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Testicular cancer

The cancer which originates in the male glands known as testicles or testis, which are located inside the scrotum. 

Symptoms 

  • A lump or enlargement in either testicles 
  • A feeling of heaviness in the scrotum
  • Change in size of scrotum 
  • Pain or discomfort in the scrotum or testicles 
  • Back pain 
  • Swelling in legs 
  • Weight Loss
  • Loss of Appetite

Cancer usually affects only one testicle 

Causes:

It may not be possible to avoid risk factors of testicular cancer, the best way is to catch it early. Men with highest risk are:

  • Men with a father or brother who had a testicular cancer 
  • Men with a history of cryptorchidism – The undescended scrotum. 
  • Abnormal cells in the testicles called germ cell neoplasia in situ 

Diagnosis 

Testicular self-examination

  • Check each testicle 
  • Look for lumps, swelling or something out of the ordinary 
  • Check yourself at least once a month

Medical Examination and Tests

  • Health record and physical exam
  • Testicular ultrasound
  • Serum tumor marker test 

Risk factors 

  • Age 
  • Cryptorchidism 
  • Family history 
  • Previous Personal history of cancer in one of the testicles

Treatment:

  • High Inguinal Radical Orchidectomy: 

It is first and foremost thing to diagnose the testicular cancer if index of suspicion is high depending on the results of imaging tests and Tumor markers.

In this surgery the entire testicle is removed from a small cut in the groin. The spermatic cord is also removed.

Biopsy of Suspicious lesion is strongly condemned due to risk of seeding of cancer along the track of biopsy needle.

  • Testis sparing surgery TSS- This surgery is recommended in very selective cases, the doctors just remove the tumor tissue, not the entire testis. For this procedure, the mass must be very small along with few more indications which needs to be discussed with the Urologist.
  • Retroperitoneal lymph node dissection (Laparoscopic/Open) (RPLND)- It is a complex surgery used to remove the suspicious/obvious lymph nodes likely to be involved due to the spread of Testicular cancer within the Abdomen. This surgery needs to be decided after orchidectomy and staging of disease
  • Chemotherapy/Radiotherapy- Chemotherapy/Radiotherapy is used for cancers that spread beyond the testicles, or if tumor markers rise after surgery in select group of patients. Serum tumor markers and imaging tests help guide about the course and type of chemotherapy to use and if radiotherapy is needed or not.

Before any Radiotherapy/Chemotherapy treatments start, men should consult a doctor if they can have babies. Infertility and changes in male hormones are quite common after the Radiotherapy/Chemotherapy. Sperm banking might be a good option before such kind of adjuvant treatment, if kids are needed by the male in the future. 

  • Surveillance- It is a way to look for changes with normal check-ups. These include physical examination, marker tests and imaging tests with an ultrasound of the scrotum and can also include chest x-ray and CT scan. Beyond basic surgery, care depends on the type of cancer cell and results. Even if cancer was found early and treated, follow-up tests are recommended.

Testicular cancer is highly treatable. Depending on the stage of the cancer, you may receive one of the several treatments or just one.