Testicular Cancer Treatment in India: An In-Depth Explanation

The scrotum is a loose sac-like structure located just under the penis. The male reproductive glands inside the scrotum are called testicles which are responsible for producing sperms and the male sex hormone (testosterone) in the body. If you are wondering where is testicular cancer found, simply put- cancer developing inside the testicles of a man is testicular cancer. While diagnosing testicular cancer, your doctor may suggest close monitoring and appropriate testicular cancer treatment in India.

Signs and Symptoms of Testicular Cancer in Indian Men

Though in rare cases, cancer can develop in both testicles, it usually occurs in one of the two testicles. Some common symptoms of testicular cancer in males include:

• • A painless lump in either testicle
  • A heavy feeling or swelling in the scrotum with or without pain
  • Dull, intermittent pain in the abdomen or groin
  • Fluid collection in the scrotum
  • Testicular or scrotal pain or discomfort

Tenderness of breast tissue in men/growth of breast tissue called gynecomastia

• Swelling in legs

Testicular Cancer

Is testicular cancer painful? The answer is, testicular cancer spread in the body may result in additional symptoms like pain in the lower back, abdomen, chest or head.

If you notice any change in your groin area or how your testicles feel, and the symptoms last for more than two weeks, consult an oncologist on MFine and get a proper testicular cancer diagnosis done.

How Is Testicular Cancer Diagnosed in India?

Detection of testicular cancer growth can happen during self-examination when you feel a lump or change in the size of the testicle. Your doctor can also identify it during a routine examination.
The doctor can perform the following tests and screenings to ascertain if it is a cancerous testicular lump and to rule out other conditions:

• Ultrasound Scan

An ultrasound scan is usually the first step taken by the doctor if there’s a testicle lump on physical examination. This test produces a picture of the testicles with the help of ultrasound for an elaborate view. It’s a painless procedure in which you have to lie down on your back before the radiologist applies a clear gel on the scrotum. A hand-held device is then moved over it to produce an image.
An ultrasound scan helps the doctor in determining the nature and location of the lump and reach the possibility of a testicular cancer diagnonsis accordingly.

• Blood Tests

Testicular cancer can result in specific proteins and enzymes to float in the bloodstream like alpha-fetoprotein or beta-human chorionic gonadotropin (HCG). Their elevated levels in the blood, helps the doctor to identify the possibility of cancer in the body, its type and spread. This blood test for testicular cancer is called a tumour marker test.

• Biopsy

In this, some testicle tissue is removed examined microscopically to detect the presence of cancer cells. But doing so has the slight risk of causing the cancer to spread through the scrotum. So instead, the doctor may choose to perform surgery and remove the whole testicle and then analyze it for cancer.
If there’s a cancer diagnosis, the doctor will perform further tests like X-ray and CT scan to be sure it hasn’t spread to other parts of the body.
However, it’s vital to know that all lumps aren’t cancerous, and the pain or discomfort in the groin region can be due to some other underlying health issue as well.

Doctors usually use the TNM staging tool for cancer staging to describe the extent of cancer present in the body. For testicular cancer staging, an ‘S’ is also added to the TNM tool. TNMS refers to:

• T (Tumour): It indicates the size of the tumour and whether it has spread to nearby tissues. It is denoted as pT with p implying pathological stage.
• N (Node): This helps to check if cancer has spread to the regional lymph nodes.
• M (Metastasis): This checks whether cancer has metastasised, i.e. spread to distant parts of the body like liver, lungs, brain etc.
• S (Serum tumor marker): It indicates the level of tumour marker proteins/enzymes present in the blood.

A number or letter is added to TNMS to specify the extent of cancer. Higher the number, more advanced is the spread of testicular cancer.

Stage 0
Stage 0, or carcinoma in situ, indicates that the cancer cells have not spread from the location they first formed. Cancer has neither spread to lymph nodes, distant parts of the body, nor any evidence of tumour markers in the blood serum (pTis, N0, M0, S0).

