Position statement - Testicular cancer

From National Cancer Prevention Policy


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Position statement - Testicular cancer



Recommendations

Cancer Council Australia recommends that:

  • Men become familiar with the usual shape, size and feeling of their testicles, and to see their doctor if they notice a lump, swelling on the surface of the testicles, heaviness, aching or other changes.
  • Medical practitioners inform men at increased risk of testicular cancer of their potential increased risk, along with potential benefits and harms associated with screening.
  • Men with testicular cancer talk to their oncologist about sperm banking before commencing chemotherapy or radiation.


Population based screening for testicular cancer is not recommended (and randomised controlled trials are not warranted) given the rareness of the disease, lack of test accuracy, and favourable treatment outcomes (even when diagnosed at a late stage).

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Overview

The testicles are two egg-shaped glands found in men. They produce semen and sex hormones.

Testicular cancer is one of the more rare forms of cancer with an estimated incidence of approximately 6.5 in every 100,000 men[1]. In 2010 there were 706 new cases of testicular cancer in Australia[1].

Young men are more commonly affected by testicular cancer, with the average age of diagnosis being around 35 years of age[2]. There are two different types of testicular cancer: non-seminoma, a cancer of the mature germ cells affecting mostly men 15-39 years of age; and seminoma, cancer formed from immature germ cells, generally affecting men 25-49 years of age[3].

The prognosis for men diagnosed with testicular cancer has improved dramatically since the 1970s when chemotherapy was introduced to treat the disease. Five-year relative survival for men diagnosed with testicular cancer is approximately 98%[4].

Testicular cancer represents less than 0.1% of all cancer deaths in Australian men[1]. In 2011, there were 16 testicular cancer deaths in Australia[1].

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Screening for testicular cancer

Testicular cancer commonly presents as a small hard lump, swelling, or change in the consistency of the testicle, or there may be a dull ache in the testicle or lower abdomen. In the majority of cases only one testicle is affected.

Self-screening

Cancer Council recommends that men become familiar with the usual shape, size and feeling of their testicles., and to see their doctor if they notice a lump, swelling on the surface of the testicles, heaviness, aching or other changes. A number of conditions other than cancer may cause changes in the testicles.

The only established risk factors for testicular cancer are a family history (in father or brother) of the disease, personal history of undescended testicle and previous testicular cancer[5]. Males with these risk factors should be informed by their physicians of their potential increased risk of testicular cancer, along with potential benefits and harms associated with screening.

Population screening

There have been no randomised controlled trials on screening for testicular cancer[6].

The U.S. Preventive Services Task Force and a 2011 Cochrane review of evidence advise that population-based screening is not beneficial (and randomised controlled trials are not warranted) given the rareness of the disease, lack of test accuracy, and favourable treatment outcomes (even when diagnosed at a late stage)[6][7].

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Treatment for testicular cancer

All testicular cancers can be effectively treated if diagnosed and treated early[8]. Cancer of the testis is the most curable of all internal cancers[4]. Advanced testicular cancer can also be cured with treatment[9][10].

In most men with testicular cancer treatment involves the surgical removal of the affected testicle. This may be followed with surveillance, chemotherapy or radiotherapy.

Testicular cancer and the removal of one testicle does not alter sexual function or fertility. The effect on fertility of removal of one of the testicles is minimal as such large numbers of sperm are produced by a single testicle.

For those men who require further treatment, fertility is likely to be affected, at least temporarily[11]. Cancer Council recommends that men with testicular cancer talk to their oncologist about sperm banking before commencing chemotherapy or radiation.

'Late' side effects can occur years after treatment for testicular cancer. Secondary cancers and cardiovascular disease are the most common serious late effects of treatment for testicular cancer, typically occurring more than 10 years after treatment for the disease[11]. In patients treated for Stage I testicular cancer, the lifetime increased risk for a secondary cancer is estimated to range from 1.9% for an 18 year old patient to 1.2% for a 40 year old patient[12].

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Public health information

Due to the lack of evidence of a benefit from screening for testicular cancer[6] and the low mortality rates of the disease[1], a public education campaign is unlikely to reduce the mortality rate further.

The low mortality rate suggests that men are currently seeking medical attention when they notice an abnormality in their testicles and are being treated effectively, resulting in the high survival rate for this disease.

A public campaign encouraging men to become more aware of abnormalities in their testicles would likely lead to an increase in unnecessary medical examinations and investigations, with no evidence there would be a significant increase in disease outcomes to justify this.

Further to this, encouraging testicular self-examination has the potential to create unnecessary anxiety and fear, with no evidence of benefit.

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Position statement details

This position statement was developed and reviewed by the Public Health Committee in February 2013. It was externally reviewed by A/Prof David Smith, Research Fellow, Cancer Council NSW and A/Prof Dragan Ilic, School of Public Health and Preventive Medicine, Monash University.

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References

  1. 1.0 1.1 1.2 1.3 1.4 Australian Institute of Health and Welfare. ACIM (Australian Cancer Incidence and Mortality) books. Canberra: AIHW; 2014 Feb 13 Available from: http://www.aihw.gov.au/acim-books/.
  2. Australian Institute of Health and Welfare, Australasian Association of Cancer Registries. Cancer in Australia: an overview, 2010. Canberra: AIHW; 2010. Report No.: Cancer series no. 60. Cat. no. CAN 56. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442472684.
  3. Baade P, Carrière P, Fritschi L. Trends in testicular germ cell cancer incidence in Australia. Cancer Causes Control 2008 Dec;19(10):1043-9 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18478339].
  4. 4.0 4.1 Australian Institute of Health and Welfare. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. Cancer Series no. 69. Cat. no. CAN 65. Canberra: AIHW; 2012 Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737422721.
  5. McGlynn KA, Cook MB. Etiologic factors in testicular germ-cell tumors. Future Oncol 2009 Nov;5(9):1389-402 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19903067].
  6. 6.0 6.1 6.2 Ilic D, Misso ML. Screening for testicular cancer. Cochrane Database Syst Rev 2011 Feb 16;(2):CD007853 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21328302].
  7. U.S. Preventive Services Task Force. Screening for testicular cancer: U.S. Preventive Services Task Force reaffirmation recommendation statement. [homepage on the internet] Maryland, USA: USPSTF; 2011 Apr Available from: http://www.uspreventiveservicestaskforce.org/uspstf10/testicular/testicuprs.htm.
  8. Shaw J. Diagnosis and treatment of testicular cancer. Am Fam Physician 2008 Feb 15;77(4):469-74 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18326165].
  9. Fukui N, Kohno Y, Ishioka JI, Fukuda H, Kageyama Y, Higashi Y. Treatment outcome of patients with extragonadal nonseminomatous germ cell tumors: the Saitama Cancer Center experience. Int J Clin Oncol 2012 Jul 5 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22763659].
  10. Calabrò F, Albers P, Bokemeyer C, Martin C, Einhorn LH, Horwich A, et al. The contemporary role of chemotherapy for advanced testis cancer: a systematic review of the literature. Eur Urol 2012 Jun;61(6):1212-21 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22464311].
  11. 11.0 11.1 Haugnes HS, Bosl GJ, Boer H, Gietema JA, Brydøy M, Oldenburg J, et al. Long-term and late effects of germ cell testicular cancer treatment and implications for follow-up. J Clin Oncol 2012 Oct 20;30(30):3752-63 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23008318].
  12. Tarin TV, Sonn G, Shinghal R. Estimating the risk of cancer associated with imaging related radiation during surveillance for stage I testicular cancer using computerized tomography. J Urol 2009 Feb;181(2):627-32; discussion 632-3 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19091344].

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