Testicular Cancer Treatment and Diagnosis in Singapore
What are Testicular Cancer Treatments in Singapore?
Testicular cancer is a rare but treatable cancer that affects the testicles, which are the male reproductive organs. In Singapore, there are various treatment options available for testicular cancer.
The specific treatment plan will depend on the stage of the cancer, the type of cancer, and other individual factors
Testicular Cancer Treatment: Surgery
Surgery is the primary treatment for testicular cancer. The type of surgery recommended depends on the stage of the cancer and whether it has spread beyond the testicle. In most cases, a radical orchiectomy is performed, which involves the removal of the entire affected testicle through a small incision in the groin.
During the surgery, the surgeon will remove the testicle, the spermatic cord, and the surrounding lymph nodes. A prosthetic testicle can be inserted in the scrotum to restore the normal appearance of the testicles.
After surgery, the removed testicle will be sent to a pathologist for examination to determine the type and stage of cancer. If the cancer has spread to the lymph nodes, the surgeon may also remove it during the surgery.
Testicular Cancer Treatment: Radiation Therapy
Radiation therapy uses high-energy radiation to destroy cancer cells. It may be recommended for testicular cancer that has spread to nearby lymph nodes or other parts of the body. Radiation therapy is usually given after surgery to reduce the risk of cancer recurrence.
There are two types of radiation therapy for testicular cancer: external beam radiation therapy and internal radiation therapy.
(A) External beam radiation therapy: This type of radiation therapy involves a machine that delivers high-energy radiation to the affected area from outside the body. The patient lies on a table while the machine moves around the body to deliver radiation to the cancerous area. The treatment is usually given daily over a period of several weeks.
(B) Internal radiation therapy (brachytherapy): This type of radiation therapy involves placing a small radioactive device directly into the body near the cancerous area. The device is removed after a short period of time, usually a few minutes. Internal radiation therapy is not commonly used for testicular cancer but may be recommended in certain cases.
Testicular Cancer Treatment: Chemotherapy
Chemotherapy is a treatment that uses drugs to kill cancer cells. It may be recommended for testicular cancer that has spread beyond the testicle or if there is a high risk of the cancer spreading. Chemotherapy may also be given after surgery to kill any remaining cancer cells in the body.
There are several chemotherapy drugs that may be used to treat testicular cancer, including:
- Bleomycin
- Etoposide
- Cisplatin
- Carboplatin
Chemotherapy is usually given in cycles over a period of several weeks. The length and frequency of the treatment depend on the type and stage of the cancer. Chemotherapy may be given intravenously (through a vein) or orally (in pill form).
Testicular Cancer Treatment: Targeted Therapy
Targeted therapy is a newer type of cancer treatment that uses drugs to target specific molecules or proteins that are involved in the growth and spread of cancer cells. Targeted therapy is not commonly used for testicular cancer but may be recommended in certain cases.
There are two main types of targeted therapy for testicular cancer:
(A) Monoclonal antibody therapy: This type of targeted therapy uses drugs called monoclonal antibodies to target specific proteins on the surface of cancer cells. The monoclonal antibodies attach to the cancer cells and either kill them directly or help the body’s immune system to attack them.
(B) Tyrosine kinase inhibitors: This type of targeted therapy blocks specific molecules inside cancer cells that are involved in their growth and spread. By blocking these molecules, tyrosine kinase inhibitors can slow or stop the growth of cancer cells.
Targeted therapy may be used alone or in combination with other treatments, such as chemotherapy or radiation therapy.
Testicular Cancer Treatment: Immunotherapy
Immunotherapy is a type of cancer treatment that works by boosting the body’s immune system to fight cancer cells. Immunotherapy is not commonly used for testicular cancer, but it may be recommended in certain cases.
One type of immunotherapy used for testicular cancer is called checkpoint inhibitors. Checkpoint inhibitors are drugs that block certain proteins on the surface of cancer cells or immune cells. By blocking these proteins, checkpoint inhibitors can help the body’s immune system to recognize and attack cancer cells.
Immunotherapy may be used alone or in combination with other treatments, such as chemotherapy or radiation therapy.
Are there any Side Effects of Testicular Cancer Treatment?
