If you were a kid growing up in India in 2005, 2006, you wore a yellow LIVESTRONG band. It didn’t matter that the founder of the foundation, Lance Armstrong, was at the centre of a widely-ranging doping conspiracy, stripped of his seven Tour De France titles. If you were wearing a LIVESTRONG band, you were cool.
Lance Armstrong was a mythical figure in sport. I mean the man won seven Tour De France titles. Do you know how difficult the Tour De France is? For a boy growing up in a country obsessed with Sachin, this was different.
On October 2, 1996, at the age of 25, Armstrong was diagnosed with stage three (advanced) testicular cancer (embryonal carcinoma). The cancer had spread to his lymph nodes, lungs, brain, and abdomen.
That’s a pretty serious diagnosis when you’re 25. Imagine you’re Lance Armstrong, chilling, riding your bike and then suddenly you’ve got testicular cancer. You might lose your balls. And your life.
Testicular cancer begins in the testicles. Well, move over Captain Obvious. It is a growth of cells that starts in the testicles, also known as testes, which are in the scrotum - a loose bag of skin underneath the penis. The testicles have two jobs - make sperm and testosterone.
Testicular cancer isn’t common. In India itself, there are just 0.5 cases per 100,000 men, making it one of the lowest rates globally. It can happen at any age, but mainly occurs between the ages of 15 and 45.
The first sign of testicular cancer? A tiny little innocuous bump or lump on a testicle. The cancer cells grow fairly quickly, spreading outside the testicle to other body parts.
Testicular cancer is highly curable, even if it has metastasised. The treatment will depend on the kind of testicular cancer you have and how much it has spread. Standard methods of treatment include surgery and chemotherapy.
What Are the Varieties of Testicular Cancer?
Most of all, testicular cancer originates from germ cells in the testicles that clump together to create a mass or a tumour. Germ cells usually develop into sperm. Typically, two variants of cancers come up from germ cells.
Seminoma - This is a slow-growing cancer that usually impacts people in their 40s or 50s.
Non-seminoma Cancer- This one grows more rapidly than seminomas. It usually impacts people in their late teens, 20s and early 30s.
Usually, you have four types of non-seminoma tumours. Each is named after the kind of germ cell that the tumour is composed of. Non-seminoma tumours are Yolk Sac carcinoma, Teratoma, Embryonal carcinoma and Choriocarcinoma. Certain testicular cancer tumours are made up of both seminoma and non-seminoma cells.
The most common sign that you have testicular cancer is a painless lump on your testicle. Other symptoms are -
Swelling or Sudden Fluid Build Up in the Scrotum
Testicular cancer can cause sudden fluid buildup in the scrotum, resulting in swelling. This might come up suddenly or develop over time. This might sometimes be painless or accompanied by a feeling of fullness. If unexplained, this swelling calls for medical advice.
A Lump of Swelling in either Testicle
A lump or swelling on one of the testicles is one of the most common signs of testicular cancer. Firm and painless, this growth can sometimes cause discomfort. Detecting it early is crucial, so if you notice any change in the shape, size, or consistency of a testicle, you must visit a doctor.
A feeling of heaviness in the scrotum
Testicular cancer might cause a feeling of heaviness in the scrotum, like a weight pulling down. This sensation might happen gradually or suddenly and might be linked to other symptoms like discomfort or swelling. If you feel a persistent heaviness, get it evaluated by a healthcare professional.
Dull Ache in the Groin or Lower Abdomen
A dull ache or discomfort in the groin or lower abdomen is the norm with testicular cancer. This pain might radiate from the affected testicle, or be more generalised. This is often accompanied by a feeling of heaviness or swelling - any unexplained pain should warrant a prompt visit to a healthcare professional.
Pain or Discomfort in the Scrotum or a Testicle
Pain or discomfort in the scrotum or testicle could be an early warning sign of testicular cancer. Some people might experience severe pain while others might feel a subtle ache or tenderness. If this pain stays for more than a few days, or is accompanied by symptoms like swellings, or lumps, it’s time to visit the doctor.
A Shrinking Testicle (Testicular Atrophy)
Testicular atrophy - or the shrinking of a testicle, could be a sign of testicular cancer. This might happen alongside other symptoms like discomfort, lumps or swelling. When cancer impacts the testicle, the tissue inside might shrink or feel softer.
Any change in the size or shape of your testicles warrants a medical examination for proper diagnosis and treatment.
Such symptoms can result from other conditions, so don’t panic if you see them. Still, schedule a visit with your doctor. Delays in diagnosis give cancer cells time to spread, making the disease tougher to treat.
Researchers are unclear about what causes most testicular cancers. Testicular cancer begins when something changes the DNA of testicle cells, which contains instructions that tell the cell what to do.
The changes mean the cells grow and multiply quickly. Cancer cells continue living when healthy cells die as a part of their natural life cycle. This results in many extra cells in the testicle that can form a mass or a tumour.
In time, this tumour can grow beyond the testicle. Some cells might break away and spread to other body parts. Testicular cancer most often spreads to lymph nodes, the liver and lungs.
When testicular cancer spreads, it is known as metastatic testicular cancer. Usually all testicular cancers originate in the germ cells. The germ cells in the testicles make sperm. What causes DNA changes in the germ cells is not clear.
There are several risk factors which may increase your risk of testicular cancer. Risk factors don’t cause testicular cancer, however, they might increase its likelihood of developing.
Age
Usually, testicular cancer commonly impacts people aged between 15 and 35 years.
