Men, beware of testicular cancer

The cancer which has one of the highest curable rates, testicular cancer is also the rarest form of cancer amongst Indian men. The cases may be rare but getting appropriate information can help one be aware, prevent it from developing to advanced stages for himself and for those around him. We talked to Dr Puneet Ahluwalia, Consultant, Urologic Oncology & Robotic Surgery, Max Institute of Cancer Care, Max Super Speciality Hospital, Saket to get a better insight.

Testicular cancer develops in the testicles, which is a part of male reproductive system. According to Dr Puneet, "As compared to other cancers, testicular cancer is rare. It is more common in whites than Asian or African men." He further adds that India has one of the lowest incidence of testicular cancer with less than 1 man per 100, 000 population affected by this condition.

It should be noted that all lumps in the testicles are not cancer. A man can be affected by many other conditions like epididymal cysts, testicular microlithiasis and appendix testis which may be painful but non-cancerous.

Signs and symptoms of testicular cancer

Testicular cancer is potentially a deadly disease. So, knowing the signs and symptoms of testicular cancer plays an important role in the treatment process at an early stage. Dr Ahluwalia says that testicular cancer may develop painless testicular mass. Acute pain is less common or is either the result of bleeding within the tumour or due to rapid tumour growth. Testicular cancer may be detected by ultrasound or is revealed by a scrotal trauma. Patients report a history of scrotal trauma, although incidental trauma is likely to be responsible for bringing the testicular mass to patient's attention for the first time.

  • Some other signs and symptoms of testicular cancer are:
  • ·a lump in or on a testicle (testicular lump)
  • shrinking of a testicle
  • enlargement or swelling of a testicle and/or scrotum
  • a collection of fluid in the scrotum
  • a feeling of heaviness in the scrotum
  • a dull ache in the lower abdomen or in the groin
  • discomfort or pain in a testicle or in the scrotum
  • enlargement or tenderness of the male breast
  • lower back pain due to retroperitoneal disease spread

Approximately, 2 per cent of men affected with testicular cancer have gynaecomastia (enlargement of male breasts). More than half of men with germ cell tumours have diminished fertility.

There are rare cases in which testicular cancer can affect other organs. If the cancer does spread, the patient may experience:

  • coughing
  • breathing difficulties
  • swelling in the chest
  • difficulty in swallowing

Factors responsible for causing testicular cancer

Dr Ahluwalia mentions a few known risk factors of testicular tumours. These factors include:

  • Family history of testicular cancer
  • A personal history of testicular cancer in the other testis
  • Infertile men have higher incidence of testicular tumour

Cryptorchidism (Undescended testis at the time of birth)

This is a condition that occurs at the time of birth. Normally, the testicles develop inside the abdomen of the fetus and they descend into the scrotum before birth. In a few cases, the testicles do not go down and remain in the abdomen. In other cases, the testicles start to descend but remain stuck in the groin area.

When one or both testicles fail to move from the abdomen into the scrotum before birth, it increases the risk of testicular cancer.

Family history of testicular cancer

If there is a family history of testicular cancer, it increases the chances of getting affected with this disease. However, there are cases where a person has testicular cancer but no family history.

A personal history of testicular cancer in the other testis

History of testicular cancer is another risk factor. It has been observed that a few men who have been cured of cancer in one testicle eventually develop cancer in the other testicle.

Infertile men have higher incidence of testicular tumour

According to a study published in Fertility and Sterility , infertile men, particularly those who fail to produce sperms while ejaculating, are at a greater risk of developing testicular cancer.

Stages of testicular cancer:

After thorough examination and tests, doctors have categorized testicular cancer in three stages:

Stage 1 - When the cancer is only in the testis and has not reached any other part.

Stage 2 - When the cancer has reached the lymph nodes in the abdomen.

Stage 3 - When the cancer has spread to other parts of the body. This may include the lungs, liver, brain, and bones.

Is testicular cancer curable?
"Testicular (germ cell) cancer is regarded as the model of curable neoplasm. Most of the testicular cancers can be cured, even if the cancer has spread. For men with cancer that has not spread beyond testicles, the survival rate is 99 per cent. For men with cancer that has spread to lymph nodes in the back of abdomen, called the retroperitoneal lymph nodes, the survival rate is about 96 per cent" says Dr Ahluwalia.

He adds that testicular cancer has shown excellent cure rates based on careful staging while diagnosis, effective surgical treatment, early treatment based on multidisciplinary approach, their chemo-sensitivity and strict follow up and salvage therapies.

Medical advancement

According to Dr Ahluwalia, "Developments of newer diagnostic modalities such as PET CT, advancement in chemotherapy regimens and lower dose conformational radiotherapy have reduced side effects while maintaining high cure rates. With the advent of robotic surgery, it is now possible to remove retroperitoneal lymph node dissections in a minimal invasive manner without making large incisions in cases with widespread disease in the abdomen."



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