Side Effects of Testicular Treatment: Surgery
Like any surgical procedure, testicular cancer surgery can cause side effects. The type and severity of side effects depend on the extent of the surgery and the individual’s overall health.
Some common side effects of testicular cancer surgery include:
- Pain and discomfort: Pain and discomfort are common after testicular cancer surgery, especially in the first few days after the procedure. Pain medication can be prescribed to manage the pain.
- Swelling: Swelling of the scrotum and surrounding tissues is common after testicular cancer surgery. It usually goes away on its own within a few weeks.
- Bleeding: Bleeding from the surgical site can occur, but it’s usually minimal and stops on its own.
- Infection: Infection is a risk with any surgical procedure. Signs of infection include fever, redness, swelling, and drainage from the surgical site. Antibiotics may be prescribed to prevent or treat infections.
- Changes in sexual function: Removal of one testicle usually does not affect sexual function or fertility. However, removal of both testicles may cause a decrease in testosterone levels and sperm production, which can affect sexual function and fertility. Testosterone replacement therapy or sperm banking may be recommended in these cases.
Side Effects of Testicular Cancer Treatment: Radiation Therapy
Radiation therapy is a common treatment for testicular cancer, especially for seminoma. Radiation therapy can cause side effects, which vary depending on the dose and duration of the treatment and the individual’s overall health.
Some common side effects of radiation therapy for testicular cancer include:
- Skin irritation: Radiation therapy can cause skin irritation and redness in the treatment area. The skin may become dry, itchy, or blistered. Moisturizing creams or lotions can help to soothe the skin.
- Fatigue: Radiation therapy can cause fatigue, which may be mild or severe. Rest and light exercise can help to manage fatigue.
- Nausea and vomiting: Radiation therapy to the abdomen can cause nausea and vomiting. Medications can be prescribed to manage these symptoms.
- Diarrhea: Radiation therapy to the abdomen can cause diarrhea. A low-fiber diet and medications can help to manage this side effect.
- Infertility: Radiation therapy to the testicles can cause infertility by damaging the sperm-producing cells. In some cases, sperm banking may be recommended before radiation therapy.
- Long-term side effects: Radiation therapy can increase the risk of long-term side effects, such as a second cancer in the radiation field. The risk of long-term side effects depends on the dose and duration of the radiation therapy.
Side Effects of Testicular Cancer Treatment: Chemotherapy
Chemotherapy is a common treatment for testicular cancer, especially for non-seminoma. Chemotherapy drugs work by killing fast-growing cancer cells, but they can also affect healthy cells in the body, causing side effects.
Some common side effects of chemotherapy for testicular cancer include:
- Nausea and vomiting: Chemotherapy drugs can cause nausea and vomiting, which can be mild or severe. Medications can be prescribed to manage these symptoms.
- Hair loss: Chemotherapy drugs can cause hair loss on the scalp, face, and body. Hair loss is usually temporary and hair will regrow after treatment.
- Fatigue: Chemotherapy can cause fatigue, which may be mild or severe. Rest and light exercise can help to manage fatigue.
- Mouth sores: Chemotherapy drugs can cause sores in the mouth and throat, which can make eating and drinking difficult. Mouthwashes and pain medication can help to manage these symptoms.
- Low blood cell counts: Chemotherapy can lower the number of red blood cells, white blood cells, and platelets in the blood. This can lead to anemia, increased risk of infection, and bleeding problems. Blood transfusions or medications can be given to manage these side effects.
- Infertility: Chemotherapy can cause infertility by damaging the sperm-producing cells. In some cases, sperm banking may be recommended before chemotherapy.
Side Effects of Testicular Cancer Treatment: Targeted Therapy
Targeted therapy is a newer type of cancer treatment that targets specific molecules that are involved in cancer growth. Targeted therapy drugs are designed to block the signals that cancer cells use to grow and divide.
Some common side effects of targeted therapy for testicular cancer include:
- Fatigue: Targeted therapy can cause fatigue, which may be mild or severe. Rest and light exercise can help to manage fatigue.
- Diarrhea: Targeted therapy drugs can cause diarrhea, which can be mild or severe. A low-fiber diet and medications can help to manage this side effect.
- High blood pressure: Some targeted therapy drugs can cause high blood pressure, which can be managed with medication.
