Q. How common is testicular cancer?

A. In 2000 (the last year for which figures are available) there were 2,000 new cases of testicular cancer diagnosed in the UK. In the USA, it is estimated that there will be 9,000 new cases diagnosed in 2004. This means it is between 1% and 2% of all cancers in men. The number of cases has been slowly increasing for some time.

 

Q. What causes testicular cancer?

A. We do not yet understand what causes this type of cancer.

 

Q. What are the risk factors for testicular cancer?

A. Unlike most cancers, testicular cancer does not get more common as you get older. Most cases occur in men aged between 25 and 45, with very few cases in men over 75. This type of cancer is most common in white Caucasian males. Men of other races have a much lower incidence, even when living in the same county. The only exception to this is the New Zealand Maoris, who have a high rate of testicular cancer. Within Europe, this cancer is up to five times as common in some northern countries (e.g. Denmark, Sweden and UK) than in many southern countries (Italy, Spain and Greece).

Babies born with undescended testicles are known to have a 5 to 10 times higher risk of testicular cancer. There are a few medical conditions, which if present during childhood, also increase the risk. These include an inguinal hernia, mumps infection of the testicles and testicular torsion. Having a vasectomy does not increase the risk of testicular cancer.

 

Q. Are there different types of testicular cancer?

A. The vast majority of testicular tumours are called germ-cell tumours. There are two main types of germ cell tumour seminomas and teratomas. Younger patients are more likely to have seminomas and older patients to have teratomas.

 

Q. How dangerous are testicular cancers?

A. There are relatively few deaths from testicular cancer, because it is one of the easiest to cure. In the year 2002, only 74 men died of this cancer in the UK and, in the USA only 360 are expected to die in 2004. This means it is a very rare cause of death.

 

Q. Does the diet affect the risk of testicular cancer?

A. There is no evidence that diet affects the risk of getting testicular cancer.

 

Q. Does testicular cancer run in families?

A. Research has found that an increased risk of testicular cancer can run in families. If you have a brother with testicular cancer, you are between 6 and 10 times more likely to get it than normal. If your father had it, you are 3 or 4 times more likely than normal to also suffer from it.

 

Q. What are the symptoms of testicular cancer?

A. The most common symptom of testicular cancer is a painless swelling or lump in one of the testicles. Other, less common, symptoms include enlargement of a testicle, a pain in one testicle and an ache in the lower stomach.

 

Q. Is there screening for testicular cancer?

A. Men can screen themselves by feeling for lumps in their testicles. Men between 25 and 45 should do this every few months. If a lump is found on one testicle, check the other one to see if the same lump is present. If there are similar lumps on both, then it is almost certainly a normal part of the testicles. If the lump is only on one testicle, you should consult your doctor.

 

Q. How is testicular cancer diagnosed?

A. First, your family doctor will check your testicles and, if there is any cause for concern, he will refer you to a specialist. An ultrasound scan of the testicles is used to check for any growths. If any are found, an operation is performed to take a tissue sample from the lump. This is examined by a pathologist, to determine if the lump is cancerous or not. Blood test will also be done to check the levels of HCG (human chorionic gonadotrophin) and AFP (alpha fetoprotein), which indicate how advanced the cancer is.

 

Q. How is testicular cancer treated?

A. The exact treatment used will depend on the type of testicular cancer and how advanced it is. An operation to remove the affected testicle is normal in all cases. The loss of one testicle does not affect a man's ability to have an erection or father children and an artificial testicle can be put in the scrotum to restore a normal appearance. If the cancer has gone beyond the testicle, radiotherapy or chemotherapy are also used. Radiotherapy is more effective for seminomas. Chemotherapy is used for both types of testicular cancer, even if it has not spread. In advanced cases, chemotherapy is given at a very high dose, which kills not only the cancer cells but also the bone marrow cells as well. However, the patient is given a stem cell or bone marrow infusion to restore the bone marrow cells.

 

Q. What are the side-effects of treatment?

A. Radiotherapy can cause nausea, tiredness and diarrhoea. However, these are not severe and can be helped or prevented by drugs. Chemotherapy can cause loss of appetite, tiredness, ringing in the ears, shortness of breath, nausea, vomiting, mouth ulcers, infections, kidney problems and hair loss. The higher the dosage, the more severe the side effects. Patients on high-dose chemotherapy are monitored carefully by their doctors.

 

Q. How effective are the treatments?

A. The current treatments are very effective. If the tumour is diagnosed early, a complete cure is achieved in nearly 95% of cases. The later tumours are more difficult to treat, but even in advanced testicular cancer over 50% of pateints are cured. For these figures, a complete cure is defined as surviving ten years after the first diagnosis.

 

Q. Is early diagnosis important?

As with all cancers, the earlier the diagnosis, the easier the cancer is to cure.