An Introduction to Testicular Cancer

Testicular cancer - the facts

Testicular cancer is very treatable and very curable, with a five year survival rateof above 95%. There are around 2000 new germ cell cases diagnosed each year in the UK, with the number diagnosed within the four counties per year standing at around 112.  They usually affect men between the ages of 15 and 35 years. The men at greater risk of getting a testicular cancer are those whose testicles did not drop as a child or if their brother or father has had a testicular cancer.

Testicular cancer can develop from any of the different cells that originate in the testicles. It is important that we find out which type of testicular cancer someone has because each type of testicular cancer behaves slightly differently. Therefore different treatment regimes will be given to different people.

There are two main types of testicular cancer- seminoma and teratoma. Sometimes they can be a mixture of the two. These are known as germ cell tumours.

The most common type of testicular tumour is the germ cell tumour. The germ cells are those that produce sperm. About 95% of testicular tumours are germ cell tumours.

Seminomas account for up to 45% of germ cells. They tend to be slow growing and are usually detected before they have spread to other parts of the body. They more commonly occur in men between the ages of 25 and 55 years of age. Teratomas usually affect men from 15 to 35 years of age.

Presentation

The majority of patients will present to their GP with:

1. A lump or a painless enlargement of the testicle
2. A change in the firmness of the testicle
3. A change in the size or weight of the testicle
4. Dull ache in the affected testicle or lower abdomen
5. Weight loss
6. General rapid deterioration in health
7. Cough or shortness of breath

Few men are aware of the risk factors or the need to carry out testicular examination. Therefore a number of men seek medical advice when the disease has already spread. A large number of men will wait for three months before they see their GP.

There are a number of reasons why men don't seek help immediately:

1. Embarrassment
2. Don't know who to tell
3. Concerns over the cause of the lump, for example, sexually transmitted diseases
4. Scared about the implications of the lump  

However, every man should remember that some lumps are benign (non cancerous). It is also important to remember that early detection saves lives. 

Your GP will refer you to see the Urologist at your local hospital who will carry out an ultrasound and perform a physical examination of the testicle. A special blood test will also be performed to look at tumour markers. These are proteins which are released in to the blood by tumour cells and are useful at diagnosis to suggest the volume of disease.

Once the Urologist has all the information he/ she requires he/ she will quickly be able to tell whether  the lump is likely to be malignant (cancerous) or not.

The ultrasound below shows a normal testicular ultrasound. You can compare this with the second ultrasound and see the difference. The second picture shows a large testicular mass. It is highly suspicious that this is a testicular cancer.

Normal testicular ultrasound

Testicular cancer 

Your Operation

The initial treatment for a testicular cancer is an operation called an orchidectomy (removal of the testicle). This will be performed through a cut in the groin and usually takes place within a few days. As a patient you will only be in the hospital for a day and the operation is fairly straight forward. It is usually carried out under a general anaesthetic unless there are any contraindications to this. Dissolvable stitches will be used to stitch the wound together again.

Sometimes wounds get infected. For example, they may be inflamed, painful or have pus coming out of them. If this happens you should seek help straight away.

If you are concerned about your wound you can either contact your practice nurse or your specialist nurse who will be able to give you advice.

The testicle will then be sent to the pathology department where it is looked at closely under a microscope. This will determine what type of testicular cancer you have.

Some people wish to consider having a prosthesis fitted. Some Urologists prefer to implant a prosthesis by means of a separate procedure following the operation. This is because of infection risks. Your urologist will be happy to discuss this with you further.

The picture below shows three differently sized prosthesis. They are filled with salty water. It should be remembered when having a prosthetic fitted that it will feel different to your remaining testicle.

Staging and Scans

Following the operation you will need to have a CT scan of the chest, abdomen and pelvis and this will show whether you have any disease that may have spread elsewhere in the body. It is important to remember that even if the disease has spread there is still a good chance that your disease will be cured with additional treatment.

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