Testis (plural, Testes)
Is a male reproductive gland (gonad) located in a sac of skin (scrotum) that hangs between the thighs below the penis. Inside are tightly packed tubules (seminiferous tubules), responsible for the production of sperm and male hormone (testosterone).

Cause of Testicular Cancer

It develops in the testes (testicles) when healthy cells become altered. Healthy cells in our body grow and divide in a systematic way for normal body function. But sometimes some cells develop irregularities and continue dividing even when new cells are not needed by the body. These excess cells accumulate and form a lump in the testicle. Nearly all testicular cancer begins in the germ cell. A germ cell (gametes) is a reproductive cell (sperm or egg) that unites with another cell to create a new organism. Testicular cancer is not contagious. It cannot spread from one person to another and usually only 1 testicle is affected. Just like other cancer types, the cause of this disease is unknown.

normal testis and testis with lump

Photo credit: Mayo Clinic

Types of Testicular Cancer

Seminoma – are made up of immature germ cells. They are usually slow-growing type of testicular cancer and stay localized in the testicle for long periods. They are highly sensitive to radiation therapy.
Nonseminoma – are made from more mature specialized germ cells. They are fast-growing type of testicular cancer that usually develops earlier in life. They are less sensitive to radiation therapy. Chemotherapy is very effective for this type of testicular cancer.
Examples of nonseminoma cancer:
* immature teratoma
* choriocarcinoma
* yolk sac tumor
* embryonal carcinoma

Stages of Testicular Cancer

Stage 1 : The cancer is confined in the testicle
Stage 2 : The cancer spread to the retroperitoneal lymph nodes (at the rear of the body, below the diaphragm and between the kidneys)
Stage 3 : The cancer has spread beyond the lymph nodes to remote areas in the body including the brain, lungs, liver and bones
Stage 4 : There is no Stage 4 for testicular cancer

Affected Person of Testicular Cancer
Only males (young or old) can be affected by testicular cancer because it develops in the testicles.
* Infants – having undescended testis (cryptorchidism), is a common genital abnormality in pediatrics
* Adult (ages 20 – 40) – having undescended testis (cryptorchidism) develop later in life in very rare cases

Risk Factor of Testicular Cancer

* Males with undescended testicles (cryptorchidism) increases the risk of developing testicular cancer
Cryptorchidism – the testis is absent or hidden, and has not moved to its proper position in the scrotum before birth. Usually just 1 testicle is affected and in very rare cases both testicles are undescended. The undescended testicle corrects itself and moves into its proper position in a few months. But if the undescended testicle does not correct itself, a surgery must be done to relocate the testicles in its proper position in the scrotum.
* Males with intratubular germ cell neoplasia (carcinoma in situ) of the testicles
Carcinoma in situ or CIS – cells that look like cancer cells are seen in the seminiferous tubules but they have not spread beyond the tubule to other parts of the testicles
* Males with family or close relative with history of testicular cancer
* Males with history of testicular cancer has an increased risk of developing cancer in the other testicle
* Males with unhealthy lifestyles such as smoking, excessive drinking, unhealthy diet and lack of exercise or physical activities

Signs and Symptoms of Testicular Cancer

Testicular cancer does not always have signs and symptoms. But these symptoms can be a sign of having testicular cancer. Consult a doctor immediately if there is a lump, pain, swelling or any other abnormalities that lasts for more than 1-2 weeks.
* Lump in the testicle – this is usually the first sign of testicular cancer. It can may or may not be painful
* Enlargement of any of the testicles
* Significant shrinking of testicles
* Swelling in the testicles
* Feeling of heaviness in the scrotum
* Hardness in the testicles hardness
* Sudden collection of fluid in the scrotum
* Discomfort in the abdomen or groin area
* Breast tenderness and enlargement
* Lower back pain
* Chest pain, cough, and shortness of breath

Diagnosis of Testicular Cancer

* Physical Examination
* Ultrasound – this is a painless test using sound waves that shows the inside image of the testicles in the scrotum. This enables the doctor to determine if the lump is solid or liquid filled, if it is inside or outside the testicle, or the nature of the lump if it is likely to be testicular cancer

* MRI Scan – this is uses magnetic fields to show the image of a body structure. It is not used very often because testicular cancer can be diagnosed in ultrasound scan test. But if the ultrasound test cannot show that the lump in the testicle is cancerous or non-cancerous (benign), the doctor may ask to take this test.

* CT Scan – this is a series of x-rays in various sections of the body (abdomen and chest) that gives the doctor a picture if the cancer has spread in the body

* Biopsy – this determines if the lump is cancerous or not, and the type of cancer, by examining the testicle in a microscope

* Blood Tests – testicular cancer often produce high or abnormal amounts of hormone that can be measured in the blood. The doctor may use this test for decision making in which treatment to take.

3 Different Tumor Markers:
* AFP (alpha feta protein)
* HCG (human chorionic gonadotrophin)
* LDH (lactate dehydrogenase)

* You could have a testicular cancer without a raised marker because not all testicular cancers produce these chemicals.
* Raised markers are usual or common in some types of nonseminoma than in seminoma.

Self-Examination Test for Testicular Cancer
1. Cup one testicle at a time using both hands. This is best done during or after a warm bath or shower.
2. Examine with slight pressure by rolling the testicle between thumb and fingers.
3. Familiarize yourself with the spermatic cord and epididymis (tube-like structure that connect on the back side of each testicle).
4. Feel for lumps, change in size, or irregularities. It is normal that one testis is slightly smaller than the other.

Testicular cancer cure Singapore depends on the stage of the disease.

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