Stage I
Cancer that has grown beyond its original location to some nearby tissues but not the lymph nodes or other regions of the body is a stage I testicular cancer. The serum tumour marker levels are unavailable or not done yet (pT1-pT4, N0, M0, SX). Stage I cancer is further divided into three sub-categories:

• Stage IA – In this, the tumour is still inside the testicle and not grown beyond it. There is no sign of testicular cancer spread to lymph nodes or distant parts of the body. The serum marker levels are well within the normal range (pT1, N0, M0, S0).
• Stage IB – When the tumour has spread outside the testicles, into the nearby structures but not to the lymph nodes or distant body parts, it is at stage IB. All tumour marker levels are also within normal limits (pT2-pT4, N0, M0, S0).
• Stage IS – Testicular cancer at this stage can be at any T level (extent of invasion to nearby structures). However, it has not yet spread to lymph nodes or distant parts of the body. The tumour marker levels are higher than the normal range (any pT, N0, M0, S1-S3).

Stage II
At stage II, testicular cancer may or may not have grown outside the testicle but has invaded nearby lymph nodes. Cancer has not yet metastasised (spread to distant parts) and tumour marker levels aren’t done or not available yet (any pT, N1-N3, M0, SX). It further has three sub-categories:

• Stage IIA – In this, either the tumour can’t be assessed or may or may not have spread beyond the testicle. Testicular cancer has spread to at least one nearby lymph node, and the mass is no larger than 2cm. The serum marker levels are either in the normal range or slightly elevated (any pT or TX, N1, M0, S0-S1).
• Stage IIB – In this, the T level of testicular cancer either can’t be assessed or may have grown outside the testicle. Cancer is present in at least one nearby lymph node, and the mass is between 2cm to 5cm in size, but cancer hasn’t spread to distant parts. The tumour marker levels are normal or slightly elevated (any pT or TX, N2, M0, S0-S1).
• Stage IIC – In this stage, cancer is at any T level, the size of the lymph node mass is more than 5cm, but it has not metastasised. The serum marker levels are within limits or slightly high (any pT or TX, N3, M0, S0-S1).

Stage III
Testicular cancer at stage three indicates any T level or N level, but cancer has spread to distant parts of the body. The levels of tumour marker are either not available or not done yet (any pT, any N, M1, SX). It is further divided into three sub-categories:

• Stage IIIA – In this, testicular cancer spread to lungs
  or lymph nodes but hasn’t spread to the distant parts. The serum marker levels are either within the normal range or slightly increased (any pT, any N, M1a, S0 or S1).
• Stage IIIB – This stage can have two scenarios:

Cancer has grown to one or more of nearby lymph nodes and not to any distant parts of the body. At least one serum marker level is much higher than the normal range (any pT, N1-N3, M0, S2).
Testicular cancer spread to lungs or lymph nodes. At least one serum marker level is much higher than acceptable (any pT, any N, M1a, S2).

• Stage IIIC – It includes either of these:

Cancer has probably spread to one lymph node or organ, and the level of one serum marker is exceedingly high (any T, N1-N3, M0, S3) or (any T, any N, M1a, S3).
The serum marker tumours may be at any level, and testicular cancer has spread to parts of the body besides the lungs and lymph nodes (any T, any N, M1b, any S).

The cells that produce sperm are known as germ cells, and this is where 90 per cent of testicular cancer tumours develop. There are two testicular cancer types of germ cell tumours:

Seminomas

Seminomas type of testicular cancer grows and spreads slowly. It has two subtypes:

• Classic Seminoma – Most testicular cancers are cases of classic seminoma. These usually occur in men between 30 to 50 years of age.
• Spermatocytic Seminoma – This is a type of testicular cancer in older males and do not tend to spread. The treatment of testicular cancer in older malesmostly includes surgery or chemotherapy, which is also discussed further in the article.

Nonseminomas

These grow and spread rapidly and may spread to other parts of the body. These usually consist of different types of cancer cells, including:

• Embryonal Carcinoma – These cells are present in about 40 per cent of the tumours. These tumours resemble that of early embryos, under a microscope. This type of testicular cancer tends to spread rapidly and is potentially aggressive.
• Yolk Sac Carcinoma – These cells resemble a yolk like sac around an embryo. If you are wondering is testicular cancer common amongst young boys, the answer is yes- this type of testicular cancer is common in children.
• Choriocarcinoma – Though it is a rare type of testicular cancer, it can grow and spread very rapidly.
• Teratoma – It resembles the layers of a developing embryo under a microscope and is an aggressive form of testicular cancer. It is best treated through surgical testicular cancer removal.