Undescended Testicles
Usually, testicles form in the abdomen of a foetus during pregnancy, dropping into the scrotum before birth. Testicles that don’t drop are known as undescended testicles and might require surgery. If you have this condition, it might increase your risk of testicular cancer.
Race and Ethnicity
Testicular cancer is more prevalent among non-Hispanic whites in the US and Europe.
Personal or Family History
You might be more likely to develop testicular cancer, if a biological parent or sibling has it. Certain inherited genetic conditions like Klinefelter Syndrome might increase your risk. If you have testicular cancer in one testicle, you might develop it in the other testicle.
Infertility
Some factors that result in male infertility might also be related to the development of testicular cancer. More research is required in this regard.
Your doctor might diagnose testicular cancer post investigation of a lump or change in your testicle that was detected during a self-exam. Sometimes, testicular cancer gets diagnosed during a routine physical exam.
Common procedures to diagnose testicular cancer are:
Physical Exam
Your doctor might ask about your symptoms and check closely for signs of testicular cancer. They might feel your testicles for lumps and inspect lymph nodes for signs of cancer spread.
Ultrasound
If your doctor notices something unusual, they might order an ultrasound. This painless medical procedure depends on high-energy sound waves to create images of tissues inside the body.
Inguinal Orchiectomy and Biopsy
If the ultrasound comes back with evidence of cancer, your doctor will remove the impacted testicle using a cut in the groin. A specialist will look at tissue from your testicle using a microscope to check for cancer cells.
Serum marker test
In this procedure, a blood sample is examined to measure the amounts of certain substances linked to certain cancers. Such substances are called tumour markers. The tumour markers often elevated in testicular cancer are alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG or beta-HCG), and lactate dehydrogenase (LDH).
Various types of tumours elevate different markers. For instance, seminomas sometimes raise HCG but not APF, non-seminomas might raise AFP but not HCG, and elevated LDH levels might indicate cancer.
CT scans, MRIs and X-rays
A CT or a CAT scan uses X-rays to form pictures of the inside of your body. Your doctor might perform a CT scan of the abdomen and pelvis to see if the cancer has spread. They might order a CT scan or X-ray to see whether cancer has spread to the lungs.
If the cancer has spread to the central nervous system, you may get an MRI, which uses magnets and radio waves to form pictures of the inside of the body.
Treatment for testicular cancer depends on several factors, such as your health, preferences for treatment, cancer stage, and tumour type. Seminomas usually grow more slowly and respond better to radiation treatments than non-seminomas. Both types of testicular cancer tumours respond well to chemotherapy treatments.
If testicular cancer involves both seminoma and non-seminoma tumours, your doctor will treat it as a non-seminoma.
Surgery
Surgery to get rid of the cancerous testicle is the most common treatment for testicular cancer, regardless of stage or tumour type. In certain cases, your doctor might also remove your lymph nodes.
Radical inguinal orchiectomy
Your doctor might perform orchiectomy (testicle removal) to treat both seminoma and non-seminoma testicular cancers. During this procedure, an incision might be made in the groin to remove the testicle that has the tumour. They will also close off blood vessels and lymphatic tissue to prevent the cancer from spreading.
Retroperitoneal lymph node dissection (RPLND)
Your doctor might perform a retroperitoneal lymph node dissection depending on the stage of cancer and tumour type. This is more common with non-seminoma testicular cancers.
During this procedure, the doctor makes an abdominal incision to remove the lymph nodes behind the abdominal organs. DPLND might be used to treat cancer and also for cancer staging. Your provider might perform surgery to get rid of tumours that have spread to your lungs or liver.
Radiation therapy
Radiation therapy uses high-dose X-rays to kill cancer cells. Radiation might be used post surgery to prevent the tumour from returning. It is limited to treating seminomas.
Chemotherapy
Chemotherapy depends on drugs like bleomycin, cisplatin and etoposide to kill cancer cells. Chemotherapy has drastically improved the survival rate for people with testicular cancer. It might replace surgery, or be used before an RPLND procedure or a radical inguinal orchiectomy. Chemotherapy might be used to treat cancer that has recurred following remission.
In conclusion, testicular cancer is quite the killer. However, with proper care and medical advice, you might well be on the path to recovery. Don’t ignore a lump on your testicles. Get it checked for signs of cancer, because you never know what that little lump may be. Getting a cancer diagnosis is not the end of the world. In fact, it might be the best thing because you can then commence treatment. Get treated and remain cancer free.
What is testicular cancer?
Testicular cancer is a type of cancer that begins in the cells of the testicles (or testes), which are the male reproductive organs responsible for producing sperm and testosterone.
What are the symptoms of testicular cancer?
Common symptoms of testicular cancer include a painless lump or swelling in one of the testicles, a feeling of heaviness or discomfort in the scrotum, or pain in the lower abdomen or back.
What are the risk factors for testicular cancer?
While the exact cause is unknown, risk factors for testicular cancer include a history of undescended testicle(s) (cryptorchidism), having a family history of testicular cancer, being between the ages of 15 and 35, and having a personal history of testicular cancer in one testicle, which increases the risk of developing it in the other.
How is testicular cancer diagnosed?
Testicular cancer is diagnosed through physical examination, ultrasound imaging of the testicles, blood tests (to check for tumor markers), and sometimes, a biopsy or surgery to remove the affected testicle for further examination.
What are the treatment options for testicular cancer?
Treatment for testicular cancer usually involves surgery to remove the affected testicle (orchiectomy). Depending on the stage and type of cancer, additional treatments may include radiation therapy, chemotherapy, or surveillance to monitor for any signs of recurrence.
