Testicular Cancer
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Testicular cancer occurs usually in young men between the age of 20 and 40.1
Usually patients feel a lump there and that’s the commonest way of presenting.
Treatment for testicular cancer has been transformed in recent years.2
You may have heard about Lance Armstrong who had spread throughout his body who is now cured of his cancer and so this, this is a cancer that we’ve had a great victory over because certain chemotherapeutic agents, for example Cisplatin, works very specifically to testicular cancer3.
Having said that, the majority of patients do not need to have chemotherapy, nor do they present with evidence it’s spread.4,5,6
Usually patients with testicular cancer present with a firm lump in the testes7, generally the way it’s treated is we do a radical orchidectomy, we remove the testes and the spermatic cord and that testes is removed and sent for pathology an analysis.
Patients are usually in hospital overnight.
Now prior to this we do some staging tests such as CT scan and a chest x-ray to make sure there’s no evidence of spread.
At the time of surgery we also give the patients the option of having a prosthesis inserted, testicular prosthesis.
So young men who are not married you know may wish to have that put in and we put a little synthetic prosthesis in and externally it appears very similar to a normal testes.
So when we get the pathology back we divide testicular tumours into two groups, seminomas and non-seminomas and it’s a very complex topic so we normally would refer you to an oncologist to discuss subsequent treatment but usually with non-seminomas we follow an observation protocol so we would do regular CT scans and monitor the situation.
With seminomas traditionally patients go radiotherapy8 to the aortic area where the, where testes cancer would first spread to.
These days we tend to also offer an observation protocol for those patients.
So the important thing with testicular cancer is there is an extremely high cure rate (95%) with testicular cancer9,1 and it’s important for patients to self examine.
The treatment is a radical orchitectomy10 plus or minus an adjunctive treatment if required.
Testicular Cancer
Testicular cancer occurs most commonly in young men aged 20–40.1 The most common way it presents is when a patient feels a firm lump in one of the testes7 - which makes self-examination an important habit.
A cancer with an extremely high cure rate
Treatment of testicular cancer has been transformed over recent decades2 - largely due to chemotherapy agents such as Cisplatin that work very specifically against testicular cancer.3 Even cases with widespread disease (such as Lance Armstrong’s) can now be cured. The overall cure rate is around 95%.9,1
Importantly, the majority of patients do not need chemotherapy and do not present with spread.4,5,6
Staging
Before surgery, staging tests are performed - typically a CT scan and chest x-ray to check for any evidence of spread.
Surgery - radical orchidectomy
The standard treatment is a radical orchidectomy,10 in which the affected testis and spermatic cord are removed and sent for pathological analysis. Patients are usually in hospital overnight.
At the same operation, patients are offered a testicular prosthesis - a small synthetic implant that externally looks very similar to a normal testis. This option is particularly relevant for younger or unmarried men who would prefer to keep a normal appearance.
After surgery - managing by tumour type
Pathology divides testicular tumours into two main groups, seminomas and non-seminomas. This is a complex area, and patients are normally referred to an oncologist to discuss further treatment.
- Non-seminomas - usually managed with an observation protocol, including regular CT scans.
- Seminomas - historically treated with radiotherapy8 to the aortic lymph-node area (the first site of spread). These days, observation is increasingly offered as an alternative.
Key points
- Testicular cancer has an excellent cure rate, around 95%.9,1
- Regular testicular self-examination helps catch it early.
- The mainstay of treatment is a radical orchidectomy, with adjunctive treatment (chemotherapy, radiotherapy, or observation) added as needed based on the tumour type and stage.
Testicular Cancer Patient Information Brochures
References
- Testicular cancer in Australia statistics - Cancer Australia - https://www.canceraustralia.gov.au/cancer-types/testicular-cancer/statistics
- Yaron Ehrlich, David Margel, Marc Alan Lubin - Advances in the treatment of testicular cancer - Transl Androl Urol. 2015 Jun; 4(3): 381–390. doi: 10.3978/j.issn.2223-4683.2015.06.02
- Onclive - How Einhorn Helped Turn a Deadly Cancer Into a Curable Disease - Oncology Live® May 2014 Volume 15 Issue 5
- Treatment for testicular cancer - https://www.cancervic.org.au/cancer-information/types-of-cancer/testicular_cancer/treating-testicular.html
- Survival for testicular cancer - Cancer Research UK - https://www.cancerresearchuk.org/about-cancer/testicular-cancer/survival
- Testicular Cancer Staging - John Hopkins Medicine - https://www.hopkinsmedicine.org/health/conditions-and-diseases/testicular-cancer/testicular-cancer-staging
- Testicular cancer symptoms - Cancer Research UK - https://www.cancerresearchuk.org/about-cancer/testicular-cancer/symptoms
- Joanna Jonska-Gmyrek, Piotr Peczkowski, Wojciech Michalski, et al - Radiotherapy in testicular germ cell tumours – a literature review - Contemp Oncol (Pozn). 2017; 21(3): 203–208. doi: 10.5114/wo.2017.69592
- Testicular Cancer Statistics - John Hopkins Medicine - https://www.hopkinsmedicine.org/health/conditions-and-diseases/testicular-cancer/testicular-cancer-statistics
- Radical Orchiectomy - John Hopkins Medicine - https://www.hopkinsmedicine.org/health/conditions-and-diseases/testicular-cancer/radical-orchiectomy