Testicular cancer: symptoms, causes, and treatment

Definition

What is testicular cancer?

Testicular cancer is a type of cancer that develops in male testicles. The testes themselves are part of the male reproductive system which consists of two pairs of organs the size of a golf ball. The organ is lined with a pouch of skin called the scrotum and hangs under the base of the penis.

The function of this organ is as a maker of the hormones testosterone and sperm (cells to fertilize a woman's egg). In addition, this organ also plays a role in producing and storing sperm.

Cancer that attacks the testicles, is divided into several types, including:

Germ cell tumor

More than 90% of the cancers that attack these men originate from germ cells, the cells that make sperm. This type of cancer is then divided into 2 types, namely:

Seminoma: Cancer cells grow and develop more slowly and are categorized into classic seminomas (occurring at age 25-45 years) and spermatocytic seminomas (occurring at age 65 years and over).
Non-seminoma: This type of cancer consists of embryonal carcinoma (cancer that spreads rapidly to the outside of the testis), yolk sac carcinoma (cancer that is common in infants and children), choriocarcinoma (cancer in adults, fast growing but quite rare), and teratoma ( cancer that attacks the lining of the embryo, such as endoderm, mesoderm, and ectoderm).

Testicular carcinoma in situ

Testicular cancer is formed from abnormal cells that are either cancerous or non-cancerous. The abnormal cells are visible, but have not spread beyond the walls of the seminiferous tubules (where sperm form).

Stromal tumor (gonadal stromal tumor)

Tumors that start in hormone-producing tissues and support testicular function. This type of tumor is divided into leydig cell tumors (formed in the area of the testes that make testosterone) and Sertoli cell tumors (formed in cells that feed germ cells).

How common is testicular cancer?

Testicular cancer is included in the list of types of cancer that are common in Indonesia. Based on Globocan data in 2018, there were 1832 new cases with a death rate of 283 people.

This disease can affect people of any age, including infants and children. Only the type of cancer that differentiates it from adults. Further doctor consultation is needed to reduce the various risks of developing this disease.

Signs & symptoms

What are the signs and symptoms of testicular cancer?

In some men, this cancer does not cause signs and symptoms at all, especially in its early stages. Even so, some men report feeling symptoms, including:

1. Lump or swelling in the testicles

The most common characteristics of people with testicular cancer are the appearance of a lump or swelling of the testicles. It can be a lump as small as a pea, but sometimes it can be bigger.

You may also notice a difference in size between your two testicles. If you look closely, one testicle may look lower down. In addition, some people also feel sore around the lower abdomen to the groin.

2. Breast pain

Breast pain is a fairly rare symptom of germ cell tumor type testicular cancer. The appearance of testicular cancer symptoms is caused by excessive human chorionic gonadotropin (HCG) hormone which stimulates breast growth.

In the type of cancer of the Leydig cell tumor, the hormone estrogen becomes excessive, making the breasts bigger. This symptom of enlarged breasts in people with testicular cancer is what makes the breasts feel sore.

Usually, people who feel the symptoms of this cancer are followed by a decrease in sex drive (libido).

3. Early puberty

Leydig cell tumor type testicular cancer can cause symptoms of early puberty. Children with this cancer may show signs of puberty earlier than other children, such as the voice becomes heavier and grows hair on the body.

4. Other testicular cancer symptoms

In addition to symptoms, children or men with testicular cancer may experience other signs, such as:

Lower back pain which indicates cancer has spread to nearby lymph nodes.
Abdominal pain due to enlarged lymph nodes or cancer that has spread to the liver.
The headaches are persistent and easily confused as the cancer spreads to the brain.
Shortness of breath, chest pain, or coughing because the cancer has spread to the lungs.

When to see a doctor?

Symptoms that really need to watch out for are the presence of lumps or swelling of the testicles followed by pain that lasts more than two weeks. Immediately see a doctor if you experience the symptoms of cancer mentioned above.

Cause

What causes testicular cancer?

The cause of testicular cancer is not known with certainty. However, scientists reveal the possibility of DNA mutation as one of the causes. DNA itself contains a series of instructions for cells to function normally.

When DNA mutations occur, the cell's command system can be damaged, making the cells abnormal. Cells that act out of control are what will continue to divide and not die, causing cancer.

Risk factors

What increases the risk for testicular cancer?

