The cells that produce sperm are known as germ cells, and this is where 90 per cent of testicle cancer tumours develop. There are two testicle cancer types of germ cell tumours:
Seminomas type of testicle cancer grows and spreads slowly. It has two subtypes:
- Classic Seminoma – Most testicle 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 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.
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 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.
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.
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.
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.
– Doctors usually use the TNM (Tumour, Lymph node, Metastasise) staging tool for cancer staging to describe the extent of cancer present in the body. In testicular cancer staging ‘S’ level is also checked for serum marker level.
– At stage 0, testicular cancer has not spread from its original location.
– At stage I, cancer is only present in the testis and has not spread to nearby lymph nodes.
– At stage II, cancer starts invading the nearby lymph nodes, and at stage 3, testicular cancer spreads out to the lungs, brain, liver etc.
– The cells that produce sperm are known as germ cells where 90 per cent of the testicular cancer tumours develop. The two types of germ cell tumours are seminomas and nonseminomas.
– While seminomas type of testicular cancers grow and spread slowly, nonseminomas spread rapidly and contain more than one type of cancer cell.
– Stromal tumours start in the hormone-producing tissues of the testicles and are also known as gonadal stromal tumours. These types of tumours are rare and often benign (harmless).
– Testicular cancer can be tested by using physical body examinations, CT scans, ultrasounds, blood tests and a surgical procedure known as orchiectomy.
Consult an oncologist on MFine to understand the different stages and types of Testicular cancer