Testicles or testes are part of the male reproductive system. They are a size of a golf ball and held within a skin sac known as the scrotum. The scrotum hangs at the base of the penis.
Testicular cancer develops when one of the many kinds of testicular cells multiply uncontrollably, forming a mass. This mass competes with healthy cells for nutrition and oxygen and eventually starves and kills the healthy cells. Furthermore, it can spread to other organs and disrupt their functioning.
Testicular cancer is not common. About 1 in 250 males will develop testicular cancer at some point during their lifetime. Testicular cancer occurs in young males. The average age of people at diagnosis is 33 years old. This cancer has specific risk factors, including
- An undescended testicle at birth.
- Family history of testicular cancer.
- Previous history of testicular cancer (history of testicular cancer in father, grandfather or brother).
- Exposure to endocrine-disrupting chemicals (EDCs), such as bisphenol A, phthalates, heavy metals, polychlorinated biphenyls and organochlorines, have been linked to testis cancer, but the evidence is inconclusive.
- Human immunodeficiency virus or HIV infection.
- Having African-American ethnicity.
It is important to know which type of testicular cell the cancer started in and what kind of cancer it is. This will help doctors treat the cancer in the best possible way.
How do they test for testicular cancer?
The following are the tests for testicular cancer
Ultrasound (USG) of the testicles
This is the first test done when testicular cancer is suspected. The USG uses sound waves to produce images of the testis. Any solid or cystic mass in the testis can be detected in the USG.
Computed tomography (CT) scan
The test shows us the exact location of the tumor and if the tumor has spread beyond the testes.
Blood tests (markers)
Certain blood tests can help diagnose testicular tumors. Many types of testicular cancers produce certain proteins called tumor markers. These markers are specific to different types of testicular cancer. The presence of these tumor markers above a certain value points to testicular cancer. Their levels may indicate how well the patient is responding to the treatment protocol. They also help the surgeon scan for residual tumors. It must be remembered that cancers other than testicular cancer as well as certain noncancerous conditions may also increase tumor marker levels.
Table. Tumor markers according to tumor type
|Tumor type||Tumor markers|
|Nonseminomas||Raised alpha-fetoprotein (AFP) and/or human chorionic gonadotropin (HCG) levels|
|Pure seminomas||Occasionally raised HCG levels but never AFP levels.|
|Yolk sac tumor||Raised AFP|
|Widely spread tumor of type seminoma or nonseminomatous germ cell tumors (NSGCTs)||Raised lactate dehydrogenase (LDH) levels|
A biopsy is the process of removing a small piece of the tumor and examining it under a microscope. A surgeon rarely does a biopsy for a testicular tumor because it increases the risk of spreading cancer. Instead, based on the blood marker and USG, the surgeon will highly likely recommend total removal of the testis (a radical inguinal orchiectomy). Once removed, the entire testicle is sent to the lab, where a pathologist will examine the tissue under a microscope to look for cancer cells.
In the cases where the diagnosis of testicular cancer is uncertain, the doctor may perform a testicular biopsy in the operating room. The surgeon will take the testicle out of the scrotum via a cut in the pubic area and examine it without dissecting the spermatic cord. A suspicious area of the testis is then removed and examined under the microscope. If a cancer diagnosis is confirmed, the testicle and spermatic cord are removed. If the tissue is noncancerous, the testicle is returned to the scrotum.
The surgeon may order additional tests for follow-up after the surgery. Sometimes, these tests may be done before the surgery to check the extent of the tumor spread inside the abdomen. These tests include
- Positron emission tomography (PET) scan: A PET scan can help spot lymph nodes that are still enlarged after chemotherapy. They need to be examined if they contain cancer or are just scar tissue. Sometimes, a CT or PET scan may be done together for greater clarity about the tumor site and spread.
- Bone scan: A bone scan will detect if cancer has spread to the bones.
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