Testicular germ cell cancers may start as carcinoma of a non-invasive form. In such cases, experts most often recommend watchful waiting to rule out any possibility of cancer spreading beyond its original location.

There are some rare types of testicular cancer in Indian men, accounting for around 5 per cent of testes cancers. These types of tumours are known as stromal tumours and are often benign (harmless) but may become malignant later. They start in the hormone-producing tissues of the testicles and are also known as gonadal stromal tumours. Some examples of stromal tumours include Leydig Cell Tumour which begins in the cells that produce testosterone; and Sertoli Cell Tumour, a tumour of the cells that support the germ cells in nourishing the developing sperm.  Both these tumours in these cells can be treated by surgery.

Staging of Testicular Cancer:

Doctors usually use the TNM staging tool for cancer staging to describe the extent of cancer present in the body. For testicular cancer staging, an ‘S’ is also added to the TNM tool. TNMS refers to:

• T (Tumour): It indicates the size of the tumour and whether it has spread to nearby tissues. It is denoted as pT with p implying pathological stage.
• N (Node): This helps to check if cancer has spread to the regional lymph nodes.
• M (Metastasis): This checks whether cancer has metastasised, i.e. spread to distant parts of the body like liver, lungs, brain etc.
• S (Serum tumor marker): It indicates the level of tumour marker proteins/enzymes present in the blood.

A number or letter is added to TNMS to specify the extent of cancer. Higher the number, more advanced is the spread of testicular cancer.

Stage 0
Stage 0 indicates that the cancer cells have not spread from the location they first formed. Cancer has neither spread to lymph nodes, distant parts of the body, nor has it been detected in the blood.

Stage I
Cancer that has grown beyond its original location to some nearby tissues but not the lymph nodes or other regions of the body is a stage I testicular cancer. Stage 1 can include 3 scenarios: i) the tumour is still inside the testicle and not grown beyond it; ii) the tumour has spread outside the testicles into the nearby structures without spreading to the lymph nodes or distant body parts, and iii) the intensity of invasion to the nearby structures is higher but it still has not spread to the lymph nodes or distant body parts.

Stage II
At stage II, testicular cancer may or may not have grown outside the testicle but has now invaded nearby lymph nodes. The cancer is still yet to spread to distant parts of the body. Stage 2 is more specifically identified based on three scenarios: i) Testicular cancer has spread to at least one nearby lymph node with the tumour being lesser than 2 cm in size; ii) Cancer is present in at least one nearby lymph node with the tumour being anywhere between 2 and 5 cm in size, and iii) the size of the cancer in the lymph node is more than 5cm, but it is yet to spread to other parts of the body.

Stage III
Testicular cancer at stage three indicates that cancer has now spread to distant parts of the body. Scenarios under this stage may include: i) testicular cancer has spread to lymph nodes or lungs but hasn’t spread to the distant parts; ii) cancer has grown to one or more of nearby lymph nodes and not to any distant parts of the body; iii) cancer has reached distant lymph nodes or the lungs and, iv) cancer has probably spread to one lymph node or organ in parts of the body besides the lungs and lymph nodes.

Staging testicular cancer in Indian men – How is it done?

Noticing physical irregularities in the testes or any other sign or symptom that could resemble testicular cancer, it is essential to get medical attention immediately. A urologist will usually be the doctor to assess your condition by using several testing procedure such as:

External examination –  Assessing relevant areas of the body such as the testicles, abdomen, the groin area for any kind of swelling or other abnormalities will be carried out by the doctor to check your risk level for testicular cancer.

Ultrasound scan – Ultrasound scans provide the doctor a clear picture of the condition of your internal organs. A sonogram of a testicle ultrasound helps the doctor identify tumours, growths or any other abnormalities inside the testicle.

CT Scan – A CT scan captures images of your internal body at different angles using x-rays that are later compiled to create a 3D image. CT scans make use of a special type of dye which is either given to the patient intravenously or made to swallow. This dye assists in providing clearer and more accurate images of the body. In testicular cancer, CT scans are often helpful to see how big or small the tumor is in the testicle.

