Although the incidence of testicular cancer has risen in recent years, more than 95 percent of cases can be cured and treatment is more likely to be successful when testicular cancer is found early.
Seminomas and nonseminomas grow and spread differently and are treated differently. Nonseminomas tend to grow and spread more quickly; seminomas are more sensitive to radiation. If the tumor contains both seminoma and nonseminoma cells, it is treated as a nonseminoma.
There are several standard treatments most men can benefit from. Side effects depend on the type of treatment and may be different for each person.
Surgery to remove the testicle through an incision in the groin is called a radical inguinal orchiectomy. Men may be concerned that losing a testicle will affect their ability to have sexual intercourse or make them sterile However, a man with one healthy testicle can still have a normal erection and produce sperm. Therefore, an operation to remove one testicle does not make a man impotent and seldom interferes with fertility.
For cosmetic purposes, men can have a prosthesis placed in the scrotum at the time of their orchiectomy or at any time afterward. Some of the lymph nodes located deep in the abdomen may also be removed. This type of surgery does not usually change a man’s ability to have an erection or an orgasm, but it can cause problems with fertility if it interferes with ejaculation. Patients may wish to talk with their physician about the possibility of removing the lymph nodes using a special nerve-sparing surgical technique that may preserve the ability to ejaculate normally.
Radiation therapy uses high-energy rays to kill cancer cells and shrink tumors. It is a local therapy, meaning that it affects cancer cells only in the treated areas. External radiation is used to treat seminomas and is usually given after surgery.
Because nonseminomas are less sensitive to radiation, men with this type of cancer usually do not undergo radiation therapy. Radiation therapy affects normal as well as cancerous cells. The side effects of radiation therapy depend mainly on the treatment dose. Common side effects include fatigue, skin changes at the site where the treatment is given, loss of appetite, nausea, and diarrhea. Radiation therapy interferes with sperm production, but many patients regain their fertility over a period of one to two years.
Chemotherapy is the use of anticancer drugs to kill cancer cells. When chemotherapy is given to testicular cancer patients, it is usually given after surgery to destroy cancerous cells that may remain in the body.
Chemotherapy may also be the initial treatment if the cancer is advanced. Most anticancer drugs are given by injection into a vein. Chemotherapy is a systemic therapy, meaning drugs travel through the bloodstream and affect normal as well as cancerous cells throughout the body. The side effects depend largely on the specific drugs and the doses. Common side effects include nausea, hair loss, fatigue, diarrhea, vomiting, fever, chills, coughing/shortness of breath, mouth sores, or skin rash. Other side effects include dizziness, numbness, loss of reflexes, or difficulty hearing. Some anticancer drugs also interfere with sperm production. Although the reduction in sperm count is permanent for some patients, many others recover their fertility. Some men with advanced or recurrent testicular cancer may undergo treatment with very high doses of chemotherapy.
These high doses of chemotherapy kill cancer cells, but they also destroy the bone marrow, which makes and stores blood cells. Such treatment can be given only if patients undergo a bone marrow transplant. In a transplant, bone marrow stem cells are removed from the patient before chemotherapy is administered. These cells are frozen temporarily and then thawed and returned to the patient through a needle (like a blood transfusion) after the high-dose chemotherapy has been administered.
Men with testicular cancer should discuss their concerns about sexual function and fertility with their physician. It is important to know that men with testicular cancer often have fertility problems even before their cancer is treated. If a man has pre-existing fertility problems, or if he is to have treatment that might lead to infertility, he may want to ask the physician about sperm banking (freezing sperm before treatment for use in the future). This procedure allows some men to have children even if the treatment causes loss of fertility.
Regular follow-up exams are extremely important for men who have been treated for testicular cancer. Like all cancers, testicular cancer can come back. Men who have had testicular cancer should see their physician regularly and should report any unusual symptoms right away. Follow-up varies for different types and stages of testicular cancer.
You can do a testicular self-exam: Boys can start doing monthly testicular self-exams during their teen years.
The best time to examine your testicles is right after a hot bath or shower. The scrotal skin is most relaxed at this time, and the testicles can be felt more easily. The exam should be done while standing and only takes a few minutes.
- Look for swelling in the scrotum
- Gently feel the scrotal sac to find a testicle
- Examine the testicles one at a time by firmly and gently rolling each testicle between the thumb and fingers of both hands to examine the entire surface.
- Note that it is normal for one testicle to be slightly larger than the other. It is also normal to feel a cord-like structure (the epididymis) on the top and back of each testicle.
If you find a small, hard lump (pea-size), swelling or any other differences, contact your urologist as soon as you can.
Generally, patients are checked frequently by their physician and have regular blood tests to measure tumor marker levels. They also have regular x-rays and computed tomography, also called CT scans or CAT scans. Men who have had testicular cancer have an increased likelihood of developing cancer in the remaining testicle. Patients treated with chemotherapy may have an increased risk of certain types of leukemia, as well as other types of cancer. Regular follow-up care ensures that changes in health are discussed and that problems are treated as soon as possible.
The purpose of cancer screening is to detect potentially life-threatening diseases as early as possible, at a point when treatment is easier and cure more likely.
Urine screening can detect cancer and other problems in both the kidneys and the bladder. It consists of a dipstick test for the presence of blood and other specific substances in the urine and is often performed at routine physician visits. If the abnormality is confirmed by the examination of urine under the microscope, a thorough evaluation of the entire urinary tract is performed.