Is there a change in your testicle? Let's learn about Seminoma?

Have you ever noticed something strange, like a small lump, when you look at or feel your testicles? Or do you just feel a heaviness or a slight pain in the lower abdomen? You may not pay much attention to these things. However, we should be a little concerned about such small changes. Today we are going to talk about a disease that can start with such a change, but can be cured if recognized early. That is seminoma.

What is Seminoma? Is it cancer?

Simply put, a seminoma is a germ cell tumor . It usually develops in one or both of your testicles. This means it is a type of testicular cancer. A man's sperm is made from these germ cells. So yes, a seminoma is a cancer.

Hearing this name can be a bit scary. That's normal. But the good news is that seminoma is a cancer that can often be cured. If treated properly, it has a very good chance of saving your life.

Sometimes, surgical removal of the affected testicle may be necessary as a treatment. However, this usually does not affect your ability to have sex, be fertile, or have children. If both testicles are removed, you can still have sex. If you want to have a child, you can use sperm banking or assisted reproductive techniques such as IVF (In Vitro Fertilization).

In addition to the testicles, seminomas can very rarely develop in other parts of the body. For example:

• The space in your chest where your heart is (mediastinum).
• The area behind the abdomen, where the kidneys are located, is called the ``retroperitoneum``.

What are the main types of seminoma?

There are two main subtypes of seminoma. Let's take a look at what they are:

1. Classic seminoma:

This type usually affects people between the ages of 25 and 45. What's special about this is that the level of a protein called `Alpha-fetoprotein (AFP)` in the blood is not elevated. `AFP` is a protein that is produced by the liver of a fetus while it is developing in the womb. An elevated `AFP` blood level in an adult can be a sign of some types of cancer, especially other subtypes of testicular cancer. However, if you have `classic seminoma`, your `AFP` level is not elevated.

2. Spermatocytic seminoma:

This type usually affects people over the age of 50. The specialty of this type is that it grows slowly. It also has a low risk of spreading (metastasizing) to other parts of the body.

How common is seminoma?

Testicular cancer is generally considered a rare disease – affecting approximately one in 250 men. However, data shows that the number of cases is increasing these days. The main reason for this is the increase in seminoma cases. For example, according to data from the CDC (Centers for Disease Control and Prevention) in the United States, 54% of testicular cancers diagnosed between 2001 and 2020 were seminoma.

The important thing is that, although testicular cancer is generally rare, it is the most common cancer in young men between the ages of 15 and 35. Therefore, it is important for men in this age group to be especially aware of this. Seminoma usually affects men in their 30s to 60s.

What are the symptoms of seminoma? Do you have these too?

The symptoms of seminoma can vary from person to person, but there are a few common symptoms.

Commonly seen symptoms:

• A painless lump or swelling in the scrotum: This is the main and most common symptom. Most people find this by accident, either while bathing or just sitting.
• Feeling of heaviness in the testicles, perineum, or scrotum: It can simply feel like something is filling up inside, making it feel heavy.
• Pain in the testicles, lower abdomen, or scrotum: Some people may not have severe pain, but may have a dull ache or a constant, dull ache.

Very rarely, things like this can happen:

• Acute pain is a sudden, sharp pain in the testicles.
• Blood in the semen (hematospermia).

Sometimes, if seminoma spreads (metastasizes) to other parts of the body, meaning the cancer grows and travels to places outside the testicles, symptoms such as:

• Lumps in the lymph nodes in the neck.
• Persistent cough.
• Difficulty breathing (dyspnea).
• Nausea and vomiting.
• Gastrointestinal bleeding.
• Pain in the bones.

If you have one or more of these symptoms, it doesn't necessarily mean you have seminoma. However, it's best to see a doctor and get checked out.

Is seminoma a serious cancer that spreads quickly?

In the early stages, seminoma is not very serious and does not spread quickly. But sometimes, it can grow quickly. That's why early detection is important. If you are diagnosed with seminoma, a doctor will check you regularly to see if it has spread and how it is doing.

Why does this seminoma develop? What is the cause?

This is a bit complicated. As we mentioned earlier, male sperm are made from germ cells. Normally, when a fetus grows in the womb, these germ cells are formed, and in a male child, those cells travel to the testicles and become sperm.

But in a person with seminoma, these germ cells do not actually develop into sperm, but divide and multiply in a different way, eventually forming tumors. Doctors still don't know exactly why these germ cells sometimes fail to develop into sperm. Research is still ongoing.

Who is more likely to develop seminoma? (Risk factors)

Anyone with testicles can develop seminoma at any age. However, some people have been found to be at a slightly higher risk. These include:

• Age: Usually people in their 30s to 60s.
• Race: Although foreign data suggests that white individuals are more likely to develop it, further study is needed to determine how this affects us in Sri Lanka.
• Family history: If you have had seminoma before, or if a close family member (such as a father or brother) has had seminoma, your risk is higher.
• Undescended testicles: If one or both testicles have not descended properly into the scrotum during childhood (undescended testicles or cryptorchidism), that is also a risk factor.