Although the cause of testicular cancer is unknown, scientists have found a variety of factors that can increase the risk, including:

Undescended testes (cryptorchidism)

Normally, the testes develop in the belly of the fetus and descend into the scrotum before birth. However, in some boys, one or two testicles do not descend and remain in the stomach.

In rare cases, the testicles are down but around the groin. This condition is known as cryptorchidism. In fact, in some children, the testicles will descend until they reach the age of 1 year. If it does not go down, the child is at risk of developing testicular cancer if it is not treated.

HIV infection

Researchers found that people who are infected with the HIV virus or have AIDS are at high risk for this cancer. Until now, there has not been found evidence of other infections that can also increase the risk of testicular cancer.

Age

About half of cases of this cancer occur in men aged 20-34 years. Only a small proportion affects elderly men, children and infants.

Presence of carcinoma in situ

Carcinoma in situ is an abnormal cell that can develop into cancer over time. Can also not develop into cancer. People have carcinoma in situ of their testicles, at risk of developing cancer later in life.

Heredity

Having a father or brother with testicular cancer puts you at a greater risk of developing this disease. In addition, Klinefelter's syndrome, which causes the testicles to not descend into the scrotum, can also increase the risk of cancer.

Diagnosis & treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How is testicular cancer diagnosed?

Make a diagnosis of testicular cancer and the status of stage 1, 2, 3, or 4, not just by observing the symptoms. Doctors must confirm the disease through medical tests, such as:

Physical examination test

The initial test that the doctor does is to check for swelling or the appearance of pain when the testicles are pressed. In addition, the doctor will also check for swelling in the stomach or nearby lymph nodes.

Imaging test

In order to detect abnormal cells in the testicles, your doctor will ask you to undergo imaging tests, such as CT scans, PET scans, MRIs, and chest x-rays. Through this test, the doctor can also find the location of the tumor and determine how big it is.

Blood test

Cancer that attacks this testosterone-producing organ, produces certain proteins such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). If the protein is found in the blood, cancer is most likely detected.

High levels of AFP or HCG also help doctors determine which type of testicular cancer is attacking. Seminoma-type cancers only increase AFP levels. While non-seminoma types can increase AFP as well as HCG.

In addition to protein, cancer can also increase levels of an enzyme called lactate dehydrogenase (LDH).

Biopsy

Another medical test you will need to undergo to detect cancer is a biopsy. In this procedure, abnormal tissue that is suspected of being cancer will be removed and sampled. Then, the sample will be viewed using a microscope in the laboratory.

What are the treatment options for testicular cancer?

Once the diagnosis is established, the doctor will recommend treatment. This is done to prevent the danger of testicular cancer from spreading and getting worse. Common ways to treat testicular cancer include:

1. Operation

Surgery is the most important cancer treatment option. This medical procedure is performed by removing the testicles which have abnormal cells by making an incision in the groin. One or both testicles are removed, depending on the severity of the condition.

The removal of the testicles may make it difficult for you to have children. Further consultation is needed if you are planning to have a child.

Another operation is to remove the lymph nodes near the cancer by making an incision in the stomach. The side effects of this cancer treatment are bleeding, infection, or nerve damage.

Radiotherapy

Radiotherapy or radiation therapy is done with light radiation, such as X-rays, to kill cancer cells. This therapy is generally performed for patients with seminoma type cancer. Side effects that may be felt are skin redness, nausea and vomiting, and stomach irritation.

3. Chemotherapy

You can also take chemotherapy to treat testicular cancer, using drugs, such as cisplatin, etoposide (VP-16), bleomycin, ifosfamide, paclitaxel, and vinblastine.

These drugs are effective at killing cancer cells, but can cause side effects in the form of body fatigue, hair loss, nausea, and vomiting.

Home remedies

What are some lifestyle changes or home remedies that can be done to treat testicular cancer?

Implementing a healthy lifestyle that is suitable for cancer patients is a home treatment that needs to be done to support the effectiveness of the treatment. This includes adopting a cancer diet, adjusting daily activities, and adhering to a doctor's medication.

If you want to use herbal medicine, make sure your doctor allows it and supervises its use.

Prevention

How do you prevent testicular cancer?

Until now, scientists are still looking for various possible ways to prevent cancer, including in this male organ. One way that can be done is to screen for cancer for those of you who are at risk.

Apart from medical tests, cancer detection can also be done independently, in the following ways: