Testicular Cancer

What Is Testicular Cancer?

Testicular tumours are the most common tumours in males between the ages of 20 and 40 and the incidence appears to be increasing, but with early detection and new improved treatments the chances of a recovery are high. The survival rate is 95%.

The causes of testicular cancer are not fully understood. The main risk factor appears to be having an undescended testicle. It also is known to run in families, men with a brother or father with testicular cancer have a higher risk of developing it.

A third of all testicular cancers present following trivial trauma. It is not the trauma that causes the cancer rather the trauma brings a pre-existing abnormality to the attention of the patient.

The most common symptom of testicular cancer is a painless swelling or lump in one of the testicles. All men should examine their testicles once a month. The best place is in the bath or shower when the scrotal sack is relaxed. Any changes should be reported to the GP.

The GP should physically examine the testicle and if a lump is found he should immediately refer to a urologist. The testes have natural lumpy structures within them and a patient can mistakenly believe these are abnormal, the GP will be able to reassure the patient in relation to this. An infection can be a symptom of an underlying malignancy as the tissues can be compromised, reducing their resistance to infection. This should be followed up to exclude a malignancy. GP's sometimes diagnose a hydrocele ( a pocket of fluid) by illuminating the testicle with a pen torch, then reassuring the patient that nothing sinister is apparent. However, in the case of testicular tumours, a small secondary hydrocele is present in one third of cases. If not referred and diagnosed early the cancer can spread quite rapidly to the lungs and lymphatic system.

Once referred the specialist will undertake investigations such as bloods, ultrasound and x-rays. With good imaging techniques the diagnosis of a testicular tumour is usually made before the patient is subjected to surgery.

Treatment for testicular cancer is usually very successful if found early. The best way to ensure the cancer has all gone is to have the testicle removed (orchidectomy). An implant can be inserted at the same operation.

The testicle will then be examined in the pathology laboratory to identify which type of cancer is present. Appropriate treatment can then be prescribed, this can be radiotherapy, chemotherapy or both depending on the type of cancer and whether it has spread.

Having only one testicle does not affect fertility or sexuality. Chemotherapy may reduce sperm count and affect fertility. Before starting this treatment sperm can be tested and, if suitable, stored and used after treatment has finished.

The error of a doctor in misdiagnosing a testicular tumour can have devastating consequences. Early referral is crucial for a successful outcome.