Testicular Cancer

Definition

Testicular cancer is a malignant tumour that develops in one or both testicles. It is relatively rare but is the most common cancer in young men aged 15-35 years.

Aetiology

The exact cause of testicular cancer is not known, but several factors may increase the risk, including:

Cryptorchidism: Undescended testicles.
Family history: Having a close relative with testicular cancer.
Previous testicular cancer: Higher risk of developing cancer in the other testicle.
Genetic factors: Certain genetic conditions and mutations.
Age: Most common in young men between 15 and 35 years old.

Pathophysiology

Testicular cancer typically originates in the germ cells, which produce sperm. The two main types are seminomas and non-seminomas. Seminomas grow slowly and are generally less aggressive, while non-seminomas grow more quickly and are more likely to spread. The cancer can spread to nearby lymph nodes and other organs if not treated promptly.

Risk Factors

Cryptorchidism: A history of undescended testicles.
Family history: A family history of testicular cancer increases risk.
Age: Most common in men aged 15-35 years.
Race: More common in white men compared to men of other races.
HIV infection: Associated with an increased risk of testicular cancer.
Personal history: Previous testicular cancer.

Signs and Symptoms

A lump or swelling in one testicle.
Pain or discomfort in the testicle or scrotum.
A feeling of heaviness in the scrotum.
A dull ache in the lower abdomen or groin.
Sudden collection of fluid in the scrotum (hydrocele).
Breast tenderness or enlargement (gynecomastia).

Investigations

Clinical history and physical examination, including a testicular exam.
Ultrasound of the scrotum: To evaluate the testicular mass.
Blood tests: Measurement of tumour markers (alpha-fetoprotein, beta-human chorionic gonadotropin, and lactate dehydrogenase).
Imaging: CT scan of the abdomen and pelvis to check for metastases.
Biopsy: Usually not performed due to the risk of spreading cancer cells; diagnosis is often made based on ultrasound and tumour marker results.

Management

Primary Care Management

Initial assessment: Prompt referral to a urologist if testicular cancer is suspected based on symptoms or physical examination findings.
Supportive care: Pain management and psychological support for anxiety and distress.
Patient education: Importance of testicular self-examination and early detection.

Specialist Management

Orchiectomy: Surgical removal of the affected testicle is the primary treatment.
Radiation therapy: Commonly used for seminomas to kill any remaining cancer cells post-surgery.
Chemotherapy: Used for non-seminomas and advanced seminomas to treat metastatic disease.
Surveillance: Regular follow-up with physical exams, tumour marker tests, and imaging to monitor for recurrence.
Retroperitoneal lymph node dissection (RPLND): Surgical removal of abdominal lymph nodes in certain cases.
Fertility preservation: Discussion about sperm banking before treatment due to potential impact on fertility.
Multidisciplinary care: Involvement of urologists, oncologists, radiologists, and fertility specialists for comprehensive management.

Example Management for Testicular Cancer

A patient presenting with a lump in the testicle and discomfort should undergo a testicular ultrasound and blood tests for tumour markers. If testicular cancer is suspected, the patient should be referred to a urologist for further evaluation and treatment. The primary treatment is an orchiectomy to remove the affected testicle. Depending on the type and stage of cancer, additional treatments such as radiation therapy for seminomas or chemotherapy for non-seminomas may be required. Regular follow-up with physical exams, tumour marker tests, and imaging is essential to monitor for recurrence.

References

NICE. (2024). Testicular Cancer: Diagnosis and Management. Retrieved from NICE
NHS. (2023). Testicular Cancer. Retrieved from NHS
American Cancer Society. (2023). Testicular Cancer. Retrieved from American Cancer Society
European Association of Urology (EAU). (2022). Guidelines on Testicular Cancer. Retrieved from EAU