Testicular cancer primarily affects young men between the ages of 20 and 40. The cancer usually only occurs on one side, in one of the two testicles. The recovery rates for testicular cancer are often very high, even at a later stage when metastases have already formed. Around 440 men are diagnosed with testicular cancer in Switzerland every year, of whom 85 % are under 50 years old at the time of diagnosis.
Testicular cancer is treated by surgically removing the testicle affected by the tumour. Patients with advanced disease may require radiation and chemotherapy. In most cases, sexual function and fertility are not affected by testicular cancer. Nevertheless, patients should freeze their sperm before chemotherapy or radiation, especially if they still wish to have children.
- Types of testicular cancer
- Causes and risk factors
- Early detection through palpation
- Testicular cancer, sexual function and fertility
Different types of cancer can develop in the testicles, depending on the cells from which the tumour originates. It is important to differentiate between seminomas (tumours of the germ cells) and non-seminomas. Non-seminoma is the collective term for all types of testicular cancer which do not originate from germ cells. The difference is important because these two tumours are treated differently. Non-seminomas are not irradiated because they are less radiation-sensitive.
The exact causes of testicular tumours are not known. The most important risk factor is undescended testicles in childhood. In this case, the testicle does not “wander” sufficiently or “wanders” too late into the scrotum and remains in the abdomen. Genetic components also seem to play a certain role in the case of testicular cancer. Testicular cancer sometimes occurs more frequently in one family. There are no known environmental factors behind testicular cancer.
Testicular cancer initially causes few or almost no symptoms. Some early symptoms are:
- swelling or enlargement of the scrotum
- calluses or lumps in the testicles.
The symptoms are usually painless. With time, a feeling of heaviness or pulling in the testicles may become noticeable. The following symptoms may occur in patients with advanced disease:
- loss of appetite,
- weight loss,
- back pain.
Testicular cancer is usually discovered coincidentally while palpating the testicles. Changes in the size of the testicles or calluses and lumps should be checked by a doctor. If testicular cancer is suspected, different examinations such as an ultrasound, computed tomography and a biopsy are carried out.
Men can detect testicular cancer or any abnormalities early by regularly palpating their testicles, such as on a monthly basis. This is best done standing up and under warm water, as it relaxes the skin of the scrotum and allows the testicles to be easily grasped. Should any enlargement, calluses or hard lumps be noticed in the testicles, this is a possible warning sign, and a urologist should be consulted to clarify the situation at the earliest opportunity.
Routine testicular palpation is recommended for young men between the ages of 14 and 45 to detect testicular cancer early.
Treatment of testicular cancer
The treatment of tumours affecting the testicles depends on the type of cancer involved and the stage of the patient's disease. To begin with, the affected testicle is usually removed surgically. At an early stage, without lymph node involvement or metastases, no further treatment is usually necessary. Regular check-ups are required to monitor the success of the treatment for the patient.
If the tumour has reached an advanced stage, surgery will be followed by chemotherapy and also, depending on the type of cancer, radiation therapy. Testicular cancer responds very well to these types of treatment. This means that even later stages of the disease involving metastases can be cured in most cases.
Sometimes the level of sex hormone (testosterone) produced after removing a testicle is no longer sufficient. In such cases, medical testosterone must be administered to the patient.
Since only one testicle is normally affected by the tumour, this has no effect on sexual function and fertility in men. In certain cases, fertility may be affected by higher doses of chemotherapy or radiation.
Therefore, patients should consider freezing their sperm before starting treatment, especially if they still wish to have children. Occasionally, insufficient sex hormones (testosterone) are produced after the removal of a testicle. In such cases, medical testosterone must be administered to the patient.