- Skin rash: Targeted therapy can cause skin rash and dry skin. Moisturizing creams or lotions can help to soothe the skin.
- Changes in liver function: Some targeted therapy drugs can cause changes in liver function, which can be monitored with blood tests.
- Infertility: Targeted therapy drugs can cause infertility by damaging the sperm-producing cells. In some cases, sperm banking may be recommended before treatment.
Side Effects of Testicular Cancer Treatment: Immunotherapy
Immunotherapy is a type of cancer treatment that helps the body’s immune system to identify and attack cancer cells. Immunotherapy drugs work by blocking certain proteins that help cancer cells hide from the immune system or by boosting the immune system to recognize and attack cancer cells.
Some common side effects of immunotherapy for testicular cancer include:
- Fatigue: Immunotherapy can cause fatigue, which may be mild or severe. Rest and light exercise can help to manage fatigue.
- Skin reactions: Immunotherapy drugs can cause skin reactions, such as rash, itching, and blistering. Moisturizing creams or lotions can help to soothe the skin.
- Flu-like symptoms: Immunotherapy can cause flu-like symptoms, such as fever, chills, muscle aches, and headaches. These symptoms can be managed with medication.
- Diarrhea: Immunotherapy drugs can cause diarrhea, which can be mild or severe. A low-fiber diet and medications can help to manage this side effect.
- Changes in liver function: Some immunotherapy drugs can cause changes in liver function, which can be monitored with blood tests.
- Infertility: Immunotherapy drugs can cause infertility by damaging the sperm-producing cells. In some cases, sperm banking may be recommended before treatment.
What Do I Need to Do If I have Testicular Cancer?
It is important to remember that testicular cancer can be treated successfully if caught early. If you have any concerns about your testicular health or notice any changes, do not hesitate to see a healthcare professional for evaluation.
If you suspect that you or your loved one have testicular cancer, it is advisable to get the support you need. Early detection and diagnosis of testicular cancer is key to treating the disease.
Regardless of what stage your testicular cancer may be at, you should schedule an appointment to see an oncologist specialising in testicular cancer as soon as possible. With the speed of developments in testicular cancer diagnosis and treatment, novel emerging treatment options could be explored by your medical oncologist.
Our cancer specialists at OncoCare specialise in treating late stage and advanced stages of testicular cancer, as well as earlier stages of the disease.
Who are the Testicular Cancer Specialists in Singapore?
Dr Akhil Chopra
Senior Consultant, Medical Oncologist
MBBS (Delhi) – American Board Certified (Int Med) – American Board Certified (Hematology) – American Board Certified (Med Oncology)
Before joining OncoCare Cancer Centre at Mount Elizabeth Hospital, Singapore, Dr Akhil Chopra was a Senior Consultant in Medical Oncology at Johns Hopkins Singapore, Tan Tock Seng Hospital and Adjunct Associate Professor at Lee Kong Chian School of Medicine.
Dr Chopra has experience treating multiple cancer types including breast cancer, lung cancer, cancers of stomach, colon, rectum, liver, prostate, kidney, testicular and bladder, gynaecological cancers such as ovarian and uterine/cervical cancers; as well as Sarcomas and chronic leukaemia’s/multiple myeloma. Besides his clinical and research work, he has been involved in teaching medical students from the Lee Kong Chian School of Medicine as well as medical residents and students from Johns Hopkins University, Baltimore in USA.
- Graduated from Delhi in 2001
- American Board Certified, Internal Medicine
- American Board Certified, Medical Oncology
- American Board Certified, Hematology
- Fellowship Training at Hahnemann University Hospital/Drexel University College of Medicine in Philadelphia, USA
Cancer Specialities: breast cancer, lung cancer, cancers of stomach, colon, rectum, liver, prostate, kidney, testicular and bladder, gynaecological cancers such as ovarian and uterine/cervical cancers
Dr Tay Miah Hiang
Senior Consultant, Medical Oncologist
MBBS (Singapore) – M.Med (Singapore) – MRCP (United Kingdom) – FAMS (Medical Oncology)
Dr Tay Miah Hiang, Senior Consultant Medical Oncologist at OncoCare Cancer Centre, was previously consultant at the National Cancer Centre Singapore’s Department of Medical Oncology, and Chairperson of Patient Education & Patient Survivorship programmes. Dr Tay also served on the board of Singapore Children’s Cancer Foundation from 2006 till 2015, and was Chairperson of this foundation from 2011 to 2013, and now serving as advisor. He is an elected member of Singapore Medical Council (SMC) since 2017 till date.