Blood tests – Blood tests are carried out only if the above testing methods prove the appearance of a tumour in the testicle. Tumour markers are often used in this case to find out the type of cancer and its stage. Tumour markers are cancer-produced substances that can be detected in unusually high amounts in the blood of some cancer patients. There are three main tumour markers which are used to detect the stage of testicular cancer and help identify the appropriate treatment in Indian men. These are:

• Alpha-fetoprotein (AFP) – It is originally a protein that is formed in a developing baby’s liver. A healthy adult usually possesses very low levels of AFP. If the body is producing high amounts of AFP, it could be a sign of liver or testicle cancer. However, high levels of AFP does not prove the evidence of cancer however when this test can assist in diagnosing and monitoring cancerous tumours when combined with other testing methods.
• Beta Human Chorionic Gonadotropin (Beta-HCG) – This is a subunit of the hormone HCG which is produced by tumor/cancer-affected tissues in the body. This is usually a serum based test which is helpful detecting germ cell tumors and other types of testicular cancers.
• Lactate Dehydrogenase (LDH) – LDH is a protein enzyme that is found in organ tissues that plays a key role in your body’s metabolism process. Damage to these tissues sparks the release of high levels of LDH directly into the blood or body fluids. Higher than usual amounts of LDH in the blood when combined with other tumour marker tests, may signify the presence of testicular cancers and that a cancer treatment may not be working.

In addition, there sometimes may be tumours that mimic the characteristics of testicular cancers. In this case, a radical inguinal orchiectomy is performed – a surgical procedure where an incision is made in the groin and the affected testicle is removed altogether for testing. Thin layers of tissues of the removed testicle are examined under a microscope. The pathologist then confirms if there are any cancer cells in the tissue sample. This procedure also helps the pathologist determine what type of cancer cells the tissue sample contains. An orhiectomy is mostly performed when results of all the previous tests provide the doctor with a high-level of suspicion of cancer. However, if a testicle is removed and the tissue samples do not contain any cancer cells, the damage to the tissue due to removal may be repairable. The replacement of the testicle in the scrotum may also be possible. However, this is a very rare instance.

The best treatment for testicular cancer in India will depend on the type, stage of cancer, and your overall health and preferences. An open discussion with your doctor will help them suggest the right option, and you can take a decision accordingly.

Standard Treatment Options in India

In the early stages of testicular cancer, your doctor might suggest monitoring the cancer to keep a check on its further growth. The following treatment options may be proposed after detection in a later stage:

1. Surgery:

• Radical Orchiectomy – This is a surgical procedure where the doctor makes an incision in your groin area and removes the entire testicle where cancer is present. Getting an appropriate prosthetic inserted after the cancer treatment surgery is also a viable option in this case.
• Testis-Sparing Surgery – The doctor targets the tumour on the testicle and leaves the testicle in place. This surgery may be done for small tumours.
• Retroperitoneal Lymph Node Dissection – It is a complicated procedure in which the doctor makes an incision in your abdomen and carefully removes the lymph nodes from the back of your belly, avoiding damage to the nearby nerves. Doctors often perform this type of cancer treatment surgery when cancer has spread to the lymph nodes.

2. Radiation treatment for cancer:
This method uses high-powered beams to kill the cancer cells on the testicles or lymph nodes. The radiation beams are used at the specific points of your body where cancer cells exist.

Radiation treatment for cancer destroys the DNA of the cancer cells preventing them from growing further. This procedure may be performed after surgery to ensure that the remaining cancer cells are killed, to prevent them from returning. However, patients may feel some side-effects of testicular cancer treatment like nausea, fatigue, reduction in sperm count, etc., but all these go away gradually after procedure is complete.

3. Chemotherapy:
Your doctor may also suggest performing chemotherapy after surgery to kill the remaining cancer cells and prevent it from recurring. Chemotherapy is a multi-stage procedure that uses cancer treatment drugs to kill cancer cells. These drugs are either given to patients orally or intravenously and work on the whole body, wherever testicular cancer spread has occurred.
Like radiation therapy, chemotherapy also has temporary side-effects like nausea, diarrhoea, hair loss, etc., depending on the cancer treatment drugs and the duration.

