Testicular Cancer

What is Testicular Cancer?

Testicular cancer is a relatively rare type of cancer that originates in the testicles, the male reproductive glands housed within the scrotum. The testicles are responsible for producing sperm and the hormone testosterone. Testicular cancer is the most common cancer in young men aged 15 to 35, although it can occur at any age.

This cancer typically develops in the germ cells, which produce sperm. While the exact cause is unknown, risk factors such as undescended testicles (cryptorchidism), family history, and previous testicular cancer are linked to an increased likelihood of developing the disease. Fortunately, testicular cancer has a high survival rate, especially when detected early.

Testicular cancer is broadly classified into the following categories:

01. Germ cell tumours

Germ cell tumours account for approximately 90–95% of testicular cancers and are further divided into two subtypes:

Seminomas: these tumours grow slowly and are more likely to remain confined to the testicle for longer periods, which makes them easier to treat. Seminomas typically affect men in their 30s and 40s and are highly sensitive to both radiation therapy and chemotherapy.

Non-seminomas: these tumours tend to grow and spread more rapidly than seminomas, often affecting men in their late teens to early 30s. Non-seminomas include several subtypes, such as:
- Embryonal carcinoma — a fast-growing cancer that may spread beyond the testicle.
- Yolk sac tumours — the most common testicular cancer in children, although less common in adults.
- Choriocarcinoma — a rare but aggressive form of cancer.
- Teratomas — tumours made up of various types of tissues, which can be either benign or malignant.

02. Stromal tumours

Stromal tumours arise from the supportive or hormone-producing tissues of the testicles, such as Leydig cells and Sertoli cells. These tumours are relatively uncommon and are usually benign, though malignant forms can occur.

03. Secondary testicular tumours

These tumours originate in other parts of the body and spread (metastasise) to the testicles. Lymphomas are the most common secondary testicular cancer, particularly in older men. Other cancers, such as those of the prostate or lung, may also metastasise to the testicles.

While germ cell tumours are the primary focus in testicular cancer treatment, stromal and secondary tumours require different approaches.

What causes testicular cancer?

The exact cause of testicular cancer remains unknown, but it is believed to result from genetic mutations within the germ cells of the testicles. These cells are responsible for producing sperm, and when their normal growth and division processes become disrupted, they may start dividing uncontrollably. This abnormal cell growth leads to the formation of a tumour in the testicle. The genetic alterations that drive this uncontrolled proliferation are not fully understood, but research suggests that disruptions in DNA repair mechanisms and cell cycle regulation play a significant role.

In many cases, testicular cancer begins as a condition known as germ cell neoplasia in situ (GCNIS). GCNIS consists of abnormal germ cells that remain dormant and do not spread immediately but have the potential to develop into invasive cancer over time. The transformation of GCNIS into invasive testicular cancer may involve additional genetic and molecular changes, including activation of oncogenes or suppression of tumour suppressor genes. This progression can result in the ability of cancer cells to invade surrounding tissues and, in some cases, spread to other parts of the body through the lymphatic or circulatory systems.

While the precise mechanisms behind these genetic and molecular alterations are still being studied, a combination of inherited genetic factors and acquired mutations during an individual’s lifetime is thought to contribute to the development of testicular cancer.

What are the symptoms of testicular cancer?

Testicular cancer often presents with noticeable changes in the testicles, though early stages may not cause significant discomfort. Recognising these symptoms can help with early diagnosis and prompt treatment.

Painless lump or swelling — the most common symptom is a lump or swelling in one of the testicles, which is usually painless.
Changes in size or shape — one testicle may become larger or feel firmer than usual.
Heaviness in the scrotum — a persistent feeling of heaviness or dragging sensation in the scrotum may occur.
Pain or discomfort — some individuals experience aching or sharp pain in the testicle, scrotum, or lower abdomen.
Sudden fluid build-up — the scrotum may suddenly accumulate fluid, leading to noticeable swelling.
Enlargement or tenderness of the breasts — hormonal changes caused by the tumour can lead to gynecomastia, which is the swelling or tenderness of breast tissue.
Back pain — in advanced cases, cancer that has spread to lymph nodes or other areas may cause persistent back pain.

These symptoms can also result from non-cancerous conditions, but any persistent changes should prompt a medical evaluation to rule out serious causes.

Who is at risk of testicular cancer in Singapore?

While testicular cancer is relatively rare, certain individuals may have a higher likelihood of developing the condition due to specific factors. Understanding these risk factors can help in recognising the need for regular self-examinations and early medical consultations.

