What Are The Treatment Options For Testicular Cancer?

Different types of cancers affect both genders.

Testicular cancer develops in the testicles in men aged from 15 to 49.

Although earlier it was considered as one of the rare cancers, the increasing number of patients over the years has compelled us to rethink.

According to the University Of Iowa Health Care, nearly 8,000 cases of testicular cancer are reported every year.

Let’s find out what testicular cancer is, its types, symptoms, and diagnosis, treatment, and survival.   

What is Testicular Cancer?

Testicular cancer develops in the male reproductive organs or testes. The male reproductive organ is made of testicles and epididymis, and other connected organs.

Testicles produce sperm and male hormones, both of which play an essential role in reproduction. The testicles connect to the spermatic cord, a channel used for transferring sperm toward the urethra. This type of cancer develops in the testicles.

A previous study shows that white males are more vulnerable to testicular cancer than Asians or Africans, although it can affect any male.

Unfortunately, researchers are still speculating on the reasons and family history with their relation or influence in developing testicular cancer; the results are still patchy. Therefore, it calls for further research and attention from healthcare experts, geneticists, and various scholars. 

It is also true that more and more males have testicular cancer, and the numbers are increasing every year. Therefore, you must be careful to identify the symptoms and seek medical help if you detect any abnormality in the testicles.

Before you understand the symptoms, let’s find more about the types of testicular cancer

Symptoms

Testicular cancer is curable in most cases. Early detection often helps the patient get rid of the disease and live a happy and healthy life.

Men are advised to recognize testicular cancer symptoms as early as possible. Due to the scarcity of cases, doctors and researchers have a limited choice to educate the patients to detect testicular cancer.

Also, due to a lack of knowledge, the patients often neglect the signs and symptoms. Therefore, one should be aware and try to physically inspect himself for any signs that can potentially be due to testicular cancer.

If you notice any of the symptoms mentioned below, you should not delay in visiting your doctor. Testicular self-examination (TSE) is one method to detect abnormal development in the scrotum, enlargement, and heaviness in the scrotum, and some other symptoms.

You should perform TSE regularly, and before doing so, please take a warm bath and relax your body; now, gently inspect the genital organs to proceed. 

  • Lump in the Testicle

  • Accumulation of Fluid

  • Pain or Discomfort

  • Enlargement and Heaviness

  • Early Puberty

  • Unusual Development of Breasts

Other Rare Symptoms

In rare cases when testicular cancer has infected the surrounding areas by spreading through the lymph nodes, these symptoms may occur: 

  1. Abdominal Pain
  2. Lower Backache
  3. Chest Pain and Coughing
  4. Headaches and Fatigue
  5. Blood Clot

Diagnosis

A patient may accidentally detect abnormal growth in the scrotum and visit a doctor for a further check-up. Otherwise, if he faces some of the symptoms of testicular cancer he should immediately get himself diagnosed. 

Diagnosis of testicular cancer may involve physical and/or radio-imaging and tests. Physical observation of the scrotum is the basic but essential part of the diagnosis. 

Physical Inspection

The physical inspection involves observing the scrotum, checking tenderness, lumps, and swelling, if any. Physical examination of the abdomen, pelvis, and other areas is conducted to check the spread and possibly affected organs. 

Going further, the specialist doctor can suggest one or multiple tests mentioned below:

  • Blood Test

  • Ultrasound

  • Chest X-ray

  • Biopsy

  • Inguinal Orchiectomy 

  • PET Scan

  • CT Scan

  • Bone Scan

  • MRI

Doctors will generally consider the type of tumor too. The patient may have a germ cell tumor, for example. In this case, germ cells become cancerous and can cause the growth of a tumor in the testicles. A Leydig cell tumor is another type that can cause the patient to develop a cancerous testicle.

During the diagnosis process, healthcare providers will generally look for a tumor marker. This data can help in determining the severity of cancer.

Tests are also used to determine specific tumor marker levels. Data related to the tumor marker levels help the healthcare provider determine the most efficient treatment for testicular cancer patients. 

Causes and Risk Factors

Exact causes and risk factors are still unknown; however, some known factors are discussed below:

Cryptorchidism

Cryptorchidism or undescended testicles at the time of birth can lead to testicular cancer. In this case, either or both the testicles remain attached to the abdomen at birth and fail to develop further, which may give rise to testicular cancer in the future. 

Usually, the early development of the testicles occurs in the fetus before birth and gradually descend and take the initial form of the scrotum.

