US Pharm. 2024;49(6):15-16.

Curable When Caught Early

The testicles are male reproductive glands that are located in the scrotum and are responsible for producing testosterone and sperm. Testicular cancer can occur in one or both testicles. The most common type of testicular cancer arises from a germ cell and is usually classified as a seminoma or nonseminomatous germ cell tumor. Testicular cancer is uncommon, occurring in about one out of every 250 males. It is most often found in young men, with an average age at the time of first diagnosis of 33 years. Approximately 6% of testicular cancer cases occur in children and teenagers, while 8% develop in men aged older than 55 years. It is one of the most treatable and curable cancers if it is caught early enough. The 5-year relative survival rate is 95%.

Risk Factors for Testicular Cancer

Certain people may be at higher risk for developing testicular cancer, such as men aged 20 to 34 years or who are white, American Indian, or Alaska Native. The risk is also higher if there is a history of testicular cancer, a family member such as a father or brother who had testicular cancer, cryptorchidism (an undescended testicle), an abnormal development of the testicles, germ cell neoplasia in situ, or an HIV infection.

No Recommended Screening Tests or Preventive Measures

Although there are no recommended preventive measures or screening tests, it might be helpful to do a monthly self-examination to identify any issues early. This is best done after a warm bath or shower while standing so that the scrotum is relaxed. Check each testicle by rolling it between the thumb and forefingers gently but firmly. The firmness should feel the same throughout the entire testicle. It is also recommended to check the soft, tube-like structures behind (the epididymis) and above (the vas deferens) the testicles to be familiar with how they feel. Check for any lumps, swelling, or other irregular feelings and for any changes to the size, shape, or texture. Any abnormalities should be discussed with the doctor as soon as possible. If there is cancer, catching it early and starting treatment promptly can prevent the cancer from spreading.

Presentation and Diagnosis

The most common symptom is a painless lump in the testicle. Other symptoms include swelling of the testicle with or without pain; a dull ache or pain in the testicle, scrotum, or groin; enlargement or changes in how the testicle feels; a feeling of heaviness around the lower abdomen, anus, or scrotum; a sudden fluid collection in the scrotum; or enlargement or tenderness of the breast tissue. Symptoms of more advanced cancer can be low back pain, shortness of breath, chest pain, cough, belly pain, headaches, or confusion.

If there is a concern for cancer, the doctor will obtain a complete medical history, perform a physical examination, and see if there are other causes for the symptoms. The doctor may order a testicular ultrasound, blood tests, or an orchiectomy. Imaging tests of the testicle using ultrasound check its size and characteristics, where the mass is located, if it contains fluid, or if it is solid. Blood tests such as alpha fetoprotein, beta-human chorionic gonadotropin, and lactate dehydrogenase can be used to look for tumor markers in the blood. An orchiectomy is surgical removal of the testicle so that the tissue can be looked at under the microscope for cancer cells. If there is cancer, the doctor will check to see what type of cancer cell it is and if it has spread beyond the testicles, called staging. The staging process may require more imaging tests such as a chest x-ray, CT scan, positron emission tomography scan, MRI, or bone scan.

Treatment Depends on Cancer Type

Testicular cancer is a very treatable cancer when it is caught early. Some treatment options include surgery to remove the testicle and any lymph nodes that have cancer, radiation to use high-powered energy beams to kill cancer cells, chemotherapy that uses strong medications to kill cancer cells, or active surveillance. The treatment option used will be based on the type of testicular cancer and how extensive the disease is. Some of these treatments can cause infertility, so you may want to talk to your doctor about sperm banking if you are thinking about having children in the future. After treatment, there is a small chance that the cancer could come back, so it is important to continue to do self-exams and have follow-up visits with the doctor regularly.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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