4. Chemotherapy With Stem Cell Transplant:
The drugs used in chemotherapy also sometimes kill healthy cells during the process, including those that make blood. In later stages of testicular cancer, doctors may give patients high doses of chemotherapy which may require a stem-cell transplant afterwards. In this process, doctors transplant stem cells into the patient’s vein, just like a transfusion. These stem cells then go and set in the bone marrow and develop into healthy blood cells.

Treatment Options in India According to the Stages of Testicular Cancer
The type and stage of testicular cancer play a vital role in determining a suitable treatment for it.

• Stage 0 Treatment

If stage 0 testicular cancer is diagnosed after the testicle is removed through surgery, no separate treatment is required. Otherwise, doctors may recommend simple surveillance program in which the cancer is monitored regularly through scans and tests to check if it is growing.

• Stage 1 Treatment

Doctors usually suggest surgery/ advanced cancer treatment options to remove the testicle. In the case of stage 1 testicular cancer treatment in India, if its the type of cancer that spreads slowly, surveillance, and a combination of light chemotherapy and radiation therapy may be useful in treating it.
For aggressive testicular cancer spread, doctors consider chemotherapy or even surgery as a viable stage 1 testicular cancer treatment to remove lymph nodes at the back of your abdomen.

• Stage 2 Testicular Cancer Treatment

In the case of stage 2 testicular cancer treatment, your doctor may perform testicle-removal surgery followed by radiation and sometimes even chemotherapy or a lymph node dissection as part of cancer treatment depending on the size of the tumour and the spread of the tumour in your body. The same goes for cancers that aggressively spread. Your doctor will take a call on how soon and how intense the above procedures need to be carried out depending on the cancer’s behaviour.

• Stage 3 Testicular Cancer Treatment

You may require a multi-drug, high dose chemotherapy in stage III testicular cancer. Doctors perform chemotherapy in both slow-spreading and aggressively spreading cancers.
In slow-spreading cancers remaining tumours do not require further surgery but may be necessary for aggressively spreading cancers to avoid relapse of testicular cancer.

After appropriate testicular cancer treatment in India, doctors may perform regular follow-up tests for some years to ensure its successful progress, and rule out possibilities of cancer relapse. If cancer recurs after the first treatment is over, it is called recurrent testicular cancer.

It can happen if cancer hasn’t completely cured during the first treatment. Even after aggressive treatment, cancer cells can sometimes survive, and only a few of them are enough to grow and spread again.

Testicular cancer recurrence is quite common. It may return at the same place (local recurrence), nearby region (regional recurrence) or a distant area in the body (distant recurrence).

Recurrent Testicular Cancer Treatment in India
If testicular cancer somehow recurs at a later stage, treatment includes a combination of surgery and chemotherapy drugs followed by a stem cell transplant. Either four cycles of normal-dose chemotherapy drugs are administered or two to three cycles of high-dose chemotherapy.
A cancer relapse occurring after two years of treatment is best treated with testicular cancer removal surgery.

Testicular Cancer Treatment in India: Risks and Management
Treatment of tumor poses some temporary or lasting risks for an individual. The fear and anxiety towards this disease and its treatment mostly revolve around sperm count, hormone level and infertility issues post-treatment.
Most men are still fertile after the removal of one testicle during surgery. Though the removal of both the testicles is rare, if it happens, you’ll be infertile. In case bilateral surgery is the only option or if there’s infertility risk is high during advanced cancer treatment, you can go for ‘sperm banking’.

• Sperm Banking – It is normal to have a low sperm count during treatment of tumor, but there’s a risk of becoming infertile too. Sperm banking allows you to keep your sperm frozen before treatment starts, to use it at a later date when you’re ready to become a parent.
• Testosterone Replacement Therapy – Some men may face permanent hormone level issues after testicular cancer treatment in India as it can reduce the testosterone-producing ability of your body. Testosterone replacement therapy is given intravenously or topically to maintain testosterone levels in the body.

