Testicular cancer is one of the most treatable cancers, with a cure rate approaching 100% (less than 1% mortality). Testicular cancer is a relatively rare cancer, but it is the most common form of cancer in young men and adolescents between puberty and age 45, with an average age of diagnosis of 37. It affects about 1 in 20,000 men. This cancer is steadily increasing, by 2.5% per year between 1980 and 2005 in France. In Canada, the incidence rate of testicular cancer has increased by approximately 80% in the last 25 years.
Testicular cancers are classified into two broad categories: seminomas and “non-seminomas” (which includes all other forms). Seminomas are more common in older men, while non-seminomas are more common in younger men. The only way to confirm the type of cancer is to surgically remove the testicle for analysis. This operation is called a total orchiectomy. It is performed through an incision in the groin.
In almost all cases, only one testicle is affected. Very often, it is the discovery of a suspicious mass during palpation of the testicles that sounds the alarm. Testicular cancer is a form of cancer that responds well to treatment (95% of men recover from it). However, treatment, whether by surgery, radiotherapy or chemotherapy, carries a risk of infertility.
When to consult
If a man perceives a ball or swelling, usually painless and gradually increasing in size in one of his testicles, he should consult a doctor. A small percentage of testicular cancers may cause pain in the early stages. Benign testicular tumours are rare, so you should see a doctor as soon as possible.
Symptoms of testicular cancer
Symptoms vary from person to person:
- A ball or lump in the testicle, discovered by human palpation. The ball is usually hard to the touch, but painless.
- A feeling of discomfort or heaviness in the scrotum (skin containing the testicles);
- The appearance of fluid in the scrotum;
- Pain in the scrotum is much rarer;
- Swelling and tenderness in the breasts is very rarely observed;
- Infertility. Testicular cancer is sometimes detected during a male infertility test.
Risk factors and people at risk for testicular cancer
Certain factors increase the risk of testicular cancer.
- Having had an undescended testicle in childhood (ectopic testicle or cryptorchidism) where the testicle remains in the womb instead of descending normally into the scrotum. The risk of testicular cancer is increased by a factor of 35. The operation to lower the testicle into the bursa does not fully protect against the risk of cancer.
- Decreasing the size of the testicle, for example after mumps (testicular atrophy), or after trauma increases the risk of testicular cancer.
- Men who are HIV-positive have a higher risk of testicular cancer.
- Men who have had testicular cancer on one side have an increased risk of having cancer on the other side. Therefore, they should regularly palpate the other testicle for screening.
- Presence of testicular cancer in a father or brother.
- Being between the ages of 15 and 35.
- Chemical pollutants of the endocrine disrupting type are suspected to be involved in the occurrence of testicular cancer.
Prevention of testicular cancer
Because there are not enough known preventable causes for testicular cancer, there are no measures that can prevent its occurrence. Instead, monthly testicular self-examination is recommended throughout life, especially in young boys with testicles that have not descended spontaneously, in boys or men with abnormally small testicles, in HIV-positive men, as they are at high risk, and more generally in all young men. Because the earlier a testicular cancer is discovered, the better the chances of recovery with as few after-effects as possible.
Testicular self-examination
This examination is easier to do if the skin of the scrotum is relaxed, such as after a hot bath or shower.
Examine each testicle with both hands by gently rolling the testicle between the thumb and fingers. One testicle is often – and normally – a little larger than the other. A man can normally feel the epididymis, a small cord on the top of the testicle that connects it to the urethra. By regularly performing such a self-examination, a man becomes familiar with the shape of his testicles.
If a lump or an increase in volume is discovered, a doctor should be consulted.
Medical treatments for testicular cancer
Treatment for testicular cancer depends on the type and stage of the cancer.
Surgery
Removal of the cancerous testicle by inguinal surgery is almost always the first and often the only treatment needed. It usually does not affect fertility or erectile capacity, since the remaining testicle is sufficient to produce the necessary hormones and sperm. A testicular prosthesis is inserted during the operation to reduce the psychological and aesthetic impact of the orchiectomy (removal of a testicle), but it is not mandatory
Surgery is systematically associated with sperm preservation. Indeed, even if fertility is preserved, if chemo or radiotherapy treatment is necessary or if the other testicle is affected by cancer, it is still possible to have children. Sometimes some lymph nodes are also surgically removed in addition to the affected testicle.
Careful monitoring
Once the affected testicle has been removed, some patients will need to have regular blood tests and x-rays for a few years. This follow-up is important to avoid radiation or chemotherapy when all is well (testicular disease), or to start them quickly if there is a change in the x-ray image or blood test (non-testicular disease).
Radiotherapy
Radiotherapy can be used as a complement after surgery to prevent the spread of cancer cells to the abdominal lymph nodes. Radiation therapy is performed when the cancer is a seminoma, a type of tumor that is very sensitive to radiation.
It can cause temporary or permanent infertility but usually does not affect erectile ability.
Chemotherapy
It is also quite often used as a complement to surgery with the removal of the testicle. Indeed, testicular tumors are very sensitive to certain chemotherapies. After the operation, to prevent some cancer cells from remaining active, preventive chemotherapy may be carried out, depending on the type of cancer and the extent of the tumor.
Chemotherapy can cause several side effects, such as fatigue, nausea, hair loss, infertility and increased risk of infection.
Sperm self-preservation
The medical team systematically proposes to a treated man to preserve his fragile fertility before potentially toxic treatments. Sperm preservation can be done before the testicle is removed, which gives a better chance of obtaining good quality sperm after thawing. Once healed, there is a choice of whether or not to use the frozen semen flakes for years to come.