer has spread beyond the lymph nodes in the belly. Cancer may be found far away from the testicles, such as distant lymph nodes or the lungs. Tumor marker levels are high.
Treatment
- Surveillance: This is a way to look for changes with normal checkups. These include a physical exam, tumor marker tests and imaging tests. Imaging tests start with an ultrasound of the scrotum which can involve chest x-rays, CT scans and signs of low testosterone. This is often recommended for patients with Stage 0 and I cancers.
- Surgery
- Orchiectomy: This surgery removes the entire testicle and mass through a small cut in the groin.
- Testis Sparing Surgery: This surgery removes just the tumor tissue, not the entire testis.
- Retroperitoneal Lymph Node Dissection: This requires a skilled surgeon to remove lymph nodes in the back of the abdomen to ensure limited side effects. This surgery is an option for patients with a more forceful Stage I cancer.
- Radiation: This is used to kill cancer cells in the testis or in nearby lymph nodes. It is only used in seminoma because some forms of non-seminoma are resistant to radiotherapy.
- Chemotherapy: This is used for cancers that spread beyond the testicles, or if tumor markers rise after surgery.