Types of testicular cancer:

About 90% of all testicular cancer arises from germ cells in your testicles that clump together to form a mass or tumor. Germ cells eventually develop into sperm. The most common types of testicular cancer include:

• Seminoma. Seminoma testicular cancers tend to happen at an older age. Seminomas often grow and spread more slowly than nonseminomas.
• Nonseminoma. Nonseminoma testicular cancers tend to happen earlier in life. They grow and spread quickly. Several types of nonseminomas exist. They include choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumor.

Other types of testicular cancer exist, but they are very rare.

• Symptoms:

Signs and symptoms of testicular cancer include:

• A lump or swelling in either testicle
• A feeling of heaviness in the scrotum
• A dull ache in the lower belly or groin
• Sudden swelling in the scrotum
• Pain or discomfort in a testicle or the scrotum
• Back pain

Usually testicular cancer only happens in one testicle.

• Risk factors:

Factors that may increase your risk of testicular cancer include:

• Having an undescended testicle, which is called cryptorchidism. The testes form in the belly during fetal development. They typically descend into the scrotum before birth. If you have a testicle that never descended, your risk of testicular cancer is higher.

• Age: Testicular cancer most commonly affects people between ages 15 and 35.
• Race and ethnicity: Testicular cancer is more common among non-Hispanic whites in the United States and Europe.
• Personal or family history: You may be more likely to develop testicular cancer if a biological parent or sibling had it. Certain inherited genetic conditions, like Klinefelter Syndrome, may also increase your risk. Having testicular cancer in one testicle increases your likelihood of developing a second cancer in the other testicle.
• Infertility: Some of the same factors that cause infertility may also be related to the development of testicular cancer. More research is needed to understand the connection.

• Diagnosis:

Your provider may diagnose testicular cancer after investigating a lump or other change in your testicle you found during a self-exam. Sometimes testicular cancer gets diagnosed during a routine physical exam.

Common procedures and tests to help diagnose testicular cancer include:

• A physical exam and history: Your provider will ask about your symptoms and examine you closely to check for signs of testicular cancer. They may feel your testicles for lumps and inspect your lymph nodes for signs of cancer spread.
• Ultrasound: If your provider notices an abnormality during the exam, they’ll likely order an ultrasound. An ultrasound is a painless medical procedure that uses high-energy sound waves to create pictures of tissue inside your body.
• Inguinal orchiectomy and biopsy: If the ultrasound shows evidence of cancer, your provider will remove the affected testicle through an incision (cut) in your groin. A specialist will examine tissue from your testicle using a microscope to check for cancer cells.

• A serum tumor marker test: This procedure examines a blood sample to measure the amounts of certain substances linked to specific types of cancers. These substances are called tumor markers. The tumor markers that are often elevated in testicular cancer are alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG or beta-HCG) and lactate dehydrogenase (LDH). Different types of tumors elevate different markers. For example, seminomas sometimes raise HCG but not AFP. Non-seminomas may raise AFP but not HCG. Elevated LDH levels may indicate cancer spread.
• CT scans, X-rays and MRIs: A CT scan (or CAT scan) uses X-rays to form pictures of the inside of your body. Your provider may perform a CT scan of your abdomen and pelvis to see if your cancer’s spread to your abdominal organs. They may order a CT scan or standard X-ray to see if cancer’s spread to your lungs. If your provider suspects cancer has spread to your central nervous system (brain and spinal cord), you may get an MRI. An MRI uses magnets and radio waves to form pictures of the inside of your body.
• PET scan: Uses a special kind of sugar that can be seen inside your body with a special camera. If there’s cancer, this sugar shows up as “hot spots” where the cancer is found. This test can help show if the cancer has spread.

The stages of testicular cancer range from 1 to 3. In general, stage 1 cancers only affect the testicle and the area around it. At this early stage, the cancer hasn't spread to the lymph nodes or other parts of the body. Stage 2 testicular cancers have spread to the lymph nodes. When testicular cancer spreads to other parts of the body, it is stage 3. Not all stage 3 cancers have spread though. Stage 3 can also mean that the cancer is in the lymph nodes and the tumor marker results are very high.

• Treatment:

Testicular cancer treatment often involves surgery and chemotherapy. Which treatment options are best for you depends on the type of testicular cancer you have and its stage. Your health care team also considers your overall health and your preferences.

Treatment depends on several factors, including your health, treatment preferences, cancer stage, and tumor type. Seminomas tend to grow more slowly and respond better to radiation therapy than non-seminomas. Both kinds of testicular cancer tumors respond well to chemotherapy treatments.

Surgery:

Surgery to remove the cancerous testicle is the most common treatment for testicular cancer, regardless of cancer stage or tumor type. In some cases, your provider may also remove your lymph nodes.

• Radical inguinal orchiectomy: Your provider may perform orchiectomy (removing the testicle) to treat both seminoma and non-seminoma testicular cancers. During the procedure, your provider will make an incision into your groin to remove the testicle with the tumor. They’ll also close off blood vessels and lymphatic tissue to prevent the spread of cancer from the tumor site to the rest of your body.
• Retroperitoneal lymph node dissection (RPLND): Your provider may perform retroperitoneal lymph node dissection depending on your cancer’s stage and the tumor type. RPLND is more common with non-seminoma testicular cancers. During the procedure, your provider makes an incision into your abdomen and removes the lymph nodes behind your abdominal organs. RPLND may be used to treat cancer and may also be used for cancer staging.

