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Testicular cancer

Testicular Cancer showing on a male body map

Facts and figures about testicular cancer

Testicular cancer is the 16th most common male cancer in the UK, around 2,200 new cases diagnosed in the UK each year, which is approximately 1% of all new male cancer cases.

Age related but unusually more common in young men. It can occur in children and young teenagers but an average of 84% are diagnosed in the 15-49 years age group and only 6% in those 60+ years. 95% are germ cell tumours, 40-45% of these are seminomas which have the highest incidence in the 30-45years age group, whilst the others are teratomas, the highest incidence of these being in the 20-35 years age group. Occasionally, these tumours are mixed seminoma and teratoma.

Higher incidence in Caucasians than other ethnic groups).

Risk factors include patients that had an undescended testicle, carcinoma in situ (benign condition often found during fertility investigations and has 50% risk of becoming malignant), fertility problems (low semen concentration or abnormal sperm), previous testicular cancer, family history of testicular cancer, HIV and AIDS.

Testicular cancer symptoms

  • Swelling or lump in a testicle, usually painless but swelling may increase and cause pain.
  • Dull ache/pain/ heaviness in scrotum.
  • Pain in the back, groin or lower abdomen.
  • Nipple/breast tenderness or swelling due to hormones being produced by the tumour.
  • Cough, breathlessness, difficulty in swallowing if spread to the lungs (late stage).

Diagnosis of testicular cancer

Investigation may include:

  • Physical examination.
  • Blood tests (will include checking hormone levels- alpha feta protein AFP, human chorionic gonadotrophin HCG, lactate dehydrogenase LDH) Ultrasound scan MRI scan- may be requested if ultrasound scan is inconclusive Removal of the testicle (orchidectomy)- the testicle will be removed ad sent for histology if investigations prove highly suspicious of cancer. A biopsy is considered unsafe as this would lead to a high risk of spread.

Testicular cancer treatment

Depends on several factors:

  • The type of tumour.
  • The stage of the cancer.

Surgery

Surgical removal of the testicle will have been performed to confirm histology, in early stage disease where the tumour is contained within the testicle; no further treatment is usually required.

If the disease has spread to the local lymph nodes, additional treatment will be required, for seminomas this may be radiotherapy or possibly chemotherapy. Teratomas and mixed tumours are more aggressive and will require chemotherapy.

Radiotherapy

Post-operative radiotherapy may be advised for seminomas that have spread to some of the local lymph nodes.

Chemotherapy

Chemotherapy would be recommended for all seminoma tumours that have spread to local lymph nodes and for all teratoma/mixed tumours that have spread outside of the testicle. It will be advised for all tumours where the disease has spread to lymph nodes in the chest or higher and if it has spread to other organs.

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