The testicles (also called testes) are a part of the male reproductive system responsible for sperm production and storage. They are housed in the scrotal sac, below the penis and are also responsible for producing the hormone testosterone. The testicles are originally located in the abdomen but move down to the scrotum before birth because the abdomen is too hot for them.
Cancer occurs when cells grow in a disorderly fashion, ignoring signals to die and grow into nearby and distant areas. Testicular cancer is cancer affecting the testes. It may affect one or both at any time but is usually present in one. While most cancers affecting the testes start from the testes (primary testicular tumours), cancers from nearby organs can also spread to the testes and infiltrate it (secondary spread). Testicular cancer can affect men of any age.
Who is affected?
Although uncommon, the incidence of testicular cancer is steadily rising, according to the World Health Organisation. Globally, it is estimated that around 71,000 people were diagnosed with testicular cancer in 2018 with nearly 10,000 deaths. There are different types of testicular cancer based on the particular cells affected.
What causes testicular cancer?
A specific cause of testicular cancer has not been identified yet. So far, some conditions have been noticed to increase the odds of developing testicular cancer. These “risk factors” are either modifiable (can be changed. Examples are smoking, alcohol intake) or non-modifiable (cannot be changed. Examples are race, family history of cancer). Having a risk factor does not mean that you will develop testicular cancer.
The following are risk factors of testicular cancer:
- Family history: If a first-degree relative has been diagnosed with testicular cancer, you are at a higher risk of developing testicular cancer too.
- Having an undescended testis: In some people, one or both testicles remain in the abdomen even after birth. Ideally, this is picked up shortly after birth during the examination of the newborn and fixed with surgery, but it can be missed in some settings. Having the testes remain in the abdomen rather than in the scrotal sac leaves one at a higher risk of developing testicular cancer. A family history of undescended testicles also increases your risk of developing testicular cancer.
- Age: Although testicular cancer can occur at any age, it is commonest in young people typically between 20 and 40 years of age.
- Hormonal medications: Some medications (such as cancer-fighting drugs) may increase your risk of developing testicular cancer.
- Other factors: taller men, men with low birth weight, men with other genetic disorders such as Klinefelter’s syndrome, and having HIV/AIDS.
What are the signs and symptoms of testicular cancer?
Symptoms are present in most cases of testicular cancer. It is common for the affected person to feel unwell and different at that time. The following are common symptoms that may present in testicular cancer:
- Lump in the scrotum
- Change in size of one or both testicles
- Scrotal pain and discomfort
- A sensation of heaviness or dragging of the scrotum
- Backache, lower abdominal pain
- Breasts growth and tenderness
How is a diagnosis of testicular cancer made?
After taking a history of your symptoms, your doctor will carry out a testicular exam, taking turns to examine each testicle. Thereafter, blood and imaging investigations will be ordered which may include a testicular scan, a CT scan or an MRI. The extent of spread is also determined with these investigations which will inform treatment options.
How is testicular cancer treated?
Treatment for testicular cancer is dependent on the stage (or extent of spread) at diagnosis. Typically, surgery, chemotherapy and radiotherapy are options that can be used singly or combined for maximal therapeutic effects. Your doctor will also consider your fertility concerns before treatment, as some treatment options can temporarily or permanently reduce your sperm count.
In most cases, testicular cancer is confined to one testicle and can be removed with minimal side effects as the remaining testicle can cope with the body’s testosterone requirements (for erections, sex drive, facial hair, and deepening of the voice). If both testicles are removed, hormone replacement is offered to help with the body’s testosterone requirements.
Testicular cancer is treatable and curable, especially in early disease.
How can I prevent testicular cancer?
For most cases of testicular cancer, an identifiable cause cannot be fingered. Thus, it is difficult to prevent testicular cancer. However, it is important to examine your testicles regularly. This helps in identifying when something is amiss.
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