Dr Tay is passionate in contributing to Continuous Medical Education in the region, giving lectures in cancer management to cancer specialists, general practitioners, medical students and patients. He has won numerous awards for his service excellence and humanity contribution to disaster inflicted regions as such as post-Afghanistan war and Sri Lanka after Tsunami.
He has been actively involved in clinical and translational research for many years, in genitourinary (testicular, kidney, bladder, prostate), lung and other cancers. His research work is well published in hormone-refractory prostate cancer involved chemotherapy agents such as docetaxel and carboplatin. Acknowledged as a senior cancer specialist and an authority in prostate cancer in Singapore, he had also published on the use of ketoconazole and as part of a multi-centre clinical trial, the use of abiraterone acetate in metastatic castration-resistant prostate cancer progressing after chemotherapy.
As a pioneer in kidney cancer oncology, he had used sunitinib (Sutent), refametinib in kidney cancer patients when the drugs were coming into clinical practice in Singapore. Recognised as an authority in prostate cancer in Singapore, he had helped developed guidelines for the treatment of prostate cancer in Singapore in 2013 and the management of kidney cancer in Asia at the Asian Oncology Summit 2012.
His significant research work has been published in both local and international journals including Urology, Cancer, and Annals of Oncology. He also wrote chapters in several internationally recognised cancer specialty books such as Comprehensive Textbook of Genitourinary Oncology (3rd Edition), American Cancer Society’s Complete Guide to Prostate Cancer 2006, and Textbook on Urologic Oncology 2004.
Dr Tay is lauded for his experience in treating prostate, kidney, testicular and the bladder, gynaecological cancers such as ovarian cancer and uterine/cervical cancers, gastrointestinal & hepatobiliary cancers, lung cancer, brain tumour. He does not see patients with lymphoma, leukemia and breast cancer.
- Graduated from the National University of Singapore in 1992.
- Obtained Master of Medicine (Internal Medicine) and Membership of the Royal College of Physicians (United Kingdom) in 1999.
- Awarded the Ministry of Health Manpower Development Programme (HMDP) Scholarship to train at Dana Farber Cancer Institute, (Teaching Affiliates of Harvard Medical School), Boston USA 2003.
- Completed the Cancer Medicine and Hematology course at Harvard Medical School, Boston, MA, USA 2003.
- He was the Chairperson of Cancer Education for National Cancer Centre and Dr Tay was also previously the Chairperson and management committee member of Children’s Cancer Foundation. He is an elected member of Singapore Medical Council since 2017.
- In clinical patient care, he was awarded for his professional and genuine care with National Excellent Service Gold Award (EXSA*) in 2006 and Star Award in 2007.
- He has been actively involved in clinical and translational research for many years, in prostate, kidney, lung and other cancers. These have involved international trials of chemotherapy drugs currently in active use and newer targeted therapy. He was principal investigator for more than 10 clinical trials for cancer drug development.
- Research work by Dr Tay has been published in both local and international journals including Urology, Cancer, Annals of Oncology. He also wrote chapters in several international books such as Comprehensive Textbook of Genitourinary Oncology (3rd Edition), American Cancer Society’s Complete Guide to Prostate Cancer 2006, and Textbook on Urologic Oncology 2004.
- With respect to public service, Dr Tay has given talks both locally and overseas. These include the 13th and 15th Malaysian Urological Symposium on management of prostate cancer and renal cell cancer and Urological Conferences held in Singapore in 2004-2007
- With teaching appointments as Clinical Teacher, Faculty of Medicine, National University of Singapore and had been one of the lecturer for the First Singapore Medical Oncology Review Course (2007) involving surgeons, medical oncologists, radiation oncologists and physicians.
- Accredited for Palliative Medicine.
- Clinical interest in lung cancer, cancers of stomach, colon, rectum, liver, prostate, kidney, testicular and the bladder, gynaecological cancers such as ovarian and uterine/cervical cancers, and brain tumour.
