Interview with Dr. Mohammad Pouri (Urologist and Uro-Oncology Fellow at Tehran University of Medical Sciences)

How Common Is Testicular Cancer?

Testicular cancer is relatively rare in men. One of the times it can appear is during infancy. However, the risk increases between the ages of 30 and 40, and another peak occurs after the age of 65-70.

Although the overall risk is low, testicular cancer is one of the more common malignancies in younger men. Fortunately, with modern chemotherapy and surgical techniques, survival rates have significantly improved. It is now considered a highly treatable cancer. However, because it grows rapidly, early detection and close monitoring are crucial.

What Are the Known Risk Factors?

Several factors can increase the likelihood of developing testicular cancer, including:

• Undescended testicle (cryptorchidism): Men with this condition are six times more likely to develop testicular cancer. Parents of children with undescended testicles should seek medical care as early as possible. If treated before age 18, the risk is almost eliminated. However, corrective surgery performed closer to puberty may still increase the risk by 2-3 times compared to the general population.
• Personal history of testicular cancer: Men who have had cancer in one testicle are 12 times more likely to develop it in the other testicle. Regular follow-ups are essential.
• Family history of testicular cancer:
  • If the father has had testicular cancer, the risk increases by 2-4 times.
  • If a brother has had it, the risk is eight times higher.
• Acquired risk factors:
  • Testicular trauma
  • Recurrent infections
  • Maternal estrogen use during pregnancy
• Infertility: Infertile men have a higher risk.
• Testicular atrophy: A smaller-than-normal testicle is linked to a higher likelihood of developing cancer.
• Microlithiasis (tiny calcifications seen in ultrasound): By itself, it is not considered a risk factor, but in individuals with a history of testicular cancer, it may indicate a higher chance of recurrence. Many patients worry when this is mentioned in an ultrasound report, but further evaluation is necessary to determine any real risk.

What Are the Most Common Symptoms of Testicular Cancer?

• Painless testicular enlargement is the most frequent symptom. Because it is painless, many patients delay seeing a doctor.
• Pain in the testicle occurs in about 10% of cases, usually due to internal bleeding or infection.
• No symptoms at all: Around 10% of cases are found incidentally during ultrasound scans performed for other reasons.
• Hydrocele (fluid accumulation around the testicle): Sometimes associated with testicular cancer, requiring further evaluation.
• Recurrent testicular infections: If the testicle becomes persistently firm, an ultrasound is necessary—antibiotics alone may not be enough.
• Back pain: Reported in 15-20% of cases due to lymph node involvement.
• Other symptoms:
  • Cough, shortness of breath, loss of appetite, bone pain, leg swelling
  • Gynecomastia (enlarged breasts)

Self-examinations are highly recommended, as they can help detect abnormalities early, such as firm lumps or generalized swelling of the testicle.

How Is Testicular Cancer Diagnosed?

Diagnosis typically involves:

1. Ultrasound: The first-line imaging test for any testicular abnormality.
2. Tumor markers: Blood tests to measure specific cancer-related proteins.
3. Chest X-ray: Since testicular cancer commonly spreads to the lungs, imaging is necessary.
4. Surgical removal of the testicle (orchiectomy): The primary treatment and diagnostic procedure.
5. CT scan of the abdomen and pelvis: Essential before and after surgery to assess lymph node involvement.

Why Is Sperm Banking Important?

While removing one testicle does not cause infertility, many patients require chemotherapy or radiation afterward, which can significantly reduce or temporarily eliminate sperm production. Though sperm count may recover within 2-5 years, sperm banking before treatment is strongly recommended to preserve fertility.

What Are the Most Common Sites of Metastasis?

• Lungs: Leading to symptoms like shortness of breath and cough.
• Liver, kidneys, adrenal glands, and bone marrow may also be affected.

How Is Testicular Cancer Staged?

Testicular cancer is classified into three stages:

• Stage 1: Cancer is confined to the testicle.
• Stage 2: Cancer has spread to nearby lymph nodes in the abdomen or pelvis.
• Stage 3: The disease has metastasized to distant organs.

Early diagnosis and timely treatment significantly improve survival rates, highlighting the importance of awareness and regular self-examinations.