How to find out if you have seminoma? (Diagnosis)

If you feel something unusual in your testicles, the first thing you should do is see a doctor. A doctor is the one who can tell you for sure if you have seminoma. He or she will usually do the following:

• Your medical history will be reviewed: Ask about your previous illnesses and whether anyone in your family has had similar conditions.
• Asks about your symptoms: Asks about any discomfort or changes you are experiencing.
• A physical exam: Your testicles will be examined carefully. They will check for lumps, swelling, or pain. They may also check for swollen lymph nodes in your neck, armpits, or groin.

If the doctor suspects testicular cancer, he or she will recommend further specialized tests to confirm the diagnosis.

What are these special tests?

To find out for sure if you have seminoma, your doctor may order one or more of these tests:

• Testicular ultrasound: This is the first major test. This is a painless test that uses sound waves to produce real-time images of the inside of the testicles. It can tell if there is a lump, whether it is solid or fluid-filled.
• Other imaging tests: A CT scan (Computed Tomography scan), chest X-ray, or rarely an MRI (Magnetic Resonance Imaging) may be done to see if the cancer has spread from the testicles to other parts of the body.
• Serum tumor marker test: This is a blood test. Some cancer cells, or healthy cells in response to cancer, release specific substances (tumor markers) into the blood. This test looks for the presence of these tumor markers in the blood. In seminomas, the levels of alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (beta-HCG), and lactate dehydrogenase (LDH) are specifically measured. Different types of testicular cancer produce different types and amounts of tumor markers. However, having normal levels of tumor markers in the blood does not necessarily mean that cancer is not present. Some seminomas (especially classic seminomas) do not produce AFP.
• Orchiectomy: This is actually a surgical procedure. A surgeon will remove your entire affected testicle and send it to a pathologist to check for cancer cells and determine what type of cancer it is. Orchiectomy is used to diagnose seminoma and is also the main treatment.

After a seminoma is diagnosed, the doctor will determine the stage of the cancer (cancer staging). This includes how large the tumor is, whether it has spread outside the testicle, to the lymph nodes, or to distant organs. This stage determines the next course of treatment.

What are the stages of seminoma?

Doctors divide testicular cancer, both seminomas and non-seminomas, into stages 0 through 3. (There is no stage 4, as there is for other types of cancer.) Simply put, the lower the stage number, the more localized the cancer is and the less likely it is to spread. Stages 1 through 3 also have sub-stages (A, B, C, or S), which help you understand the nature of the cancer in more detail.

In addition, doctors also use the `TNM` system. Learn more:

• T (Tumor): The size of the tumor and whether it is within the testicle or has spread to surrounding tissue.
• N (Node): Whether and how far the cancer has spread to the lymph nodes in the back of the abdomen.
• M (Metastasis): Whether the cancer has spread to organs beyond the lymph nodes (e.g. lungs, liver, brain, bones).
• S (Serum tumor markers): Blood tests show the levels of `tumor markers` (`AFP`, `beta-HCG`, `LDH`).

This information may be a little confusing and even scary. However, it is essential information for your doctors to diagnose you correctly and plan the best treatment for you. If you don't understand any of this, don't be afraid to ask your doctor again.

How is seminoma treated?

The treatment for seminoma depends on many factors, including the type of cancer (seminoma or non-seminoma), stage, and your overall health.

The first treatment for almost all stages of seminoma is a radical inguinal orchiectomy . This is a surgical procedure. In this procedure, a surgeon makes a small incision in your groin and completely removes your affected testicle and the spermatic cord. The spermatic cord is not only the tube that carries sperm from the testicles to the penis, but it also contains the blood vessels, nerves, and lymph vessels that supply blood to the testicles. The surgeon seals off these blood vessels and lymph vessels to stop the cancer cells from spreading to other parts of the body.

Other treatments after an orchiectomy depend on the stage of your cancer and the results of the examination of the removed tumor. They may include one or more of the following:

• Active surveillance / Watchful waiting: For early stage (Stage I) seminoma, no other treatment is given after orchiectomy, and regular medical tests (such as physical exams, blood tests, and CT scans) are done to closely monitor for recurrence or spread. In most cases, the cancer is completely cured at this point.
• Chemotherapy: This involves giving the body special drugs to kill cancer cells. These can be taken as pills or given intravenously. If the cancer has spread to the lymph nodes or distant organs, chemotherapy may be given after the orchiectomy.
• Radiation therapy: This uses high-powered X-rays to destroy cancer cells. Seminoma cells are very sensitive to radiation. In the past, radiation therapy was often given to the lymph nodes in the back of the abdomen after an orchiectomy for stage II seminoma. However, chemotherapy is now preferred because of its fewer side effects. However, radiation therapy is still used in some cases.

