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Clinical Specialties - Cancer

Testicular Cancer

San MDTIf you have testicular cancer or are close to someone who does, knowing what to expect can help you cope. Here you can find out about testicular cancer, including risk factors, symptoms, how it's found, and how it's treated. Learning about the disease can help you feel better prepared, and can make it easier to speak to your Uro-Oncology MDTdoctor and feel confident asking questions about your condition, treatment options and care.

At Sydney Adventist Hospital, our cancer experts have the training and expertise to quickly diagnose your disease, explain the range of treatment options available and help you decide on a plan tailored to meet your needs and goals.

About testicular cancer

The testicles are two small, egg-shaped glands located close to the penis. The loose skin that surrounds them is called the scrotum. Testicles contain many specialised cells, including germ cells which make sperm, and stromal cells that make testosterone.

Germ Cell Tumours
The majority of cancers of the testicle start in cells known as germ cells that make sperm. The main types of germ cell tumors (GCTs) in the testicles are seminomas and non-seminomas which occur equally.

Seminomas tend to grow and spread more slowly than non-seminomas. More than 95% of seminomas are ‘Classical’ (or typical), and usually occur in men between 25 and 45. Spermatocytic seminoma are a rarer type that occur in older men (average age is about 65), growing more slowly and are less likely to spread to other parts of the body than classical seminomas.

Nonseminomas are often more aggressive than seminomas, and more likely to spread beyond the testicle. These types of germ cell tumours usually occur in men between their late teens and early 30s.

Many testicular cancers contain both seminoma and non-seminoma cells. These mixed germ cell tumors are treated as non-seminomas because they grow and spread like non-seminomas.

Stromal Cell Tumours
A smaller percentage of testicular cancers start in stromal cells which make testosterone. Testicular stromal tumours are often benign (not cancerous), however a stromal cell tumour could also be a cancer that has spread from another part of the body (called a secondary cancer).

While testicular cancer is a relatively rare disease, it was one of the more common cancers diagnosed in younger men. In 2014, 852 new cases of testicular cancer were diagnosed in Australia1. For Australian men, the risk of being diagnosed with testicular cancer by age 85 is 1 in 1871. In 2015, there were 23 deaths from testicular cancer. With recent advances in the diagnosis and treatment of this cancer, most men – especially those with early-stage tumours – can expect to survive the disease.

What are the symptoms of testicular cancer?

Testicular cancer may cause no symptoms however the most common symptom is a painless swelling or a lump in a testicle.

Less common symptoms include:

  • feeling of heaviness in the scrotum
  • change in the size or shape of the testicle
  • feeling of unevenness
  • pain or ache in the lower abdomen, the testicle or scrotum
  • back pain
  • enlargement or tenderness of the breast tissue (due to hormones created by cancer cells).

While these symptoms don’t necessarily mean cancer is present, if you do experience any of them it is important to see a doctor - early detection does increase your chance of successful treatment.

Who is at risk of getting testicular cancer?

Testicular cancer isn’t linked to any habits, activities, or lifestyles. There is no known link between testicular cancer and injury to the testicles, sporting strains, hot baths or wearing tight clothes. Some factors that may increase a man’s risk of testicular cancer include:

  • Undescended testicle (when an infant) - Testicles drop down from the abdomen to the scrotum before birth, however if you were born with an undescended testicle you have a greater risk of testicular cancer even if you’ve had surgery to the fix the issue.
  • A previous testicular cancer diagnosis - If you’ve been diagnosed with cancer in one of your testicles, you’re more likely to get cancer in the other one.
  • Family history (having a father or brother who has had testicular cancer) - Having a father or brother with testicular cancer increases the risk that you will get it, too. But only a small number of testicular cancers occur in families; most men with testicular cancer do not have a family history of the disease.
How is testicular cancer diagnosed?

Tests used to diagnose testicular cancer include:

  • ultrasound (to confirm the presence of a mass) and
  • blood tests for tumour markers

Most types of cancer are diagnosed by biopsy where a small piece of the tumour is removed and examined under a microscope for cancer cells. However a biopsy is rarely done for a testicular tumour because it might risk spreading the cancer. The ultrasound and blood tests should give your doctor a reliable diagnosis, and if they believe it is testicular cancer, instead of a biopsy it is likely that surgery to remove the tumour will be recommended as soon as possible.

What are the stages of testicular cancer?

In addition to the results of the diagnostic tests above, a chest X-ray and CT scans of the chest, abdomen and pelvis may be required to determine if and how far the cancer has spread.

  • Stage 1 means the cancer is found only in the testicle
  • Stage 2 means it has spread to the lymph nodes in the abdomen or pelvis
  • Stage 3 means the cancer has spread beyond the lymph nodes to other areas of the body such as the lungs and liver.
What are my treatment options?

If the cancer is found only in the testicle (stage 1), surgical removal of the testicle (orchidectomy) may be the only treatment needed. In some cases “insurance” or “mop up” chemotherapy may be given after surgery depending on certain risk factors.

If the cancer has spread beyond the testicle, chemotherapy and/or radiotherapy may be used as part of your treatment as well.

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