Recognising these risk factors does not mean a diagnosis is inevitable but highlights the importance of early detection and proactive health management. Regular self-examinations and discussions with a healthcare professional are vital for those at higher risk.

Family history

Men with a close relative, such as a father or brother, who has had testicular cancer are at a higher risk.

Undescended testicle (cryptorchidism)

Individuals with a testicle that did not descend into the scrotum during infancy are more likely to develop testicular cancer, even if corrected surgically.

Previous testicular cancer

Those who have had testicular cancer in one testicle have an increased risk of developing it in the other.

Age group

Most cases occur in men between the ages of 15 and 35, though it can affect men of any age.

Ethnicity

Testicular cancer is more commonly observed in Caucasian men compared to other ethnic groups.

HIV infection

Men with HIV, particularly those with AIDS, may have an increased risk of developing testicular cancer.

How is testicular cancer diagnosed?

At Allen Sim Urology, we understand the importance of early and accurate diagnosis in ensuring optimal outcomes for testicular cancer. Our personalised approach incorporates the following diagnostic tools to identify and confirm the presence of cancer with precision.

01. Physical examination

Our specialists carefully assess the testicles for lumps, swelling, or any unusual changes that may indicate potential concerns.

02. Ultrasound imaging

We use high-resolution ultrasound to create detailed images of the testicles, which helps differentiate between benign and malignant conditions.

03. Blood tests for tumour markers

Specific proteins like alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH) are checked to identify markers associated with testicular cancer.

04. Radical Inguinal Orchiectomy

If a tumour is suspected, we may recommend the surgical removal of the affected testicle for further pathological examination to confirm the diagnosis.

05. Imaging scans

In certain cases, additional imaging such as CT scans or MRI may be performed to determine if the cancer has spread beyond the testicles.

What are the treatment options for testicular cancer in Singapore?

We offer a range of personalised treatment options for testicular cancer, according to your specific diagnosis and health needs. Our treatment methods include:

Surgical removal (Radical Inguinal Orchiectomy)

This is often the first step in treating testicular cancer. We perform precise surgical removal of the affected testicle to eliminate the tumour and confirm the diagnosis through pathology.

Lymph node dissection

For certain cases, we may recommend removing lymph nodes in the abdomen to ensure the cancer has not spread further. This procedure is performed with meticulous attention to minimise complications.

Radiation therapy

For some cases, primarily seminoma-type testicular cancers, we recommend radiation therapy to target cancer cells with high-energy beams, which minimises damage to surrounding tissues.

Chemotherapy

For advanced or aggressive cancers, we recommend consulting oncology specialists who can help with tailored chemotherapy regimens that effectively target cancer cells throughout the body.

Continuous monitoring

In some early-stage cases, we may recommend regular monitoring with scans and blood tests instead of immediate treatment. We will closely track your condition to ensure timely intervention if necessary.

Our holistic approach combines expertise with personalised care to guide you through every step of your treatment journey. If you are experiencing symptoms or are worried about testicular cancer, please schedule a consultation with us today for a thorough evaluation and personalised treatment plan.

Frequently Asked Questions (FAQs)

01. Is testicular cancer the same as prostate cancer?

No, testicular cancer and prostate cancer are different. Testicular cancer originates in the testicles and typically affects younger men, while prostate cancer begins in the prostate gland and is more common in older men. Both have distinct causes, symptoms, and treatment approaches.

02. Can testicular cancer affect fertility?

Yes, testicular cancer and its treatments can impact fertility. It is advisable to discuss sperm banking options with your healthcare provider before starting treatment.

03. Is testicular cancer hereditary?

While most cases are sporadic, having a family history, especially a father or brother with testicular cancer, can increase your risk.

04. How can I perform a testicular self-examination?

Perform monthly self-exams after a warm bath or shower. Gently roll each testicle between your fingers, checking for lumps, swelling, or changes in size. If you notice any abnormalities, consult a healthcare professional promptly.

05. What is the survival rate for testicular cancer?

Testicular cancer has a high survival rate, especially when detected early. The five-year survival rate is 95%.

06. Can testicular cancer recur after treatment?

While treatment is often successful, there is a possibility of recurrence. Regular follow-up appointments are crucial to monitor for any signs of return.

07. Does having one testicle affect testosterone levels?

In most cases, the remaining testicle produces sufficient testosterone to maintain normal levels. However, it is important to have regular check-ups to ensure hormonal balance.

08. Are there lifestyle changes to reduce the risk of testicular cancer?

While specific causes are not fully understood, maintaining a healthy lifestyle and performing regular self-examinations can aid in early detection and overall well-being.