Cancer of the Testis

The testes or testicles are egg-shaped organs suspended below the penis in a pouch of skin called the scrotum.

Symptoms

Cancer of the testes mainly affects young men and is easily detectable as a small hard lump about the size of a pea. In the early stages it is usually painless and gives no warning of the danger it represents. Being so easy to reach, the testicles should be subjected to regular examination by hand similar to the regular examination for breast cancer in women. Husbands and wives should be taught what it is they are looking for and should be encouraged to carry out such examinations on their partners at least once a month. Other later symptoms of testicular cancer include enlargement of the organ, a heavy feeling in a testicle, a sudden build up of fluid or even blood in the scrotum.

Diagnosis

The diagnosis is confirmed by a biopsy and further help is the detection in the bloodstream of two substances, one called alphafetoprotein and the other human chorionic gonadotropin. The measurement of these proteins can be helpful not only in the diagnosis and the detection of spread of the disease but also in assessing the effectiveness of treatment and the discovery of a recurrence.

Once the diagnosis has been made an X-ray of the chest is taken to ensure there is no secondary growth in the lungs. An intravenous pyelogram is carried out and a lymphangiography is ordered to show up involvement of lymph nodes. This involves injection of a dye between the toes which will travel up the legs and outline lymphatics and enlarged lymph nodes on the X-ray. Finally, a CAT scan is used to confirm or exclude the presence of enlarged lymph nodes.

Treatment

The treatment for testicular tumour is a combined one and can involve surgery, radiotherapy and chemotherapy. The first step always includes surgical removal of the affected testicle. If all the additional investigations have proved to be negative this may be the only treatment required. Usually it is thought safer to follow orchidectomy (removal of the testis) with a full course of post-operative radiotherapy aimed at all Lymphatic channels.

There are two main groups of tumours affecting the testes: the seminoma and the teratoma. Of these, the seminoma has a much more favourable prognosis owing to its being so very radio-sensitive and therefore readily responsive to radiotherapy alone. In the case of teratoma extra chemotherapy is recommended.

Having a testis removed does not involve any loss of 'manhood' and a patient is rendered neither sterile nor impotent. One healthy testis is enough for full sexual function. Following treatment it is imperative to have regular check-ups and to test for the presence of either of the two proteins in the bloodstream.