Testicular Cancer – Causes, Symptoms and Risk Factors

Testicular Cancer | Causes, Symptoms and Risk Factors

Male sex hormones and sperm cells are synthesized, stored and released by a pair of round or oval shaped organs, which are referred to as the testicles. Due to vitality and importance of this organ, Nature has devised several protective barriers for the optimal functioning of this gland such as:

• Testicles are protected by a lax pouch of muscle (also referred to as the scrotum) to prevent the sudden impact of force, trauma or pressure on the glands
• In order to maintain normal secretary functions of the gland, the temperature in testicles is maintained at 3 to 4 degrees lower than the basal body temperature
• Testicles receives exceptional blood and nervous innervation for maximal support, strength and stability

However, due to certain genetic or acquired risk factors, some males may develop malignant transformation of testicular cells, leading to cancer or malignancy of testicles.

What are Classic Symptoms of Testicular Cancer?

Most cases of testicular cancer are reported in young males (aged 15 to 35 years). Since early diagnosis improves the overall prognosis and treatment options, it is usually advised to conduct periodic self-examination of testicles for the early identification of a problematic lump.
Patient of testicular cancer may present with following signs and symptoms:

• A bulge or protuberance in one or both of the testicles
• A sensation of bulkiness in the scrotal sac
• Poorly localized, gnawing pain in the abdominal region or the groin
• An abrupt fluid accumulation of liquid in the scrotal sac
• Tenderness or uneasiness in either testes or scrotum
• Increase in size or pain in the breast tissue
• Backache

Most cases of testicular malignancy are unilateral (involving one testicle only). It is recommended to consult a primary care physician if you are experiencing above signs and symptoms for a period of more than fourteen days.

Pathophysiology of Testicular Cancer

Like any malignant process, the testicular cancer is also believed to have multifactorial origin. Testicular cancer occurs when a normal healthy cell in the testes becomes abnormal and cancerous due to a genetic mutation. The division of normal cells occur in a very ordered fashion to balance bodily functions. A slight error in this normal division can predispose to cancer growth and this division goes haywire. These extra formed cells coalesce to form a testicular lump. In advanced cases:

• The cancerous mass grows in size and eventually compromise the normal functioning of the gland
• Affects the nutritional status of normal healthy testicular cells
• Invade blood vessels, nerves and lymph channels to invade other tissues and organs

Eventually, the rate of hormonal secretion decreases. Abnormal testicular cells release obnoxious chemicals and mediators that produce a wide variety of abnormal symptoms.

Risk Factors of Testicular Cancer

Elements predisposing to testicular malignancy are:

• Cryptorchidism: It is a condition that is characterized by abdominally restricted testes. When the embryo is forming inside the womb, the testes develop in the abdomen and then travel their way through to the scrotum to attain their original position prior to birth. In a few cases this descent fails and predisposes that individual to the development of testicular cancer (as compared to those who have normally descended testes). Clinical data indicates that early correction of cryptorchidism (undescended testes) can minimize the risk of malignant transformation (3).
• Aberrant Development of Testes: Genetic conditions like Klinefelter syndrome increases the chances of developing testicular cancer.
• Family History: A positive family history of testicular cancer is associated with a substantial risk of developing testicular cancer.
• Age: Although young males (aged 15 to 35 years) are at significantly higher risk; yet testicular cancer may occur at any age.
• Race: White men are more prone to testicular cancer than black men.

How to Prevent Testicular Cancer?

Preventive strategies mainly revolves around early identification of testicular lesions for prompt management and treatment. Many physicians recommend periodic self-examination of genital area for lumps, masses or pain. It is usually much easier to perform a self-exam after a warm bath because the heat makes your scrotum relaxed for vigilant palpation.
Follow these actions for self-examination:

• Stand against a mirror to look for apparent swellings.
• Use both hands for testicular self-examination. Gently press your testes between your index and middle fingers and your thumb
• Check gently for smoothness, firmness and oval shape of testicles. Difference in the size of both testes is normal and a thin cord is also felt normally at the top of testis. Regular examination is helpful in identifying the slightest changes in the size and texture of testicular tissue

If a mass is felt, consult your doctor as soon as possible.
References:

1. Albers, P., Albrecht, W., Algaba, F., Bokemeyer, C., Cohn-Cedermark, G., Fizazi, K., … & Laguna, M. P. (2011). EAU guidelines on testicular cancer: 2011 update. European urology, 60(2), 304-319.
2. Siegel, R., DeSantis, C., Virgo, K., Stein, K., Mariotto, A., Smith, T., … & Ward, E. (2012). Cancer treatment and survivorship statistics, 2012. CA: a cancer journal for clinicians, 62(4), 220-241.
3. Kollin, C., Stukenborg, J. B., Nurmio, M., Sundqvist, E., Gustafsson, T., Söder, O., … & Ritzén, E. M. (2012). Boys with undescended testes: endocrine, volumetric and morphometric studies on testicular function before and after orchidopexy at nine months or three years of age. The Journal of Clinical Endocrinology & Metabolism, 97(12), 4588-4595.