Typically, the underdeveloped scrotum systematically develops and continues to drop as the baby grows. But in some cases, the scrotum struggles to grow and remains stuck with the abdomen or the groin. 

If a parent notices that their child is suffering from cryptorchidism during his early years, they should consult with a doctor. A surgical procedure such as orchiopexy is performed to treat this condition.

Abnormal Cell Development

Abnormal cell development or carcinoma in situ (CIS) is not cancer. However, it may develop into cancer if it is left untreated for long. It can easily be removed after detection with the help of testicular biopsy. 

Genetic Reason

The risk of getting testicular cancer gets high if a person’s closest blood relatives had it earlier. Patients with a previous family history are more prone to suffer from this disease. However, it alone does not determine the possibilities of testicular cancer; there can be several other factors as well.

The doctors and researchers are concurrently trying to find the exact reasons for this disease. Therefore, it is a little early to defend why family history plays an important role in spreading this disease. Eminent researchers have suggested specific genes responsible for the disease, which will be further elaborated on in the coming years. 

Previous Patients

The study shows that patients who had previous conditions of testicular cancer are on edge. Therefore, if you had suffered from it earlier, chances are you may develop it again.

Moreover, if one testicle has been affected earlier, the other testicle may also develop the disease. That is why you should always be cautious and aware and get yourself checked by a doctor. Additionally, you may also perform TSE to self-detect.

HIV Positive

A limited number of cases were found where the patients who were HIV positive were at a higher risk of testicular cancer. It is one of the rare infections which seems to increase the risk. Once again, further research is still required to confirm the exact association of HIV with testicular cancer. 

Age

Testicular cancer can affect any male at any age; there are several cases where the patients are as young as six months and also elderly patients above 60. But the researchers have also pointed out that the adolescent years to early adulthood fall within the expected time limit when one may develop testicular cancer.

Race and ethnicity

In several cases, it has been found that white Caucasian males are more prone to testicular cancer than aboriginal Americans, Africans, and Asians. Specific reasons are still unknown; therefore, it is always advised to be on the safer side and once a while goes for a routine checkup.  

Hernia

According to the American Cancer Society, an inguinal hernia can potentially damage the tissues creating ‘weak spots.’ This will, in turn, promote the development of fatty cells in the testicles and lead to complications.  

Mumps

Mumps orchitis is said to increase the risk of testicular cancer among men. In mumps orchitis, a patient suffers from severe inflammation in his testicles. 

Klinefelter’s Syndrome

The Irish Cancer Society says that Klinefelter’s syndrome is involved in promoting testicular cancer. Klinefelter’s syndrome is a genetic disorder in which the sex chromosomes negatively impact the male sex hormones and sterility. 

Others

There are several other causes of testicular cancer, such as infertility, congenital disorder, height, body weight, testicular microlithiasis or calcium specks, hypospadias or abnormality of the penis, and previous injury.

Treatment for Testicular Cancer

Depending upon the medical test reports and stage of testicular cancer, a doctor determines to take appropriate actions to begin the treatment. Some of the methods may also have potential side effects, which are discussed here. 

Testicular cancer treatment can involve a surgical procedure, radiation, chemotherapy, clinical trials, stem cell treatment, and a few others. 

Surgery

A surgical procedure is sometimes used as part of testicular cancer treatment. The main aim of surgery is to segregate the affected testicle from the body to prevent its spread. 

Radical Inguinal Orchiectomy

Surgical procedure to remove the affected testicle is called radical inguinal orchiectomy. When both the testicles are removed, it is known as bilateral orchiectomy. Rare cases of low testosterone secretion have been found.

Surgical removal of one testicle may not cause infertility, but removing both from the body may cause permanent male infertility. Patients are asked to store sperm for future use. 

Retroperitoneal Lymph Node Dissection

When the lymph nodes at the abdomen and back are removed through surgery, it is called retroperitoneal lymph node dissection (RPLND). These are known as retroperitoneal lymph nodes.

Side effects of the surgery may include infertility and difficulty in bowel movement. Sperm banking is recommended before opting for RPLND.

Radiation Therapy

Powerful x-rays are used to kill the cancer cells in a testicular tumor. An experienced radiation oncologist will perform this therapy. It can be used after the surgery to treat the patient and it completely eradicates the DNA of the affected cells, so cancer does not spread. It is often conducted in the case of seminomas.

Side effects of radiation therapy are fatigue, inflammation or pain, numbness, nausea, and loss of appetite. 

Chemotherapy

Chemotherapy refers to the drug support to treat and kill cancer cells. It stops the growth of the disease and prevents the ability of the cancer cells to multiply. The drugs can be administered orally and/or by injecting directly into the veins.

