April is Testicular Cancer Awareness Month

Testicular Cancer Awareness Month: Survivorship & Follow-up Care

All About Testicular Cancer

April is Testicular Cancer Awareness Month. This is a good time to learn about testicular cancer and its risk factors, symptoms, treatments, and more. Testicular cancer is relatively uncommon. However, testicular cancer cases have increased in the United States over the last several decades, though rates have stabilized in recent years. It is estimated that less than 10,000 testicular cases will be diagnosed in 2024, and 500 people will die from testicular cancer. Overall, about 1 in 250 men will develop testicular cancer in their lifetime. 

Most cancers are diagnosed in older adults. However, this isn’t the case with testicular cancer. Most testicular cancer cases occur in young or middle-aged men, but it can occur less commonly in children, teens, and older adults. The average age of testicular cancer diagnosis is 33. 

The exact cause of testicular cancer is not known. Cancer develops when cells begin to grow out of control. These cells can grow into tumors. Testicular cancer can cause symptoms, such as swelling, lumps, pain, and/or a heavy or achy feeling in the stomach. However, some people don’t experience any symptoms. Researchers have identified some risk factors for developing testicular cancer. These include cryptorchidism (undescended testicles), family history of testicular cancer, an inherited disease called Klinefelter's syndrome, HIV infection, previous cancer in the other testicle, age, and race/ethnicity. However, most of these risk factors are not able to be changed, so testicular cancer cannot be prevented. 

Testicular Cancer Survivorship Research

Testicular cancer is typically very treatable with treatments like surgery, radiation, and chemotherapy. The risk of dying from testicular cancer is 1 in 5,000. About 95% of testicular cancer survivors are alive 10 years later. Because of this, there are many testicular cancer survivors who live decades after diagnosis and treatment. These individuals have unique needs and experiences that we need to learn more about to understand long-term health outcomes, treatment effects, and more. This is where research comes in!

Observational studies can provide a wealth of information about cancer survivorship and experiences over time. Observational studies observe processes and outcomes that are already occurring organically. Researchers don’t try to make one outcome occur or change any exposures. Instead, they observe and do not intervene. Researchers will analyze these observations and outcomes and see if any relationships exist. 

One type of observational study is cohort studies. Cohort studies follow a group of people with a common characteristic over time and observe outcomes. This can occur by following people forward in time, or looking back to the past. For testicular cancer, a cohort study could follow a group of survivors and observe their quality of life, cancer recurrence or second cancers, other health conditions, and more. 

One such cohort study, published in 2005, looked back on health outcomes for nearly 41,000 long-term testicular cancer survivors. The study analyzed the risk of being diagnosed with a second cancer after surviving testicular cancer. Researchers found that testicular cancer survivors had significantly increased risk of developing a second cancer for 35 years after treatment. The most common diagnoses were cancers of the pleura (mesothelioma), esophagus, bladder, stomach, kidney, lung, colon, prostate, and pancreas. This risk was higher for testicular cancer survivors who were diagnosed at younger ages. The increased risk was significant for those who received chemotherapy alone and those who received radiation alone, but was highest for those who received both chemotherapy and radiation. 

A similar study followed testicular cancer survivors and compared their health outcomes to the general male population over 20 years. This type of observational study is a case-control study because it compares cases (testicular cancer) to controls (people without testicular cancer). This study, however, looked at cardiovascular health instead of second cancers. The study found that testicular cancer survivors treated with chemotherapy and/or radiation had increased risk of cardiovascular disease compared to the general population and to testicular cancer survivors who were treated with surgery alone. Those treated with radiation also had increased rates of diabetes. Studies like this are important because they inform doctors who is most at risk and when are they most at risk based on previous health conditions and treatments so they can be monitored more closely as they age.


Testicular Cancer Follow-up Care

Observational and survivorship studies provide valuable information about health outcomes and future risks from previous cancer diagnosis and treatment. For testicular cancer, this is especially important because most survivors will have a very long life expectancy after treatment, with some men living 30-50+ years. Therefore, survivorship research is extremely beneficial to inform testicular cancer follow-up care to ensure survivors are monitored for any future cancers or health conditions.

Testicular cancer follow-up care typically includes regular physical exams and tests. Testicular cancer screening tests will usually be given for at least ten years after treatment to check for recurrence. Tumor marker level blood tests may also be given depending on the cancer type. Doctors will also monitor your side effects and any long-term symptoms or damage from cancer treatment. 

A useful resource in testicular cancer follow-up care is a survivorship care plan. Testicular cancer survivors can work together with their doctor to develop this plan. It should cover a schedule for follow-up exams and tests, a schedule for screening tests for other cancers due to increased risk, a list of possible side effects from treatment and symptoms to look out for, diet and physical activity guidelines, any medications or supplements, and primary care physician appointment schedules.