Though testicular cancer in Indian men has a good prognosis and a cure percentage of more than 90 per cent, it is natural to feel scared about your future after diagnosis. Follow-up holistic cancer care is a significant part of testicular cancer management.
Doctors often perform regular tests and checkups for some years after the treatment is over to be sure of treatment progress, signs of cancer relapse or managing side effects of testicular cancer. You may need follow-up treatment for complications arising out of surgery or chemo or radiation therapies.
Questions about fertility and sex life after the cancer treatment might also be a concern for you. You can openly talk about it with your doctor who will suggest measures to take.

Some Post-Treatment Care Tips

• In general, you can resume your normal activities after two weeks of testicular cancer surgery but avoid any kind of exertion for about a month.
• If you’ve had an incision during the surgery, make sure it’s clean and dry to prevent any sort of infection.
• Although the exact cause of testicular cancer remains unknown, your doctor may recommend a healthy diet and exercise regime after treatment to maintain good health in general.
• Always practice good hygiene
• Avoid using products laden with chemicals and use organic, mild ingredients.

Coping and Support for Testicular Cancer
Talking candidly about your condition with your loved ones and your healthcare provider is a great way to let all your emotions out and find support. You can also try to connect with cancer organisations like the National Cancer Institute and cancer survivors support groups for additional motivation and mindful living.

Q1. Is testicular cancer curable?

If you are wondering is testicular cancer curable, out of all the cancers, this type of cancer has a better prognosis with a cure percentage of more than 90 percent. In this case, the testicular cancer survival rate is quite high. However, it is crucial to get it detected and diagnosed as early as possible and seek medical help if any irregularities, pain and other symptoms were to be found.

Q2. How is testicular cancer caused?

There isn’t a definitive explanation yet as to what can cause testicular cancer. It can happen to anyone. People who may be at a higher risk for testicular cancer can be those with a family history of testicular cancer, or have an undescended testicle. Certain body types, ethnicities and body sizes are also risk factors for testicular cancer.

Q3. What are the symptoms of testicular cancer?

Is testicular cancer painful? The answer is, testicular cancer spread in the body may result in symptoms like pain in the lower back, abdomen, chest or head. Other prevalent signs and symptoms of testicular cancer include a lump or change in the size of the testicle, swelling or heaviness in the scrotum, fluid collection in the scrotum, etc.

Q4. What is the testicular cancer recovery time?

Recovery normally doesn’t take too long, and most patients can go back to their daily routine after two weeks of testicular cancer surgery. However, it’s important to avoid any kind of exertion for about a month, during. Emotional support is also imperative in testicular cancer treatment recovery time. Connecting with cancer organisations like the National Cancer Institute and other cancer survivors support groups can provide additional motivation and promote mindful living.

Q5. How is testicular cancer detected?

Apart from a physical examination, doctors perform tests like ultrasound scans, blood tests, surgical procedures, X-rays, CT scans etc. to diagnose testicular cancer in males. Early detection is vital in order for your chances of survival and successful treatment.

Q6. What are the most common treatment options for testicular cancer?

Treatment for testicular cancer most commonly includes surveillance, surgery to remove the testicle or affected lymph nodes, chemotherapy with or without stem cell transplant, radiation therapy. if you are wondering how serious is testicular cancer, the good news is that early detection is key to treating it successfully. The chance of dying from testicular cancer is only 1 in 5,000. In this case, the testicular cancer survival rate is quite high. While there are no natural cancer treatment programs, maintaining a healthy lifestyle and diet can go a long way in ensuring good health.

Q7. Can you prevent testicular cancer?

Since doctors don’t know what exactly causes testicular cancer, it is not possible to prevent it. If it occurs genetically, even then it is not in your hands to avoid it. Regular self-examinations of the testicles is one of the best ways to monitor the health of the organ and immediately seek medical attention if any abnormalities were to be found.

Final Take

A cancer diagnosis is, indeed, one of the toughest things to come to terms with in life. Testicular cancer affects different people in different ways. It is essential to be aware of your disease and the way it shall impact your body to understand and cope with it in a better way.

Either way, the treatment options mentioned above, along with a positive mindset, are the fundamental factors that will ultimately help you win the battle over testicular cancer.