The most common drugs used for treatment are cisplatin, vinblastine, paclitaxel, bleomycin, etoposide, and several others. These drugs are used in chemotherapy regimens depending upon the severity, dosage, and duration of the treatment.

Side effects of chemotherapy are hair loss, nausea, and fatigue.  

Stem Cell Transplant

A stem cell transplant is recommended to a patient when the doctor uses chemotherapy to kill the cancer cells and replaces the blood-forming cells in the bone marrow.

Once the chemotherapy is over, the patient is infused with stored stem cells, so it helps the healthy development of new and uninfected blood cells.  

Clinical Trial

Clinical trials are optional to a patient when he chooses his case to be further studied by the doctors and researchers to provide further support and treatment. They are effective in certain ways because a patient is likely to receive newly developed methods along with traditional therapy. 

Stage-wise Treatment

Stage I

Treatment in Stage I includes surgery, surveillance, and chemotherapy. For non-seminoma, RPLND, surveillance, or chemotherapy is recommended. Surveillance is a medical procedure to observe the patient after a regular interval. CT scans and x-rays are performed every few months’ duration to check how the patient responds to the treatment.

For Stage I seminoma testicular cancer, adjuvant radiation therapy and chemotherapy and surveillance are performed. The seminoma tumor is consistently monitored to check the progress of treatment provided.

It is generally easier to treat seminoma cancer at stage one, which is why testicular gem cell tumors and other types of gonad cancers need to be detected early. Nonseminoma cancer at an early stage will receive similar treatment.  

Stage II

To treat Stage II testicular patients, a combination of surgery, radiation, and chemotherapy is used.

This treatment is often cited as combination chemotherapy. To make sure that recurrence does not happen, a long-term follow-up with the patient is scheduled.

Treatment of Stage II seminoma involves chemo and radiation therapy, whereas non-seminomas involve chemo and RPLND. 

Stage III

Chemotherapy, clinical trials, and surgery are conducted for Stage III seminomas and nonseminomas. Surveillance and PET scans are also performed after chemotherapy and surgery to check if there was any further development or growth of the cancer cells.

The patient may be provided with high-dose chemotherapy at this point. Serum tumor marker tests are performed frequently. This helps the care providers keep track of testicular cancer cells more effectively.

If cancer spreads, additional treatments, such as lymph node dissection, are sometimes needed. 

Conclusion

Chances of survival are always high, with a success rate of more than 95%. However, even after successful treatment, testicular cancer can come back in the future.

Early detection increases the chances of successful treatment and prevention of the disease.

Additionally, one should also be careful if he has a family history and previous encounter with testicular cancer.

Testicular cancer can affect any male at any age; that is why we also encourage the parents to learn the symptoms and causes of testicular cancer to help their children in their early stages.   

Sources

  1. University of Iowa. What men should know about testicular cancer. [online] Available at: https://uihc.org/health-library/what-men-should-know-about-testicular-cancer
  2. American Cancer Society. Tests for Testicular Cancer. [online] Available at: https://www.cancer.org/cancer/testicular-cancer/detection-diagnosis-staging/how-diagnosed.html
  3. American Cancer Society. Risk Factors for Testicular Cancer. [online] Available at: https://www.cancer.org/cancer/testicular-cancer/causes-risks-prevention/risk-factors.html
  4. Cancer Research UK. Risks and causes. [online] Available at: http://www.cancerresearchuk.org/about-cancer/testicular-cancer/risks-causes
  5. Ugboma HA, Aburoma HL. Public awareness of testicular cancer and testicular self-examination in academic environments: a lost opportunity. Clinics (Sao Paulo). 2011. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148452/
  6. American Cancer Society. Signs and Symptoms of Testicular Cancer. [online] Available at: https://www.cancer.org/cancer/testicular-cancer/do-i-have-testicular-cancer.html
  7. Irish Cancer Society. What increases my risk of testicular cancer? [online] Available at: https://www.cancer.ie/cancer-information-and-support/cancer-types/testicular-cancer/what-increases-my-risk-of-testicular-cancer#sthash.NtlJLXAz.dpbs
  8. Irish Cancer Society. How is testicular cancer treated? [online] Available at: https://www.cancer.ie/cancer-information/testicular-cancer/treatment#sthash.0LTQ03RK.dpbs
  9. National Cancer Institute. Testicular Cancer Treatment (PDQ) – Patient Version. [online] Available at: https://www.cancer.gov/types/testicular/patient/testicular-treatment-pdq#section/_89

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