Testicular Cancer – Diagnosis and Treatment
Diagnosis
Figuring Out Which Type of Cancer It Is
People usually suspect testicular cancer when they notice a lump, swelling, or changes in the testicle.
A healthcare provider first does a physical exam and checks for hard spots, swelling, or tenderness. Next, the provider performs a scrotal ultrasonography (ultrasound of the testicles).
This imaging test uses sound waves to create pictures of the testicles and scrotum. It shows if a lump is inside or outside the testicle and whether the lump is solid or filled with fluid.
Lumps inside the testicle are more likely to be cancerous. If the ultrasound shows a solid tumor, doctors order blood tests for tumor markers.
These markers include:
- Alpha-fetoprotein (AFP)
- Beta-human chorionic gonadotropin (ฮฒ-hCG)
- Lactate dehydrogenase (LDH)
High levels can suggest testicular cancer, but some non-cancerous conditions can also raise these markers.
When cancer is likely, surgeons usually remove the testicle through a small cut near the groin. A pathologist then examines the removed tissue under a microscope. This exam identifies the exact type of cancer.
The main types are:
| Type of Testicular Cancer | Common Age Group | How It Behaves | Subtypes |
|---|---|---|---|
| Seminoma | Older adults | Grows slowly | Classic, Spermatocytic |
| Nonseminoma | Younger people | Grows quickly | Choriocarcinoma, Embryonal carcinoma, Yolk sac tumor, Teratoma |
| Rare types | All ages | Varies | Very uncommon |
- Seminomas often affect older adults and usually grow slowly.
- Nonseminomas usually appear in younger men and can grow and spread quickly.
- Rare types of testicular cancer exist, but they are not common.
Doctors need to know the exact type because treatment and prognosis differ for seminomas and nonseminomas.
Checking How Far the Cancer Has Spread
After diagnosis, doctors check if the cancer has spread outside the testicle. This step helps plan treatment and provides information about the outlook.
Doctors may use several tests:
-
CT (Computerized Tomography) Scan
This scan takes detailed X-ray pictures of the abdomen, pelvis, and chest.
It shows if the cancer has reached the lymph nodes or other organs. -
Blood Tests for Tumor Markers
Doctors check tumor marker levels again after removing the testicle. High marker levels might mean some cancer remains or has spread. Doctors also test markers during and after treatment to watch for recurrence. -
Other Imaging Tests
- Chest X-ray helps detect cancer in the lungs.
- Sometimes, doctors use MRI, bone scans, or PET scans if needed.
Doctors call the spread of cancer staging.
The stages for testicular cancer are:
| Stage | What It Means |
|---|---|
| 0 & 1 | Cancer is only in the testicle or has not spread to other areas. |
| 2 | Cancer has reached the lymph nodes but has not traveled to distant parts of the body. |
| 3 | Cancer has spread to distant organs, very high marker levels, or both. |
At early stages, cancer is only in the testicle or nearby. At later stages, cancer can reach lymph nodes or other organs such as the lungs or liver.
Doctors use the stage, marker levels, and cancer type to choose the best treatment plan. They also track marker levels after treatment to check for recurrence.
Symptoms like swelling, hard lumps, pain, or changes in the testicle may suggest cancer. Only these tests can confirm a diagnosis and show how serious the condition is.
Treatment
Surgical Procedures
Surgeons play a key role in removing and controlling testicular cancer. The main operation is a radical inguinal orchiectomy.
In this surgery, the surgeon removes the affected testicle through a cut in the groin. This is usually the first step for most people with this cancer. If desired, a gel-filled artificial testicle can replace the removed one.
If doctors think cancer has spread, they may perform another surgery to remove some lymph nodes from the belly. This is more common for non-seminoma testicular cancer.
This procedure is called a retroperitoneal lymph node dissection. Surgeons try to avoid cutting nerves, but sometimes nerve damage happens and can cause problems with ejaculation. Usually, erections are not affected.
Risks of these surgeries include infection, bleeding, and nerve injury. Doctors often suggest talking about sperm preservation before surgery.
Key Points in Table Form
| Surgery Type | What it Involves | Main Purpose | Possible Risks |
|---|---|---|---|
| Radical Inguinal Orchiectomy | Removes the affected testicle. | First treatment for most cases. | Infection, bleeding |
| Lymph Node Removal | Takes out lymph nodes in the abdomen. | Checks for cancer spread. | Nerve injury, possible fertility issues |
Medicine-Based Cancer Control
Doctors use chemotherapy to attack cancer cells throughout the body. Chemotherapy is often given after surgery to destroy any remaining cancer cells.
For advanced cancer, doctors may use chemotherapy before surgery. Common side effects include tiredness, infections, and hearing changes.
Chemotherapy can also affect sperm production. Sometimes fertility returns after treatment, but sometimes the change is permanent. Doctors recommend discussing sperm storage before starting chemotherapy.