If I have seminoma, what should I expect? (Recovery and outlook)

This is the most important and comforting news. In the case of seminoma, very good results can be expected. This is a disease that is usually very curable:

• Overall, the 5-year survival rate is over 95%.
• If detected early and the cancer has not spread beyond the testicle (Stage I), the chance of survival is about 99%.
• Even if it has spread to nearby lymph nodes (Stage II), there is a 96% chance of survival.
• Even if distant parts of the body are affected (Stage III), there is a survival rate of over 70%.

So you can see, the earlier you recognize it, the greater the chance of recovery.

After treatment for seminoma, your doctor will give you a long-term follow-up plan. You will need to have regular checkups throughout your life to check for recurrence of the cancer. These checkups may include:

• Physical examination of the contralateral testicle.
• Regularly check blood tests for `tumor markers`.
• From time to time, a chest X-ray or CT scan is okay.

What is the chance of dying from seminoma?

As we mentioned earlier, seminoma is usually very curable. However, like any cancer, there is a small chance that it can be fatal. According to the American Cancer Society, about one in 5,000 people with testicular cancer will die. That means the mortality rate is very low.

Can seminoma be prevented?

In fact, there is no proven way to prevent most testicular cancers, including seminoma, because we still don't know exactly why they develop.

But, even if you can't prevent it, early detection can make a big difference. The best way to do this is to examine your testicles yourself (testicular self-exams - TSE) at least once a month . You can ask your doctor how to do this. It's as easy as taking a shower. Then you can see for yourself if there is any change in their appearance or feel, lumps, swelling, or pain. If you notice a lump or change in size , don't panic and see a doctor right away.

Also, it's a good idea to do these things to reduce your risk of cancer in general:

• Stop smoking and vaping completely.
• Exercise vigorously for at least 20-30 minutes a day.
• Include plenty of fresh fruits, vegetables, legumes, and whole grains in your diet.
• If you drink alcohol, limit it.
• Maintain a healthy body weight that is appropriate for your height.

How do I take care of myself? (Mental well-being)

Although seminoma has a good cure rate, it's normal for anyone to feel scared and anxious when they hear the word "cancer." When you find out you have testicular cancer, you may experience a variety of emotions – anger, sadness, fear, frustration, helplessness. Whatever you're feeling is normal, so let those feelings flow.

Some days you will feel very confident and energized. Other days you will feel like you are tired of everything. It is very important to take the time to understand your feelings and deal with them. These tips will help you:

• Rest: When you feel tired, give your body and mind a good rest.
• Stress Management: Find a way to manage your stress that works for you. Exercise, yoga, meditation, engaging in a hobby you enjoy, or art therapy can help.
• Be informed: Be well informed about your condition and treatment. This can reduce unnecessary fear.
• Support groups: Look into cancer survivorship programs. Also, find a support group for people with testicular cancer. Talking to people who have been through the same things as you can be a great source of strength.
• Support from loved ones: Seek support from your family, close friends, and those you trust. Share your feelings with them.
• Professional Counseling: If necessary, do not hesitate to seek the help of a counselor or psychologist.

When should I see a doctor?

This is very clear. In your testicles:

• A lump
• Swelling
• Size difference
• Change in shape
• Unusual pain or heaviness
• Something else that feels strange to you.

If you see anything like this, don't delay and don't be afraid to see a doctor. Then they can diagnose what it is and recommend further tests and treatment if necessary. The earlier it is recognized, the more successful the treatment.

If you have been treated for seminoma, make sure to go for regular checkups as prescribed by your doctor to monitor your overall health and to check for any recurrence of the cancer. Don't miss them.

Is seminoma or non-seminoma more risky?

Germ cell tumors that develop in the testicles are divided into two main types: seminomas and non-seminomas. Seminomas generally respond better to treatment (especially radiation therapy) than non-seminomas. Non-seminomas may be made up of more than one type of cell, and they tend to grow and spread more quickly than seminomas. However, both types now have very effective treatments.

The most important things you need to remember (Take-Home Message)

Remember that seminoma has very good results when treated. It is a curable condition in most cases. However, being diagnosed with cancer is a life-changing and stressful experience.

It's important to take care of yourself – not just your physical health, but your mental and emotional health as well. Find support groups that understand what you're going through, and get help from your loved ones. If you have any questions, don't hold them back and ask a doctor. He or she can answer all your questions and recommend the best solutions for you.

Don't forget, you are not alone. When you are faced with a situation like this, asking for help and seeking information is your strength. Always take care of your body, do a monthly testicular self-exam, and seek medical advice immediately if you notice any changes. It can give you a great chance to save your life.

` Seminoma, testicular cancer, men's health, cancer symptoms, cancer treatment, orchiectomy, testicular self-exam