Transcript of Video
I’m Dr. Russell Libby with Northwoods Urology of Texas and today we’re gonna be talking about testicular cancer. Testicular cancer is cancer of the testes. And in men, we can see this in a variety of ages. It actually has what we call a bi-modal age distribution, where very young men and their teens can get it versus men in their fifties and sixties.
Often, these are caused by different types of testicular cancer, but we’re gonna give a general overview today about what to kinda look for and what treatment options that are available. Men often come to see me and they have on a exam at home. I felt something abnormal or their primary care physician sent them over to me with an abnormal mass on their testicle. We typically follow this up with a scrotal ultrasound that can further characterize the detail of the testicle and see if there’s a mass within it. Certainly if we do find a mass, then we work that up further. In clinic, I’ll do a complete history and physical. See if you’ve had any things in your past that may put you at risk for testicular cancer.
Some of those things may be a failure of a testicular to descend at an early age versus having a cancer in the other testicle at some other point in your life. That would put you at increased risk for testicular cancer. So after we would work you up with a scrotal ultrasound to get better imaging, if we found a mass, then we’d send tumor markers, including an alpha-fetoprotein, a lactate dehydrogenase, as well as a beta-hCG. These are the most common tumor markers found in testicular cancer and we would send these as a blood test.
Some of the chemotherapies that we use in the treatment for testicular cancer, as well as the surgeries that we do to help cure node positivity can take away a man’s fertility. Is important that early on you bank sperm. That way that you know you have access to sperm should you desire to become pregnant later on after your treatment. If we did find that we were suspicious for testicular cancer, the first thing that we would do is surgically remove the testicle in a procedure called a radical inguinal orchiectomy.
In that procedure, we would make an incision in your groin and we would remove the testicle as well as the spermatic cord. After removing the testicle and the spermatic cord, you have to wait for the pathologist to come back and render a diagnosis. And at that point, he can tell you what kind of testicular cancer you have. And testicular cancer comes in multiple shapes and sizes and varieties. And we can really divide testicular cancer into two most common types other than a metastatic lesion.
So the most common kind of testicular cancer in an older individual, say in their sixties or seventies, is actually lymphoma. But if it’s a primary testicular cancer, meaning it’s cancer that originates from the testicle, we divide that into two categories, seminoma and non-seminoma. Seminoma is by far the most common type of testicular cancer. And it’s one that carries a very good risk in terms of prognosis and treatment.
So as we go down the path of what we decide ultimately needs to happen in terms of treatment for the testicular cancer, we rely on those labs and the pathology from the specimen that we sent off during the surgery. In addition to surgery and tumor markers, we would need to get additional imaging, including a chest x-ray and a CT scan of the abdomen and pelvis with contrast to assess for any kind of lymph node involvement with the testicular cancer. If the tumor markers are elevated or there’s node positivity on the CT scan, then that would change the way you’re treated.
In terms of seminoma, there’s chemotherapies that can be used to treat disease in the retroperitoneum as well as radiation. When it comes to non-seminoma, the treatment options are typically chemotherapy versus surgery. And depending on the severity of your disease with both seminoma and non-seminoma, this would dictate your treatment.
If you think that you may have a mass on your testicle that needs to be worked up further, you should definitely see a urologist and come see me at Northwoods Urology of Texas. You can visit us online or call and make an appointment today.