High-Energy Cancer Destruction
Doctors use radiation therapy to focus beams of energy, like X-rays or protons, to kill cancer cells. This treatment is usually used for seminoma testicular cancers, especially after removing the testicle.
Doctors rarely use radiation for non-seminoma cancers. During treatment, the patient lies on a table while a machine targets specific body areas. Side effects can include tiredness, nausea, and lower sperm counts.
Doctors recommend discussing sperm storage before starting radiation.
Tips for Managing Side Effects
- Plan for rest after sessions.
- Talk about fertility concerns before treatment.
- Report any new symptoms, such as severe tiredness or trouble hearing.
Supporting the Bodyโs Own Defenses
Doctors may use immunotherapy to help the immune system find and destroy cancer cells. Immunotherapy helps the body recognize and attack cancer cells that might otherwise hide.
Doctors sometimes use this treatment if the cancer is advanced or does not improve after other treatments. Not everyone needs immunotherapy, but it can be an option in difficult cases.
Summary Table: Main Treatments for Testicular Cancer
| Treatment Method | When Used | Key Considerations |
|---|---|---|
| Surgery | Most cases as first treatment | Nerve-sparing efforts, fertility |
| Chemotherapy | After or before surgery | Side effects, may affect sperm |
| Radiation therapy | Some seminoma cancers | Not usually for nonseminoma |
| Immunotherapy | Advanced or treatment-resistant cancers | Not a first-line option |
Common Questions to Ask Your Cancer Care Team:
- Which treatment options are best for my type and stage?
- What are the risks and possible side effects?
- How can I keep my fertility options open?
- Are there options for less-invasive surgery?
- Can I try another treatment if the first one doesnโt work?
Emotional Support and Practical Steps
People facing testicular cancer often experience changing emotions. Common feelings include worry, sadness, or confusion.
Building a plan to manage emotions and daily life can help.
Strategies for Emotional and Practical Support:
- Understanding testicular cancer helps people make informed choices.
- Nutrition, rest, and physical activity support recovery during and after treatment. Eat a mix of fruits and vegetables and get enough sleep.
- Daily walks help both physical and emotional health.
- If you smoke, seek help to quit to improve treatment results.
- Connect with others; support groups or online communities help people feel less alone.
- Sharing experiences with other survivors can provide comfort and advice.
Dealing with Side Effects and Future Planning:
- A testicular prosthesis can restore a natural look for some people.
- Sperm banking before treatment keeps future options open for those who want children.
- Regular testicular self-exams help check for changes early.
Quick Tips Table
| Tip | Why it Helps |
|---|---|
| Join support groups | Reduces isolation. |
| Eat balanced meals | Supports recovery. |
| Try self-exams | Helps detect changes early. |
Getting Ready for Your Visit
Steps You Can Take Before Your Appointment
Being organized helps your appointment go smoothly.
Here are some tips for preparation:
- Check for special instructions. When scheduling, ask if you need to do anything before you arrive, such as fasting or bringing test results.
- Write down your symptoms. List any symptoms you notice, even if they seem minor.
- Record key personal details. Note any ongoing health conditions, recent stresses, or important life events.
- List current medications. Include prescription drugs, over-the-counter medications, vitamins, or supplements.
- Invite a support person. Bring a family member or friend to help remember details and ask questions.
- Organize your documents. Keep all medical records, test results, and insurance information in one place.
You might find this table useful as a quick checklist:
| Task | Completed (โ/โ) |
|---|---|
| Confirmed appointment details | |
| Asked about pre-visit requirements | |
| Listed symptoms and their timing | |
| Gathered personal health information | |
| Made a list of medications/supplements | |
| Asked someone to join you | |
| Collected important documents |
Questions You Might Hear from Your Health Provider
During your appointment, the doctor will ask for detailed information to help with diagnosis and treatment planning.
Here are some common questions they may ask:
- When did your symptoms start?
- Are your symptoms constant or do they come and go?
- How would you rate the severity of your symptoms?
- Does anything make the symptoms better?
- Does anything make the symptoms worse?
Prepare answers to these questions to use your time more effectively. If your provider suspects testicular cancer, they may refer you to a urologist or an oncologist.
Useful Actions Until Your Scheduled Visit
While you wait for your appointment, you can plan ahead to make the most of your time with the doctor.
Start by making a list of questions, beginning with the most important ones. This helps you stay focused if your time is limited.
Here are some example questions you might ask:
- What kind of testicular problem do I have?
- What type of treatment do you recommend?
- Are there different options for treatment?
- What are my chances of being cured?
- Will treatment affect my fertility, and is there anything I can do to help preserve it?
- Can I get a copy of my test results or reports?
- Should I see a specialist, such as a urologist? Will my insurance cover this?
- Where can I find more information or helpful materials?
Ask more questions as they come up during your appointment. If you are concerned about having children, ask about sperm banking or fertility preservation before starting treatment.
Tip: Write your questions down and bring the list with you. Mark the most important questions so you can address them first.
