Testicular Cancer
Comprehensive care for testicular cancer including surgery (orchiectomy), chemotherapy, radiation therapy, and surveillance protocols.
Testicular Cancer
Solid Tumors
Overview
Testicular cancer is a highly curable malignancy that originates in the testicles, the male reproductive glands located inside the scrotum that produce sperm and testosterone. Although it is relatively rare overall, it is the most common cancer diagnosed in young men between the ages of 15 and 35. The vast majority (over 95%) of testicular cancers are Germ Cell Tumors (GCTs), which develop from the cells that produce sperm.
GCTs are divided into two main histological types: Seminomas, which grow and spread more slowly and are highly sensitive to radiation and chemotherapy ; and Non-Seminomas, which tend to grow rapidly, affect younger men, and contain multiple cell types (embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma). Teratomas are unique because they are resistant to chemotherapy and must be surgically removed. The most common symptom of testicular cancer is a painless lump, hard nodule, or swelling in one testicle, often noticed by the patient during self-examination.
Other symptoms include a feeling of heaviness or aching in the scrotum or lower abdomen, breast tenderness or enlargement (gynecomastia) caused by hormone-secreting tumors, and back pain or shortness of breath in advanced stages due to metastatic spread to retroperitoneal lymph nodes or lungs. Testicular cancer has a predictable pattern of lymphatic spread, moving from the testicles up the spermatic cord to the retroperitoneal lymph nodes in the back of the abdomen.
When to Consult
Upon detection of testicular lump, pain, swelling, heaviness, or confirmed testicular cancer diagnosis.
What to Bring
Ultrasound reports, biopsy results, tumor marker tests (AFP, HCG, LDH), CT scans of chest/abdomen/pelvis, and surgical history.
Risk Factors
Causes
Treatment Options
Radical Inguinal Orchiectomy
Radical Inguinal Orchiectomy is the definitive diagnostic and primary therapeutic surgery for all suspected testicular cancers. The procedure involves making an incision in the groin (inguinal region) and removing the entire affected testicle and the spermatic cord up to the internal inguinal ring. A transscrotal approach is avoided to prevent altering the lymphatic drainage of the tumor. During the procedure, a testicular prosthesis can be inserted into the scrotum for cosmetic restoration if desired. Removal of one testicle does not typically affect long-term fertility or testosterone production, provided the remaining testicle is healthy, though semen banking is routinely offered before treatment.
Surveillance Protocols
For patients diagnosed with Stage I seminoma or non-seminoma (where the cancer is confined to the testicle and tumor markers normalize after surgery), Surveillance is the preferred management option. Rather than undergoing immediate chemotherapy , radiation, or additional surgery, patients are monitored closely with regular physical exams, serum tumor marker tests, and chest/abdominal CT scans according to a strict schedule for 5 to 10 years. If the cancer recurs (which occurs in about 15-20% of cases), it is almost always detected early and cured with standard chemotherapy . Surveillance avoids the toxicities of unnecessary active treatments.
Systemic Cisplatin-Based Chemotherapy
Testicular cancer is exceptionally sensitive to chemotherapy , which is the cornerstone of treatment for advanced or metastatic disease, and as adjuvant therapy for high-risk Stage I cases. The standard first-line regimen is BEP, combining Bleomycin, Etoposide, and Cisplatin, typically administered in 3 or 4 cycles depending on the patient's risk group (Good, Intermediate, or Poor Risk according to IGCCCG classification). For patients with contraindications to bleomycin (due to risk of pulmonary toxicity), the EP (Etoposide and Cisplatin) doublet is used. Salvage regimens like VIP, TIP, or high-dose chemotherapy with autologous stem cell transplant are used for relapsed cases.
Retroperitoneal Lymph Node Dissection (RPLND)
Retroperitoneal Lymph Node Dissection (RPLND) is a complex surgical procedure to remove the lymph nodes in the back of the abdomen. For Stage I or II non-seminomas, RPLND can be used as a primary treatment option to remove microscopic disease and provide accurate staging. In advanced non-seminomas, RPLND is routinely performed to remove residual masses (>1 cm) that remain after chemotherapy . These residual masses often contain benign teratoma (which is resistant to chemotherapy but can grow and undergo malignant transformation) or active cancer. Modern RPLND utilizes nerve-sparing techniques to preserve the sympathetic nerves responsible for ejaculation.
Adjuvant Radiation Therapy
Radiation therapy is an adjuvant treatment option for patients with Stage I or II seminoma, which is highly radiosensitive. Following radical orchiectomy, low-dose External Beam Radiation Therapy (EBRT) can be delivered to the para-aortic lymph nodes in the abdomen to destroy any microscopic cancer cells and prevent recurrence. However, due to the long-term risk of secondary malignancies and cardiovascular disease associated with radiation, adjuvant chemotherapy (a single dose of Carboplatin) or active surveillance has increasingly replaced radiation for Stage I seminoma, keeping radiation as a targeted option for Stage II nodal disease.
Frequently Asked Questions
Q. What is the most effective treatment for Testicular Cancer?
The most effective treatment for Testicular Cancer depends on the stage, location, molecular profile of the tumor, and the patient's overall health. Dr. R. Srinath Bharadwaj provides personalized protocols including chemotherapy , immunotherapy , targeted therapy , or combination approaches.
Q. Where can I get expert treatment for Testicular Cancer in Hyderabad?
You can consult Dr. R. Srinath Bharadwaj, a leading Medical Oncologist, at the American Oncology Institute, Nallagandla, Hyderabad. Call +91 91213 36638 to schedule an appointment.
Q. What documents should I bring for a Testicular Cancer consultation?
Please bring all recent biopsy reports, imaging scans (CT, MRI, or PET-CT), tumor markers, blood test results, and any previous treatment or surgery details to help outline your care plan.