What is Testicular Seminoma?
Testicular cancers are a variety of types that start from different cells in the testicles. These include seminomas, non-seminomas, Leydig, Sertoli, choriocarcinoma, embryonal, teratoma, and yolk-sac-based cancers. The most common types often seen together are seminoma and non-seminomas, typically known as germ cell tumors. These are known to respond well to chemotherapy compared to other types of testicular cancers. Seminoma composes about one-third of all testicular germ cell cancers and is highly treatable. In its early stages, the survival rate ranges between 98% and 99%.
Even though testicular germ cell tumors are not very common, making up only 1% to 2% of all male cancers, it is the most common cancer in males aged between 15 and 35 years.
What Causes Testicular Seminoma?
We aren’t exactly sure what causes seminoma, a type of testicular cancer. One theory suggests that chemicals in the environment that disrupt hormone activity could play a role. These chemicals might have effects similar to estrogen or might oppose the action of male hormones, leading to stalled development of certain cells in the testicles. This could potentially result in seminoma, which is believed to originate in the womb as a form of pre-cancer.
Testicular dysgenesis syndrome (TDS) is an idea that explains the links between several testicular conditions. TDS includes germ cell tumors (which include seminomas), impaired sperm production, undescended testicles (cryptorchism), and a malformation of the urethra called hypospadias. These conditions all seem to have common risk factors suggesting they might originate during fetal life. The incidence of testicular cancer has reportedly increased over the past decades.
About 10% of patients with germ cell tumors have a history of undescended testicles. These patients have four times the risk of developing cancer than those with normally descended testicles. The age at which the undescended condition is corrected doesn’t affect this elevated risk.
Trisomy 21, commonly known as Down syndrome, is associated with an even greater risk: those with this condition are 50 times more likely to develop testicular cancer. Genetic studies have found evidence suggesting a gene related to testicular cancer might be inherited. In a Japanese population, this link was found to be associated with a specific gene (HLA class II allele DRB1*0410). A UK research found a connection with a different gene (a specific form of the GSTP1 gene) and the expansion of a specific genetic sequence referred to as (CAG)n repeats.
Risk Factors and Frequency for Testicular Seminoma
Testicular germ cell tumors (GCT) are the most common type of solid cancer found in young men between the ages of 15 and 45. These tumors are ten times more common in men of Northern European descent, and five times more common in white males, compared to those from other backgrounds. The number of cases of seminoma, a type of testicular cancer, typically rises as men get older.
Signs and Symptoms of Testicular Seminoma
Typically, someone with testicular cancer will notice a lump in their testicle that doesn’t cause any pain. This might even be associated with infertility. Even though pain in the testicle due to cancer is relatively rare, it’s still important to consider it as a possible cause.
Upon a physical examination, doctors usually find a hard lump on one side within the scrotum. Sometimes, this lump might be hard to feel because of a condition known as hydrocele, which is an accumulation of fluid in the scrotum. If this happens, an ultrasound might be required to spot the lump. In rare cases, this cancer can spread and cause swelling in the lymph nodes located in the chest area and behind the abdomen. Interestingly, an individual might have a significant spread of the disease even if the testicular cancer is too small to feel.
An ultrasound of the testicles commonly shows a mass within the testicle that appears darker and uniform in comparison to the surrounding healthy tissue. As this lump grows larger, it might become less uniform because of tissue death and internal bleeding.
Testing for Testicular Seminoma
The initial checkup for testicular cancer typically involves an ultrasound scan of the testicles. A further detailed scan known as a CT scan (computed tomography) of the abdomen and pelvis is done for staging, which means understanding the size and spread of the cancer. However, this method might miss cancer that has spread to the lymph nodes behind the stomach and intestines in about 15 to 20% of cases.
A chest CT scan, which checks if the cancer has spread to the lungs or not, is usually suggested only when there’s something unusual in a primary chest x-ray. PET scans (positron emission tomography), which show how tissues and organs are functioning, aren’t usually part of the initial tests, but may be helpful in monitoring activity and growth in leftover masses after chemotherapy treatment.
Your doctor might track the growth of your tumor by frequently checking certain substances in your blood. These include AFP (alpha-fetoprotein), B-HCG (Beta-human chorionic gonadotropin), and LDH (lactate dehydrogenase). AFP is an indicator of nonseminomatous (a type of aggressive testicular cancer) disease. If your AFP is high, this means you have some nonseminomatous cancer and will be treated accordingly.
LDH is used to monitor seminomatous (a type of slow-growing testicular cancer) tumor growth. B-HCG is found in about 5 to 10% of seminoma patients and is usually linked with the spread of cancer to other parts of the body – but having high levels of B-HCG doesn’t necessarily mean you won’t survive the disease.
As stated earlier, a basic chest x-ray may show whether the disease has spread to the lungs or not. A chest CT scan is only done when there’s something unusual in the basic chest x-ray. Ultrasound scans are typically most useful for monitoring the spread of the disease after treatment.
