Testicular cancer develops when normal cells in the testicle(s) become abnormal and start growing uncontrollably, forming a tumour or mass. The exact reason why a cell becomes cancerous is unclear. Testicular cancer accounts for 1% of all male cancers and according to GLOBOCAN statistics for South Africa, the incidence is 218 cases per year. It is one of the most common cancers in men aged 15 – 44 years and rarely occurs before puberty.1,2,3,4
Most types of testicular cancer develop in the sperm-producing cells known as germ cells, and are referred to as germ cell tumours. Germ cell testicular cancers are divided into two main types:2
1. Seminomas (about half of cases) occur most commonly in men aged 25 – 55 years.
2. Non-seminomas, usually affect men aged 15 – 35 years. These tend to grow and spread more quickly.
RISKS FOR DEVELOPING TESTICULAR CANCER:
Family history: brothers and sons of affected men have an increased risk.
Race: white men are about 5 times more likely to get testicular cancer.
Undescended testicles (testes): increased risk.
Infertility: men with fertility problems have an increased risk.
HIV/AIDS: increased risk.
WHAT ARE THE TESTICULAR CANCER SYMPTOMS?
Typical signs of cancer in its initial stage:
- Painless (or painful) swelling or lump in/on the testicle
- Change in the size or shape of the testicles
- A feeling of heaviness in the testicle or the scrotum
- Twinge in the groin
- Pain and discomfort in a testicle or in the scrotum
Typical signs of cancer in an advanced stage:
If the cancer is found at a more advanced stage and has spread to other parts of the body then various other symptoms can develop.
- Back pain
- Chest pain, coughing and difficulty breathing
- Enlarged abdominal lymph nodes
- Enlarged or painful breast tissue
TESTICULAR SELF EXAMINATION (TSE):
The TSE is an easy way for you to check your own testicles for any unusual lumps or bumps which can be the first sign of testicular cancer. It is important to do a TSE every month so that you become familiar with the normal size and shape of your testicles. This will make it easier for you to notice any changes that may occur in the future.
- Self examination is best to do after a hot shower or bath.
The scrotum (skin that covers the testicles) is most relaxed then, making the testicles easier to examine. - Use both hands to examine each testicle separately. Starting with the thumbs placed on top of your testicle and your index and middle fingers behind your testicle, gently roll each testicle between your fingers.
- You should feel a soft rope-like tube (called the epididymis) located at the top back part of each testicle. This is normal.
- Remember that one testicle (the right one usually) is larger than the other.
- Feel for any lumps along the front and sides of your testicle. The lump can be as small as a grain of rice.
Contact your doctor if you notice any of the following:
- Change in the size of your testicles
- Swelling, lumps or pain in the testicles
- Change in the colour of your scrotum
- Pain in your groin
These changes do not necessarily mean you have cancer, but they should be checked by your doctor.
DIAGNOSIS
A doctor will feel the testicles for any sign of swelling, tenderness, or hardening. They may also feel the abdomen, neck, upper chest, armpits and groin for evidence of enlarged lymph nodes
Ultrasound:
A testicular ultrasound test uses sound waves to create an image of the testicles. This test can show the presence and size of a mass.
Blood Tests:
Blood tests can be done to determine the levels of tumour markers in the blood. Tumour markers are substances that occur normally in the blood, but the levels may be elevated in certain situations, including testicular cancer.
Biopsy:
A biopsy is the removal of a small amount of tissue for examination under a microscope. This may be done to determine whether cancer is present or not.
Surgery:
If testicular cancer is suspected, a surgeon may perform a procedure in which the entire testicle is removed through an incision in the groin. The testis is then examined to determine if it is cancerous, and if so, which type of cancer.
TREATMENT OPTIONS:
1. Surgery:
The removal of the affected testis may be used to make a diagnosis of cancer, and in doing so, is also a treatment option.
2. Chemotherapy
Chemotherapy is the use of anti-cancer medications that destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body.
3. Radiation Therapy
Radiation therapy is also referred to as radiotherapy. High-energy rays are used to kill cancer cells and shrink tumours.
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