Understanding Testicular Cancer: From Diagnosis to Treatment

Although white Americans have a higher rate of diagnosis, Black people are at a greater risk of having advanced testicular cancer as well as experiencing death from testicular cancer.

Testicular cancer can occur at any age, but it is most common among males aged 20 to 44 years old, according to the Centers for Disease Control and Prevention (CDC). The American Cancer Society estimates that in 2024, there will be 9,760 new cases of testicular cancer diagnoses and about 500 deaths from testicular cancer. Although testicular cancer is not common, 1 in every 250 males will develop it at some point in their lifetime.

What is Testicular Cancer?

According to the Mayo Clinic, testicular cancer is a growth of cells that start in the testicles. The testicles, which are also called testes, are in the scrotum. The scrotum is a loose bag of skin underneath the penis. The testicles are responsible for making sperm and the hormone testosterone.

What Are the Symptoms?

The first sign of testicular cancer is often a bump or lump on a testicle. The Mayo Clinic has formulated a list of signs and symptoms of testicular cancer, which includes:

• A lump or swelling in either testicle.
• A feeling of heaviness in the scrotum.
• A dull ache in the lower belly or groin.
• Sudden swelling in the scrotum.
• Pain or discomfort in a testicle or the scrotum.
• Enlargement or tenderness of the breast tissue.
• Back pain.

If these symptoms last longer than two weeks, please see your healthcare provider; an early diagnosis is always best.

What Does Your Diagnosis Mean?

The Black community is used to taking the lead in many cancers, but in the case of testicular cancer, white people are at greater risk due to the genetic factors involved in the disease. According to Healthline, white people tend to be four to five times more likely to have testicular cancer than Black or Asian people.

If you are diagnosed with testicular cancer, it is important to know what type of testicular cancer you have. John Hopkins Medicine gave insight into the different types of testicular cancer, including:

* Seminomas.

* Nonseminomatous Germ Cell Tumors (NSGCT).

* Stromal Tumors.

Seminomas are tumors originating in male germ cells. They tend to grow and spread slowly, but some seminomas can grow rapidly. 95% of seminomas are classic, and then there are spermatocytic seminomas, which tend to occur in older men. Seminomas can secrete human chorionic gonadotropin (HCG). Four main types of NSGCTs can appear alone but often appear mixed, meaning there is more than one type of NSGCT. This includes:

• Embryonal carcinoma is present in about 40 percent of tumors and is among the most rapidly growing and potentially aggressive tumor types. Embryonal carcinoma can secrete HCG or alpha-fetoprotein (AFP).
• Yolk sac carcinoma is the most common type of tumor in children; it responds well to chemotherapy in children and adults. Yolk sac tumors almost always secrete AFP.
• Choriocarcinoma is a very rare and very aggressive form of testis cancer. It can secrete HCG.
• Teratoma most often appears as a mixed NSGCT. They usually grow locally but can appear in retroperitoneal lymph nodes. Teratoma is chemotherapy- and radiation-resistant and best treated with surgical removal.

Then, there are stromal tumors, which develop from the supportive tissues around the germ cells in the testicle. These tumors are rare as they make up less than 5% of testis cancers, and they have an excellent prognosis if treated surgically. There are two types of stromal tumors including:

• Leydig cell tumors impact the Leydig cells responsible for making testosterone.
• Sertoli cell tumors impact Sertoli cells, which support and nourish the developing sperm.

Tests and Detection of Testicular Cancer

Testicular cancer is usually found because of symptoms that a person is having but it can also be found when tests are done for another condition, according to the American Cancer Society. When going to see a doctor regarding the concern of testicular cancer, the doctor may give you an exam to detect any swelling, lumps, or tenderness. The doctor may also examine your abdomen, lymph nodes, and other parts of your body to look for signs of cancer spread. To better assess your condition, you may also partake in the following procedures:

• Ultrasound of the testicles.
• Blood tests for tumor markers and the secretion of HCG and AFP can be found in the blood; this will signal your doctors to look further into the possibility of cancer.
• Biopsy is a rare method for testicular cancer.
• Scans and imaging tests, including x-rays, CT scans, MRI scans, and PET scans.

Treatment Options

Testicular cancer treatment often involves surgery and chemotherapy, according to the Mayo Clinic. Still, your treatment plan is unique to your specific needs, and only your healthcare team can provide you with the best plan.

Some common forms of treatment include:

* Surgery.

* Chemotherapy.

* Radiation therapy.

* Immunotherapy.

Surgery can be conducted to remove the testicle or nearby lymph nodes. Chemotherapy treatment uses strong medicines, either implemented orally or through intravenous injection (IV), to kill cancer cells; this can aid in treating cancer spread as well. Radiation therapy includes the use of special high-energy X-rays that can kill cancer cells and or alter their ability to multiply. Then, there is immunotherapy, a cancer treatment method that uses drugs and vaccines to aid white blood cells in identifying and attacking the cancerous cells. This is sometimes used in advanced testicular cancer cases.

It is essential for you to ask your medical team any questions that you have regarding treatment, as every approach has its risks, advantages, and disadvantages. Also, some doctors may suggest a mixture of treatments; be prepared for this, as your treatment plan will be personalized just for you.

Although there is cause for concern regarding testicular cancer, there is also room for optimism as studies have shown that the average five-year survival rate for Black males with testicular cancer is 88.8%, as reported by VeryWellHealth. So, stay informed, and good health is within reach with the right medical care.

Risk Factors

Genetics are heavily to blame for testicular cancer diagnoses as having a parent with the disease increases your risk by nearly 400%, and having a sibling with the disease increases your risk by more than 800%, according to VeryWellHealth.

There are a few risk factors beyond family genetics that can increase your risk for testicular cancer. These include:

•  Being between the ages of 20 and 34.
• Having an undescended testicle (known as cryptorchidism).
• Having had testicular cancer before.
• Having human immunodeficiency virus (HIV).

Your Medical Team

The type of medical team you have is based on the treatment options you need and the severity of your condition. The American Cancer Society reports that different types of doctors may be on your treatment team, including:

• Urologists: surgeons who specialize in treating diseases of the urinary system.
• Radiation oncologists: doctors who treat cancer by using radiation therapy.
• Medical oncologists: doctors who treat cancer with medicines like chemotherapy.

Although there is cause for concern regarding testicular cancer, there is also room for optimism as studies have shown that the average five-year survival rate for Black males with testicular cancer is 88.8%, as reported by VeryWellHealth. So, stay informed, and good health is within reach with the right medical care.