Chemotherapy:

Chemotherapy treatment uses strong medicines to kill cancer cells. Chemotherapy travels throughout the body. It can kill cancer cells that may have spread beyond the testicle.

Chemotherapy has improved the survival rate for people with both seminomas and non-seminomas. Chemotherapy is often used after surgery. It can help kill any cancer cells that are still in the body. When testicular cancer is very advanced, sometimes chemotherapy is used before surgery. Chemotherapy may also be used to treat cancer that’s returned (recurred) following remission.

Chemotherapy also may cause your body to stop making sperm. Often, sperm production starts again as you get better after cancer treatment. But sometimes losing sperm production is permanent. Ask your health care provider about your options for preserving your sperm before chemotherapy.

Radiation therapy:

Radiation therapy is sometimes used to treat the seminoma type of testicular cancer. Radiation therapy may be recommended after surgery to remove your testicle.

Radiation therapy typically isn't used to treat the non-seminoma type of testicular cancer.

Immunotherapy:

Immunotherapy is treatment with medicine that helps your body's immune system kill cancer cells. Your immune system fights off diseases by attacking germs and other cells that shouldn't be in your body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. Immunotherapy is sometimes used for advanced testicular cancer. It might be an option if the cancer doesn't respond to other treatments.

Testicular cancer care at Shefa-El Orman:

At the hospital, urologists, oncologists, radiation oncologists, pathologists, and radiologists work as a multidisciplinary team to provide comprehensive care for people with testicular cancer. Other professionals, such as fertility preservation experts, are consulted as needed to provide exactly the care you need.

Doctors at Shefa-El Orman evaluate and care for more than 400 people with testicular cancer each year. This includes adults, young adults and children. Our specialists are deeply experienced not just in one specific aspect of the disease but across all the specialties involved testicular cancer care.

Our urologic surgeons have advanced training in urologic cancers, including testicular cancer, and are experienced with surgical techniques designed to avoid injury to crucial nerves needed to retain fertility. Your care team is extensively trained and prepared with the knowledge and resources to provide you with exactly the care you need.

When you receive testicular cancer treatment at Shefa-El Orman, you have access to:

• Advanced radiation therapy methods, including intensity-modulated radiation therapy and proton therapy
• Minimally invasive surgery techniques, such as robotic retroperitoneal lymph node dissection
• Carefully selected systemic therapy, including chemotherapy and immunotherapy treatments that consider the specifics of your cancer
• Access to a full range of treatment options, including surgery, radiation therapy, chemotherapy and immunotherapy

• Diagnosis and surgery:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• urological examination
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• inflammation indicators (CRP, ESR)
• indicators blood coagulation
• tumor marker (AFP, B HCG, LDH)
• testicular ultrasound, CT/ MRI Scans (if indicated clinically)
• preoperative care
• Operative:
• Orchidectomy with prosthetics

• radical orchidectomy

• histologically and immunohistochemically examination of the excised tissues
• symptomatic treatment
• control examinations
• the cost of essential medicines and materials
• nursing services
• full hospital accommodation
• explanation of future recommendations

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: Inpatient

Expected duration of the program: 8 days

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• Chemotherapy:

 The program includes:

• Initial presentation in the clinic
• clinical history taking
• analysis of medical records
• physical examination
• laboratory tests:

• complete blood count
• biochemical analysis of blood
• tumor markers
• inflammation indicators
• indicators of blood coagulation
• ultrasound scan of the abdomen (if indicated).
• CT / MRI scans (if indicated).
• 1 course of chemotherapy
• consultations of related specialists
• symptomatic and specific treatment
• the cost of essential medicines and materials
• nursing services
• control examinations
• full hospital accommodation
• recommendations for further treatment

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy is carried out as the inpatient procedure or outpatient according to chemotherapy protocol type. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. After the completion of the chemotherapy course and control examinations you will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results
• Any recent laboratory results.

Price from: On request (regarding chemotherapy protocol)

Type of program: Inpatient or outpatient (regarding chemotherapy protocol)

Expected duration of the program: from 1 to 4 days per cycle (regarding chemotherapy protocol)

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• Radiotherapy

Treating testicular cancer with different modalities according to treatment plane that will be explained by the treating physician that may include:

• IMRT
• 3D

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• urological examination
• CT /MRI or ultrasound pelvic (if indicated clinically)
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• inflammation indicators (CRP, ESR)
• indicators blood coagulation
• tumor marker
• CT planning of radiation therapy
• Physics calculation
• A full course of intensity-modulated radiation therapy (IMRT) or 3D radiotherapy or brachytherapy and treatment plan will be explained by your treating physician.
• symptomatic treatment
• the cost of essential medicines and materials (needed for fixation during radiotherapy)
• nursing services
• control examinations
• consultation of related specialists

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: Outpatient

Expected duration of the program: 39 days