By Dr. Octavio Almanzor
The testicles represent the principle male sex glands. They are located under the penis in a pouch of skin called the scrotum and their functions are sperm production and secretion of a sex hormone called testosterone, which has to do with the sexual development of man.
Compared with other types of cancer, testicular cancer is relatively uncommon, and represents approximately 2% of all cancers in men. It appears most frequently in males aged 20–35 and is much less common after age 50. Risk factors for developing testicular cancer include undescended testicles at birth, family history of testicular cancer, viral diseases of childhood, such as mumps and even infertility.
Usually, this cancer does not cause symptoms, only the growth of one or both testicles. On suspicion, the doctor performs a thorough physical examination and scrotal ultrasound – which can show the presence and size of a tumor mass in the testicle-. Besides there are certain laboratory blood tests that measure increased presence of certain substances that function as tumor markers for testicular cancer, such as the alpha fetoprotein, lactate dehydrogenase and the determination of the human chorionic hormone gonadotropoina subunit B.
Diagnosis is based on the clinical examination, histopathological findings of tumor cells within the organ. In such a case, further tests will be needed to see if the cancer has spread from the testicle to other parts of the body. Determining the stage of the disease helps plan the entire treatment.
Treatment should be multidisciplinary, where the urologist, medical oncologist and radiation therapist are involved. In general, it depends on the patient’s age, the type of tumor and how advanced it is found to be, although cure rates are calculated as high as 95%, especially in those cases detected early.
The surgery called radical orchiectomy is the removal of the testicle and is often sufficient for the complete cure of the patient. After surgery the patient retains exactly the same potency and the same capacity for parenthood, because he retains the healthy testicle. If the patient wishes, a prosthesis can be inserted in place of the testicle removed by surgery. In cases where the patient has only one testicle, and it is affected by the cancer, surgery will be needed where only the tumor is removed and the remaining healthy testicular tissue is preserved.
If the tumor has spread outside the testicle and depending on the type of tumor it may be necessary to have both chemotherapy and radiotherapy, to be administered by the medical oncologist or radiation oncologist, respectively.
These two treatment modalities can interfere with sperm production, so that the preservation of semen in biobanks is required for these patients.
Chemotherapy is the use of special drugs that destroy cancer remaining in the body after surgery, although it may be the initial treatment if the cancer is in an advanced stage, i.e., where it has spread outside the testicle before the operation. Most drugs have some side effects including nausea, hair loss, fatigue, diarrhea, vomiting, fever and chills.
In the case of radiation, electromagnetic waves of high intensity that kill cancer cells and shrink the size of the residual tumors are employed. Side effects of radiation therapy depend mainly on the treatment dose. These commonly include fatigue, skin changes where the treatment is performed, loss of appetite, nausea and diarrhea.
Because testicular cancer is curable when detected early, experts recommend conducting a monthly testicular self-examination after a hot shower – when the scrotum is more relaxed-, for lumps, enlargement or other abnormalities; also, try to identify if there is pain or discomfort when doing the exploration and also a sense of heaviness. It is always important to consult a doctor to determine the cause of any of these symptoms.
Testicular cancer can recur. Monitoring can vary depending on the type of tumor and, in general, patients are examined by an urologist 2 or 3 times per year with scans and blood tests.
Translated by Weldon Woodard