2. TESTICULAR CANCER

What Is Testicular Cancer?
Testicle or testicular cancer develops in one or both testicles in men or young boys usually between the ages of 15 to 39. The testicles contain several types of cells, each of which may develop into one or more types of cancer. It is important to distinguish these types of cancers from one another because they differ in their prognosis (outlook for survival) and in the ways they are treated.
Testicular cancers may be classified as follows:

• seminomas (about 40% of all testicular cancers)
• spermatocystic embryonal carcinomas (about 20% of testicular cancers)
• yolk sac tumor (about 60% of all testicular cancers in young boys)
• teratomas (about 7% of testicular cancers in adult men and 40% in young boys)
• choriocarcinoma (rare)

Testicular cancers can also develop in specialized cells within the gonads such as the Leydig cells (cells that produce testosterone)and Sertoli cells (cells that provide nurishment for the sperm).

Secondary Testicular Tumors:
Secondary testicular tumors are those which start in another organ and then spread to the testicle. Lymphoma is the most common secondary testicular cancer. Among men over 50 years of age, testicular lymphoma is more common than primary testicular tumors. Their prognosis depends on the type and stage of lymphoma. The usual treatment is surgical removal, followed by radiation and/or chemotherapy.

Cancers of the prostate, lung, skin (melanoma), kidney, and other organs can secondarily spread to the testicles. The prognosis for these cancers is usually poor because these cancers generally spread widely to other organs as well. Treatment depends on the specific type of cancer.

What Causes Testicular Cancer?
The National Cancer Institute also reports that men who have an undescended testicle are at higher risk of developing cancer of the testicle. This is true even if surgery has been done to place the testicle in the appropriate place in the scrotum.

Although the exact cause has not been identified, several predisposing factors may place some men at higher risk. These include a past medical history of undescended testicle, mumps, orchitis, inguinal hernia during childhood, or previous testicular cancer on the other side.

Frequently, testicular tumors are noted after an episode of trauma however, trauma is not believed to be a causative or predisposing factor.

Symptoms of Testicular Cancer

• Testicular enlargement
• Testicle lump
• Pain in back or abdominal discomfort
• Breast enlargement (gynecomastia)
• Blood in the semen
• Testicular discomfort/ pain (rare, but may occur occasionally)

*Note: There may be no symptoms

Keys to Prevention

• The key to defeating testicular cancer is early detection. Regular self-examinations increase the likelihood of discovering testicular cancer at an early stage, when it is most easily cured. Testicular cancer is a highly treatable and usually curable form of cancer.
• Immunization against the mumps should be done at 15 months and again between 4 to 6 years old. This prevents the potential of developing mumps orchitis (inflammation of the testicles), which is believed to be a predisposing factor for testicular cancer.
• Young men should be taught to perform a testicular self-examination (TSE) shortly after puberty, and the procedure should be re-emphasized upon all routine health examinations of young men (such as sports, school, or camp physicals). A TSE, performed on a monthly basis, may play a major role in detecting tumors at earlier stages, prior to metastasis

Testicular Self-Exam
Testicular cancer often develops without symptoms; therefore, male between the ages of 15 and 40 should do a monthly self-exam. After age 40, the chances of cancer are rare, and monthly examinations are not necessary.

How the Test is Done:
Place your right leg on an elevated surface about chair height. Gently feel your scrotal sac until you find the right testicle. Firmly and gently roll the testicle between the thumb and fingers to examine the surface. Repeat the procedure with your left leg elevated to examine your left testicle.

How the Test Will Feel:
The test should not be uncomfortable.

How to Prepare for the Test:
The test is best performed after a shower or bath so that the scrotal muscles are warm and relaxed.

Results:

• Normal Values: The testicle feels firm but not hard. The surface is smooth. There are no lumps or bumps. One testicle may be lower and/or larger than the other one.
• Special Considerations: Lumps may be cancerous, requiring immediate treatment.

What Abnormal Results Mean:
If a small hard lump (like a pea) or an enlarged testicle is found, consult the health care provider immediately. It may be testicular cancer.

Consult the health care provider also if:

• One or both testicles are not located (the testicles may not have descended properly)
• There is a soft collection of thin tubes above the testicle (may be varicocele, or a collection of dilated veins)
• There is pain or swelling in the scrotum (it may be an infection or a blockage of blood to the area)

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