Treatment Options for Testicular Seminoma
For patients diagnosed with testicular cancer, there are several treatment options available. However, the most common treatment is surgery, specifically an operation called a radical orchiectomy. During this surgery, the surgeon makes an incision in the groin and removes the entire affected testicle along with most of the connecting spermatic cord. This procedure not only treats the cancer but also helps to determine how advanced the cancer is.
It’s important to note that a scrotal incision, which is an incision in the sac that holds the testicles, is typically avoided if cancer is suspected. This is to prevent the potential spread of cancer cells.
For early-stage testicular cancer (Stage 1), patients may be treated with a type of chemotherapy medication called carboplatin. For more advanced stages of the disease, other chemotherapy drugs such as bleomycin, etoposide, and cisplatin – either alone or in combination – may be used.
Most men do not experience a significant decrease in testosterone levels or sexual dysfunction after the removal of one testicle. The surgery usually does not lead to infertility, especially considering that about a quarter of men with testicular cancer are already infertile before they are diagnosed. Interestingly, some men may even see an increase in sperm counts after the removal of the cancerous testicle.
If a testicle has been removed, men have the choice to have reconstructive surgery where a prosthetic testicle can be inserted. This can be done at the time of the initial operation, delayed until after other treatments, or declined altogether.
Moreover, there is a more complex and invasive procedure known as a retroperitoneal lymph node dissection, which involves removing lymph nodes from the abdomen to help determine the stage of the cancer. While this procedure can now be done laparoscopically (a less invasive surgical technique), it carries risks of complications like infections, bowel blockage, and loss of the ability to ejaculate. Therefore, this procedure is rarely used for a type of testicular cancer called seminoma, unless there are growing abdominal masses that are not responding to other treatments. In cases where the cancer has spread to the lymph nodes, radiation or chemotherapy is generally the preferred approach.
What else can Testicular Seminoma be?
The following conditions could also be considered when diagnosing your symptoms:
- Other germ-cell tumors
- Testicular dermoid
- Trauma
- Metastatic disease
Surgical Treatment of Testicular Seminoma
The National Cancer Institute (NCI) is conducting a Phase III clinical trial, referred to as ‘Retroperitoneal Lymph Node Dissection’. In simple terms, this is a medical study aiming to understand how best to treat patients experiencing swelling of the lymph nodes in the abdomen (lymphadenopathy) due to a particular type of testicle cancer known as Testicular Seminoma. This study includes those in the early to moderate stages of the disease, specifically stages I to IIB.
Similarly, the Sloan Kettering Institute is running a Phase I/II clinical trial. This study involves testing a medical cream called ‘Topical SOR007’. It’s being tested on people who have skin metastases from cancer – meaning cancer that has spread to their skin from another part of the body.
What to expect with Testicular Seminoma
The Testicular Cancer Society has stated that the overall survival rate for testicular cancer is above 95%. If the cancer is detected early while it is still only in the testicle, the survival rate increases to 99%. If the cancer spreads to the surrounding lymph nodes, the survival rate is still a high 96%. Even in cases where the cancer has spread to distant parts of the body, the survival rate is over 70%.
Possible Complications When Diagnosed with Testicular Seminoma
Surgery: The process of removing the testicle (orchiectomy) due to cancer can possibly result in a condition known as retrograde ejaculation. However, it is important to note that not all patients face issues with fertility. In fact, the number of sperm could actually increase after the problematic testicle is removed.
Here are some potential consequences of radiation therapy and chemotherapy:
- Anemia: This is a condition marked by a deficiency of red cells or of hemoglobin in the blood.
- Compromised immune system: This means the body’s defense system may be weakened.
- Hair loss: It’s possible that patients could lose hair as a result of these treatments.
If the cancer is not treated completely and is allowed to spread, it can lead to serious complications such as extensive bleeding, which can be life threatening. The most common areas where the cancer could spread include the lungs, lymph nodes, liver, and bones.
Recovery from Testicular Seminoma
Reconstructive surgery to include a prosthetic testicle is a possibility that can be considered. This procedure can be either done after all active treatments have been finished or not done at all, depending on the patient’s preference.
Preventing Testicular Seminoma
Research indicates that TGCT (Testicular Germ Cell Tumors) might start early in life. Thus, it’s key to avoid contact with persistent organic pesticides during pregnancy or while breastfeeding to prevent possible exposure. Persistent organic pesticides are chemicals used in pest control that can remain in the environment for a long time and may lead to harmful effects on health.
There is no specific guideline currently established for screening for testicular cancer. However, it’s important for young men to learn how to conduct a testicular self-examination. This education should also inform them of the high success rate when the disease is detected and treated early. Interestingly, more than half of the hard, noticeable lumps within the testicles (intratesticular masses) are found to be non-germ cell tumors, which means they do not originate from the reproductive cells in the testicles.
