Urology

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Testis Cancer

  • 1% of all cancers
  • Is the most common solid organ cancer in young adult men (15-40 years old)
  • Generally has a very high cure rate
  • Often first found when a man notices a ‘lump’ in his testicle
  • May or may not cause pain
  • Usually first diagnosed on Ultrasound
Testis Cancer
Risk Factors
  • A history of testis cancer in the other testicle
  • History of an undescended testicle
  • Hypospadias
  • Reduced fertility
  • Family history
Type of Cancer
  • 95% of testis cancers arise from cells of the testicle that give rise to sperm. These are often referred to as Germ Cell Tumours (GCTs).
    • GCTs are further classified into seminomatous (SGCT) or non-seminomatous germ cell tumours (NSGCT)
  • The remaining 5% of testis cancers are rare and can include stromal tumours or a lymphoma arising in the testicle: anything else would be very rare
Stage of Cancer: How Far Has it Gone?
  • These cancers may be isolated to the testicle or they may spread to lymph nodes in the body
  • The cancer may less commonly go to the lungs or even less commonly to other organs
  • How far the cancer has spread will be determined mostly by imaging studies (CT scan) and tumour markers (blood test).
What Investigations will I require Prior to Treatment?
  • Prior to treatment, the majority of men will have an ultrasound of the testicles, a CT scan of the chest, abdomen and pelvis and a blood test check for tumour markers (beta HCG, alpha fetoprotein (AFP) and lactate dehydrogenase (LDH)).
  • Fertility and family planning will also be discussed, in particular sperm banking.
What Will My Treatment Involve?

Your treatment for testis cancer will usually involve a Urologist (for removal of the testicle) and a Medical Oncologist (for the possible need for chemotherapy)

  • Treatment will usually begin with an inguinal orchidectomy (removal of the affected testis via the groin)
    • This will provide the treating team with the histopathology (the exact type of cancer) and guide any further treatments if they are required. An orchidectomy may be all that you need.

 

  • Your treatment pathway thereafter can be a little complex. It will very much depend on whether the cancer is confined to the testicle only or whether it has spread to other places. Your Surgeon will guide you through this.
      • If confined to the testicle only, options are
        • Active surveillance: regular CT scans and blood tests to ensure the cancer does not re-appear anywhere else in your body
        • Short course chemotherapy: this is to reduce the risk of the testis cancer re-appearing in the future
      • If the cancer has spread to lymph nodes or other organs, further treatments usually involve one or a combination of the following:
        • chemotherapy
        • surgery – RPLND (removal of the lymph nodes in the back of the abdomen)
        • radiotherapy – rarely used
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