Testicular Tumour

Testicular tumours develop in the testicles that are located inside the scrotum. This part of the male body is responsible for producing sperm and sex hormones. The testicular tumour is highly treatable even when the tumour has spread beyond the testicles. It usually begins with abnormal changes in the germ cells. There are mainly two types of germ cell tumours:-

1. Seminomas: These testicular tumours grow slowly. Usually, they are confined to the testes, but the lymph nodes may also be involved in some cases. 
2. Non-seminomas: This is the most common type of testicular tumour that grows faster and spreads to other body parts. 

Here are some of the symptoms of testicular tumour that one needs to be aware of:

1. Testicle enlargement
2. Heaviness in the scrotum
3. Sudden fluid collection in the scrotum
4. Pain or discomfort in the testicles or the scrotum
5. Dull ache in the groin or abdomen
6. Back pain
7. Testicular atrophy (a shrinking testicle)

In most cases, the cause of the testicular tumour is not clear. Doctors know that testicular tumours develop when abnormal germ cells multiply, forming a tumour in the testicle. However, what causes these germ cells to become abnormal is not known. 

Risk Factors Associated with Testicular Tumour

Here are some of the risk factors associated with the presence of testicular tumours:

1. Undescended testicle (cryptorchidism): A testicle fails to move into its proper position in the scrotum before birth. 
2. Abnormal development of testicles: Conditions such as Klinefelter syndrome can cause testicles to develop abnormally, increasing the risk of testicle tumours. 
3. Age: Males between the age of 15 to 35 are at a higher risk.
4. Family history: If your family members had a testicular tumour, your risk increases. 
5. Race: The condition is more common in white men than in black men.

You may need to get a diagnosis done for a testicular tumour after you feel a lump in your testicle during self-examination. Your provider will ask you about your symptoms and perform a physical test to feel your testicles for lumps. They may also examine your lymph nodes to check whether the tumour has spread. Other diagnostic tests for testicular tumour include:-

1. Ultrasound: The procedure uses high-energy sound waves to create images of the tissues inside your body. 
2. Biopsy: If the ultrasound shows evidence of a tumour, the doctor will remove your affected testicle. Next, a specialist will examine your testicle tissue under a microscope to check for cancer cells. 
3. CT Scans, MRIs, and X-ray: These imaging tests create detailed pictures of the inside of the body to see if the tumour has spread from the testicles. 
4. Serum Tumour Marker Test: A blood sample is examined to measure certain amounts of tumour markers linked with testicular cancer. 

Men are recommended to do a self-exam every month to check for a testicular tumour. The best time to self-exam the testicles is during or after a shower, as the warmth relaxes the scrotum skin. Following are the steps to perform a self-check for testicular tumour:-

1. Gently hold your testicles with index and middle fingers beneath them and the thumb on the top. 
2. Roll the testicles between your fingers and thumb. 
3. Feel for any pea-size or larger lumps or any other changes in the shape, size, or consistency of the testicles. 

There are four main treatments to eliminate testicular tumours from the body. They have been briefly explained below:

1. Surveillance
   1. Surveillance involves monitoring the changes in the tumour size with regular check-ups. Your doctor may ask you for a regular examination, imaging tests, and tumour marker tests. You may have to undergo multiple ultrasounds of the scrotum to get a scan of the affected site. Sometimes chest X-rays and CT scans are also suggested during the surveillance period.
   2. Even if there are no major symptoms of testicular tumours, you must always get a test for signs of low oestrogen to be sure. The tests and scans are taken every 4 to 6 months for the first two years and then every 6 to 12 months for the next 3 to 5 years. This treatment method is only recommended for patients in stages 0 and I of cancer. Other treatment options must be offered if there is an increase in the size of the tumours or the severity of cancer symptoms. 
2. Surgery: Surgery is the primary treatment for the testicular tumour. Most of the time, the surgery involves the removal of the complete testis to ensure that the tumour does not spread into other parts of the body. However, depending on the stage and diagnosis of your tumour, other surgical options might also be offered, such as:
   1. Orchiectomy: Both early and late-stage tumours can be treated with this method. The entire testicles are removed during this surgery by making a small cut in the groin. The surgeon also removes the spermatic cord. After the procedure is completed, the patient is put through surveillance to ensure no signs of any other tumours in the surrounding areas. If you are worried about your appearance, the doctor may insert a prosthetic, saline-filled testicle. 
   2. Retroperitoneal lymph node dissection (RPLND): This surgery is performed through a cut in your abdomen to remove the lymph nodes in the back of the abdomen. It is more commonly used to treat non-seminoma tumours. A highly skilled surgeon is required to perform this procedure. 
   3. Testis-sparing surgery (TSS): Only the affected tissues are removed in this procedure, not the entire testis. This treatment is advised if the tumour is small and the tumour markers are negative. It is recommended only for men who have benign tumours. After this surgery, it is very important to get regular check-ups and stay under surveillance as the tumour can return. 
3. Radiation: In radiation, the surgeon uses high-powered targeted beams to kill the cancer cells in the testis or the nearby lymph nodes. This radiation therapy is also helpful if the tumour has spread to other body parts because it is safe and effective and does not harm the surrounding healthy tissues. However, radiation therapy can only be used in seminoma cells because the non-seminoma cells are resistant to radiation.
4. Chemotherapy: Chemotherapy is used for cancers that have spread beyond the testicles or when the levels of tumour markers rise after surgery. Depending on the tumours’ size and the severity of the spread, chemotherapy is advised. Doctors use imaging tests and scans to decide what level of chemotherapy will be used and if it will be helpful. Chemotherapy might require several sessions to show effects. The drugs injected during chemotherapy wipe out cancer cells in the lymph nodes. This method is helpful because it reduces the chances of recurring cancer once the surgery is complete. However, even after injecting drugs, you may require surgery to remove the residual tumours in the body. 

Please Note: The selection of the treatment approach is based on the type and stage of the tumour, your overall health, and your doctor’s opinion.

1. Though testicular tumour is highly treatable, it can still spread to other parts of your body. 
2. If the treatment is delayed, the doctor may have to remove one or both of your testicles. 
3. If only one testicle is removed, there may be no change in fertility or sexual energy. 
4. However, there might still be a risk of low testosterone levels and infertility in men who have been diagnosed with testicular tumours. 

Stages of Testicular Tumours

There are four stages of testicular tumours that have been identified:

Stage 0: In this stage, the abnormal cells have developed, but they are only present inside the testicles, where the sperm cells also develop. This stage is also known as germ cell neoplasia in situ or GCNIS.

Stage I: Cancer develops but remains in the testicles, including the nearby blood vessels and lymph nodes. Tumour markers (substances produced by cancer cells in the blood, urine, or body tissue) may or may not be elevated.

Stage II: In this stage, the tumour cells tend to develop in the lymph nodes in the back of your abdomen, also called the retroperitoneum. However, they do not spread anywhere else. Tumour markers may become mildly elevated in the lymph nodes.

Stage III: This is the last stage of testicular tumours. In this stage, cancer or the tumour has spread to the lymph nodes beyond the abdomen or another organ. Tumour marker levels are moderate or high.