Testicular Cancer

While rare, testicular cancer is the most common cancer in males ages 15 to 34. It’s highly treatable, even if the cancer has spread beyond the testes. Regular self-examination can help identify growths in their early stages when treatment can be most successful.

Symptoms

  • A lump or enlargement in either testicle
  • A feeling of heaviness in the scrotum
  • A dull ache in the groin or abdomen
  • Fluid collected in the scrotum (especially if it’s sudden)
  • Pain or discomfort in the testicle or scrotum
  • Breast tenderness or enlargement

See your doctor if you find any lumps or abnormalities in your testes, or if you have pain, especially if the symptoms last longer than two weeks.

Causes

Abnormally dividing cells can cluster together and cause tumors. It’s not known what causes these cells to behave abnormally. It is known that nearly all testicular cancers begin in the germ cells—the cells that produce immature sperm.

Treatment Options

After diagnosis, your team will determine the stage and discuss your treatment options. A lot of progress has been made in the last few years, and treatments have been refined. Your doctor can help you decide what is best, and the best ways to implement your options.

Depending on the type of cancer and stage, as well as other factors like age and health, we could use a combination of therapies.

Surgery is usually the first treatment for all testicular cancers, sometimes augmented by chemotherapy and/or radiation therapy. There are different types of surgeries we can employ.

  • Radical Inguinal Orchiectomy – This type of surgery removes the testicle or testes containing the cancer through a small incision made just above the pubic area. Early in the operation, the surgeon ties off the blood and lymph vessels in the spermatic cord to avoid spreading cancer cells into the surgical wound or releasing them into the bloodstream. All stages of testicular cancer can be treated with this surgery.
  • Retroperitoneal Lymph Node Dissection (RPLND) – In some cases, either during or in a separate surgery from the orchiectomy, it may be necessary to remove some lymph nodes at the back of the abdomen. This isn’t always the case, so it’s important to fully discuss this and possible alternatives with your doctor.
  • Laparoscopic Surgery – A laparoscope is a narrow, lighted tube with a camera at the end. The surgeon can use this to see inside the abdomen. Using this, very small incisions and long, thin tools, the surgeon can remove lymph nodes without putting hands inside the patient’s body. This seems to be much easier on the patient because of minimal invasion, and patients recover more quickly. However, doctors aren’t sure if this procedure is as effective as standard “open” surgery. If cancer is found in the lymph nodes, chemotherapy may be deemed necessary as well.

Surgical Risks and Side Effects

As with any surgery, there are short-term risks such as reactions to anesthesia, excess bleeding or blood clots, and infections. Most men will also experience some pain which can be lessened with pain medicine, if necessary.

After orchiectomy: losing one testicle usually has no effect on a man’s ability to have an erection or have sex. However, if both testicles are removed, sperm cells cannot be produced resulting in infertility. Without testicles, a man cannot produce enough testosterone. This may decrease sex drive and affect the ability to have erections. as well as possibly cause fatigue, hot flashes and loss of muscle mass. Testosterone supplements, whether in the form of a gel, patch or shot, could help. Pills are not an effective source.

Many men with testicular cancer are young, and worry about appearance as well as performance. To restore a more natural look, you can have a testicular prosthesis surgically implanted in the scrotum. We use prosthetics that have been filled with saline. We can match the size of the remaining testicle and the resulting scar is usually hidden by pubic hair. If a prosthesis would benefit you, be sure to discuss with your doctor.

After lymph node dissection: RPLND is a major operation, usually requiring a large incision in the abdomen that will take time to heal and leave a scar. Your ability to resume activity will be limited for some time. About 5 – 10% of patients can have temporary complications post-surgery, such as bowel obstructions or wound infections.

RPLND does not cause impotence. You can still have erections and intercourse; however, there may be damage to the nerves that control ejaculation. If this is the case, at ejaculation semen is propelled back into the bladder, rather than out through the urethra. This “retrograde ejaculation” can make it hard to father children. Normal ejaculation function can be saved with “nerve-sparing” surgery. If you wish to father children, please discuss this surgery with your doctor. Also consider sperm banking, in case sperm count has dropped.

Chemotherapy: Chemo is drug-based cancer treatment commonly taken by pill or injection. Testicular cancer patients are usually treated by injection into a vein. Chemo is considered a systemic therapy, because it travels through your body to reach and destroy cancer cells. This is especially effective when cancer cells have broken from the main tumor to reach lymph nodes or distant organs. Chemo is given in cycles, with a treatment period followed by a rest period. Cycles usually last three to four weeks.

Radiation therapy: If cancer cells have spread to lymph nodes, radiation therapy is a treatment option. It uses a high-energy beam to destroy or slow the growth of cancer cells. This beam could either be gamma or X-rays, or subatomic particles (electrons, protons or neutrons). If the beam is delivered from a machine outside the body, it is called “external beam radiation.” It’s like getting an intense X-ray. The treatment itself only lasts a few minutes but it takes longer to get set up. Radiation can affect healthy tissue as well, but we do our best to minimize these effects using the Calypso System. Common side effects include fatigue, nausea or diarrhea. Sometimes, the skin reacts as if sunburnt, but that fades in time. Possible long-term effects include damage to blood vessels or other organs near the treatment site and an increased chance of getting a second non-testicular cancer later in life.