Testicular Cancer Information and cancer facts
Originally published in October 2003 icon
Family Connections Diagnosis Fertility The Warning Signs
Its most common in young men aged 25-35, affecting one in every 600
Testicular cancer affects about 1700 men in the UK each year - and the incidence has risen 70 per cent in the past 20 years. Its the most common malignancy in young men aged 25-35, affecting one in every 600. But the good news is that over 95 per cent of men with this diagnosis are cured - even when the cancer has spread.
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Self-examination is the best way to check for any testicular change and Cancer BACUP recommend doing so once a month after a bath or shower.
Men with a father or brother who has had this disease are more at risk, and the Institute of Cancer Research, Sutton, Surrey has recently begun trials designed to assess this - and also any additional risk of other cancers.
Contrary to some misconceptions, there are no proven links between injury or sporting strains and testicular cancer.
The two main types of testicular cancer are seminomas (most common in men aged 25-55) and teratomas (which affect 15-35 year olds). Occasionally tumours are of mixed type or more rarely a type of non Hodgkins Iymphoma.
Nobody knows exactly what causes this particular cancer, but undescended testicles after the first year of life are a known risk factor, and theres been a steady increase in this problem during the past century. There has also been a fall in sperm count and both these trends may be contributing to gene damage (which turns normal cells into cancer cells) in the womb or in infancy.
Men with a father or brother who has had this disease are more at risk
Swedish research believed there was a direct line correlation between dairy consumption and testicular cancer in 2001; oestrogen has also been blamed, and particularly oestrogen mimics.
icon has already reported on the Swedish research, showing the majority of perfumed products raise DEHP levels in the body. With pregnant women US research reported that 11 per cent of male off spring had genital problems and increased risks of testicular cancer. The Athlone Technological Institute has also researched oestrogen mimics from toxic toiletries and environmental factors being linked to falling sperm counts.
Oestrogen mimics are known to be genotoxins (Tufts Cancer Centre). One vital field of research is dedicated to identifying which genes are damaged in this cancer, and therefore how specific tumours of the testes develop. Genetic research will also lead to new means of diagnosis. Its already known that almost all testicular tumours have some sort of abnormality on chromosome number 12.
Although one in five men may have inherited the faulty genes that predispose them to testicular cancer, only a few will develop it. Scientists from the Institute of Cancer Research recently discovered that one of the genes responsible (TGCT1) is on the X chromosone which men inherit from their mothers. Men with faulty variations of this gene have a 50 times greater risk of contracting testicular cancer and the very rare cases where the cancer occurs in both testicles is linked to the same gene fault.
Scientists have evidence of at least three more faulty genes and further work on understanding them all should lead to new treatment and means of prevention.
Most testicular cancers come to light when a man consults his GP about a painless lump. Many of these will turn out to be harmless cysts or benign swellings, but you should always get checked out. Some men may notice symptoms such as aching in the lower abdomen or affected testicle or heaviness in the scrotum. A hormone sometimes produced by tumours can in rare cases cause tender nipples. After examination your doctor may refer you for an ultrasound scan, but the only way to confirm that a swelling is malignant is by surgical examination which sometimes includes a biopsy.
Genetic research will also lead to new means of diagnosis
If the biopsy tests positive then the affected testicle will be removed (this operation is called an archidectomy). Most patients go home within a day or two and if the cancer has not spread no further treatment may be necessary, though you will need regular check-ups. A straightforward orchidectomy does not affect potency or fertility.
Blood tests, chest x-rays and CT scans can detect any spread of the cancer. Tumours found in the lymph nodes of the pelvic area or back of the abdomen are regarded as stage two, in the chest or above the collarbones, stage three, and in the lung or other organs, stage four. If the cancer has spread, then the current treatment for men with non-seminomas is chemotherapy with combined bleomycin, etoposide and cisplatin. For information on your Cancer Drugs and chemotherapy click here.
UK trials (managed from the Beatson Oncology Centre, Western Infimary, Glasgow) are in progress to assess whether new drugs such as Taxol can lower the relapse rate.
Unfamiliar side-effects of combined chemo could be shortness of breath (bleomycin), hearing loss and tingling hands and feet (cisplatin). These usually resolve after treatment.
Seminomas respond well to radiotherapy, but research suggests that stage one tumours of this type may also do very well with carboplatin chemo. In advanced stage cases, oncologists may suggest high dose chemo with stem cell transplant. For information on your Cancer Drugs and chemotherapy click here.
The reason why testicular tumours respond so well to chemo is partly because these particular cancer cells are very poor at repairing the damage done to them during chemo, because testicular tumours contain very small amounts of the relevant protein XPA.
Looking to the future, scientists hope to design drugs to block XPA in all treatment-resistant cancers.
Men coping with testicular cancer are understandably concerned about future fertility following treatment. Doctors will advise them to wait for a year following either radiotherapy (which does not usually affect fertility) or chemotherapy before trying for a baby. If surgery is necessary to remove affected lymph glands in the abdomen it is possible that damage to the nerves controlling ejaculation could occur. But new surgical techniques make this less likely. If you are at all concerned to start or increase your family, ask about frozen sperm storage which would need to be done before treatment
Testicular cancer is the most common cancer in men aged 15-45 and has risen by 84 per cent since 1978. The cause remains a mystery but some men do have a higher risk of developing the disease if:
- One or both of a boys testicles hasnt descended
- A close family member has had the disease
- They are white, and from a higher income background
A recent study in Scandinavia that claimed a direct link between dairy consumption and testicular and prostate cancers.
The incidence of testicular cancer in men is 5.6 per 100,000.
By contrast, Nigeria has rates of 0.6 per 100,000;
Japan 1.3 per 100,000.
Testicular cancer is almost always curable if detected early. In fact, the disease responds well to treatment even if it has spread to other parts of the body. Ninety five per cent of patients survive for at least five years.
The warning signs to watch out for are:
- A hard lump on the front or side of a testicle
- A swelling or enlargement of a testicle or an increase in firmness of a testicle
- Pain or discomfort in a testicle or in the scrotum
- An unusual difference between one testicle or the other
Information provided by Cancer Research UK.