- (*) National Excellent Service Award (EXSA) is a national award managed by SPRING Singapore and nine industry lead associations in Singapore. This award recognises the best of the best individuals who have delivered outstanding service in their respective industries. It seeks to develop models for service staff to emulate, create service champions and enhance professionalism in service delivery.
What is Testicular Cancer?
Definition of Testicular Cancer
Testicular cancer is a type of cancer that begins in the testicles, which are the male reproductive glands located in the scrotum. Testicular cancer occurs when abnormal cells in the testicles grow and divide uncontrollably, forming a mass or tumour.
The most common type of testicular cancer is germ cell tumourus, which account for about 95% of all testicular cancers. Germ cell tumours are divided into two subtypes:
- Seminomas: Seminomas are slow-growing tumours that usually occur in men between the ages of 25 and 45. They are usually highly responsive to radiation therapy and chemotherapy.
- Nonseminomas: Nonseminomas are a group of faster-growing tumours that tend to occur in younger men. They are less responsive to radiation therapy but are usually treated with chemotherapy.
Other, less common types of testicular cancer include:
- Leydig cell tumours: Leydig cell tumours are rare and account for only 1-3% of all testicular tumours. They develop in the cells that produce testosterone and other male hormones.
- Sertoli cell tumours: Sertoli cell tumours are also rare and account for less than 1% of all testicular tumours. They develop in the cells that nourish and support the sperm-producing cells.
- Lymphoma: Lymphoma is a type of cancer that begins in the lymphatic system. It can sometimes spread to the testicles and cause swelling or a lump.
According to the World Health Organization (WHO), testicular cancer is a relatively rare cancer, accounting for less than 1% of all male cancers. However, it is the most common cancer in young men aged 15-44 years.
In Singapore, testicular cancer is also relatively rare, accounting for about 1-2% of all male cancers. According to the Singapore Cancer Registry’s Annual Registry Report 2020, there were 100 cases of testicular cancer diagnosed in Singapore between 2014 and 2018. The incidence rate was 1.1 cases per 100,000 men, and the median age at diagnosis was 35 years.
It’s important to note that while testicular cancer is relatively rare, early detection and treatment can greatly improve the chances of a successful outcome. Regular self-examination and seeing a doctor in Singapore promptly if you experience any symptoms are important steps in detecting testicular cancer early.
What are the Signs and Symptoms of Testicular Cancer?
The most common symptoms of Testicular Cancer include:
- A lump or swelling in one or both testicles
- A feeling of heaviness or aching in the scrotum
- Pain or discomfort in the testicle or scrotum
- Enlargement or hardening of the testicle
- Changes in the texture or shape of the testicle
- A dull ache or pain in the lower abdomen or groin area
- Fluid buildup in the scrotum
- Breast tenderness or growth (in rare cases)
It’s important to note that not all lumps or swelling in the testicles are cancerous, and there can be other causes of these symptoms. However, if you experience any of these symptoms, it’s important to see a doctor for an evaluation.
Screening for Testicular Cancer
There is currently no standard screening test for testicular cancer, as routine screening is not recommended for the general population. However, men should perform regular self-examinations of their testicles to help detect any changes or abnormalities.
Here’s how to perform a testicular self-examination:
- Stand in front of a mirror and look for any swelling or changes in size or shape of your scrotum.
- Examine each testicle with both hands by gently rolling it between your thumb and fingers. You should feel for any lumps, swelling, or changes in texture.
- Check the epididymis, which is a tube behind each testicle that carries sperm. It can sometimes feel like a small bump, but it should not be painful or tender.
- Repeat the examination monthly, ideally after a warm bath or shower, when the scrotum is relaxed.
If you notice any changes or abnormalities, such as a lump or swelling, it’s important to see a doctor for further evaluation. They may perform a physical examination, imaging tests, or a biopsy to determine if there is a cancerous growth.
It’s important to note that while routine screening for testicular cancer is not recommended, men who are at higher risk, such as those with a family history of the disease or a personal history of testicular cancer, may benefit from more frequent self-examinations or screening tests.
How Testicular Cancer is Diagnosed
Testicular cancer is typically diagnosed through a combination of physical examination, imaging tests, and biopsy.
- Physical examination: Your doctor will examine your testicles, scrotum, groin, and abdomen for any lumps, swelling, or other abnormalities. They may also check for signs of swelling or fluid accumulation in the scrotum or abdomen.
- Imaging tests: If a lump or other abnormality is found, your doctor may order imaging tests to get a closer look at the area. Common imaging tests used for diagnosing testicular cancer include ultrasound, CT scan, and MRI.
- Blood tests: Blood tests can be used to check for tumour markers, such as alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH). These markers are produced by some types of testicular cancer and can help in diagnosis and monitoring of the disease.
- Biopsy: If a lump or abnormality is found during the physical examination or imaging tests, your doctor may perform a biopsy to remove a small sample of tissue for examination under a microscope. A biopsy can help determine if the growth is cancerous and, if so, what type of testicular cancer it is.
What are the Causes and Risk Factors of Testicular Cancer?
The exact causes of testicular cancer are not well understood, but research suggests that several factors may increase the risk of developing the disease. Here are some known risk factors for testicular cancer:
These include:
Age: Testicular cancer is most common in young and middle-aged men, with the highest incidence occurring between the ages of 15 and 44.
Family history: Men with a family history of testicular cancer are at higher risk of developing the disease. Having a brother or father who has had testicular cancer increases the risk by about 4 to 6 times.
Personal history: Men who have had testicular cancer in one testicle have an increased risk of developing cancer in the other testicle.
Abnormal testicular development: Men born with abnormalities of the testicles, such as undescended testicles, are at increased risk of developing testicular cancer.
Race/ethnicity: Testicular cancer is more common in Caucasian men than in men of other races and ethnicities.
HIV infection: Men with HIV have an increased risk of developing testicular cancer.
It’s important to note that having one or more of these risk factors does not mean that a man will develop testicular cancer. Conversely, some men who develop testicular cancer have no known risk factors.
What are the Types of Testicular Cancer?
There are several types of testicular cancer, but the two main types are:
- Seminomas: Seminomas are a type of germ cell tumour that typically grow slowly and are highly sensitive to radiation therapy. They are usually found in men between the ages of 30 and 50 and tend to grow larger than non-seminomas before spreading to other parts of the body.
- Non-seminomas: Non-seminomas are a group of tumours that develop from several types of cells in the testicles. They tend to grow more quickly than seminomas and are less sensitive to radiation therapy. Non-seminomas are often found in younger men, typically in their late teens or early twenties.
There are several subtypes of non-seminomas, including embryonal carcinoma, yolk sac tumour, choriocarcinoma, and teratoma. In some cases, these subtypes may be mixed together, and the tumour is then referred to as a mixed germ cell tumour.
Less common types of testicular cancer include:
- Leydig cell tumours: These tumours develop in the cells that produce testosterone in the testicles.
- Sertoli cell tumours: These tumours develop in the cells that support the growth and function of the sperm-producing cells in the testicles.
- Lymphoma: Lymphoma is a cancer that develops in the lymphatic system, which is responsible for fighting infection and disease. Testicular lymphoma is a rare type of cancer that accounts for less than 5% of all testicular cancers.
It’s important to note that the treatment and prognosis for testicular cancer may vary depending on the type and stage of the cancer.
What are the Stages of Testicular Cancer?
Testicular cancer is typically staged based on the extent of the disease, which includes the size of the tumour, whether the cancer has spread to nearby lymph nodes or other parts of the body, and whether there are any tumour markers (substances in the blood that can indicate the presence of cancer).
The stages of testicular cancer are:
- Stage 0: This stage is also known as carcinoma in situ. In this stage, abnormal cells are found in the testicle, but they have not spread beyond the testicle.
- Stage I: In this stage, the cancer is confined to the testicle and has not spread to lymph nodes or other parts of the body.
- Stage II: In this stage, the cancer has spread to nearby lymph nodes, typically in the abdomen or pelvis.
- Stage III: In this stage, the cancer has spread to other parts of the body, such as the lungs, liver, or brain.
Doctors use several diagnostic tests, including blood tests, imaging tests (such as CT scans and PET scans), and sometimes surgical exploration, to determine the stage of the cancer. Knowing the stage of the cancer helps doctors develop a treatment plan that is tailored to the patient’s individual needs.
