Testicular Cancer Treatment in Singapore

Germ cell tumours originate from the cells that produce sperm and are divided into two main categories. Seminomas grow slowly and may respond well to radiation therapy, typically occurring in men between 30 and 45 years old. Non-seminomas tend to grow more rapidly and often affect younger men in their twenties, including several subtypes such as embryonal carcinoma, yolk sac tumour, choriocarcinoma, and teratoma.

These tumours develop from the supportive tissues of the testicles. Leydig cell tumours arise from hormone-producing cells and can occur at any age, often producing excess testosterone or oestrogen. Sertoli cell tumours develop from cells that nourish developing sperm cells and are typically benign, though malignant forms exist.

Lymphoma of the testicle represents a testicular malignancy that can occur in men over 50, usually as part of systemic lymphoma. Metastatic cancer from other primary sites, such as the prostate, lung, or kidney, can occasionally spread to the testicles, though this is relatively uncommon.

• Painless lump or swelling in one testicle (most common initial sign)
• Feeling of heaviness in the scrotum
• Change in testicle size or firmness
• Mild ache in the lower abdomen or groin
• Sudden collection of fluid in the scrotum

• Persistent back pain (may indicate lymph node involvement)
• Shortness of breath or cough (may suggest lung metastases)
• Breast tenderness or growth (from hormone-producing tumours)
• Testicular pain or discomfort
• Weight loss and fatigue
• Abdominal mass or bloating

• Neck mass (supraclavicular lymph nodes involvement)
• Neurological symptoms (brain metastases)
• Bone pain (skeletal metastases)
• Jaundice or abdominal distension (liver metastases)

Radical inguinal orchiectomy is a treatment for testicular cancers. This involves removing the affected testicle and spermatic cord through a groin incision. The procedure is performed under general anaesthesia. Testicular prosthesis insertion can be performed simultaneously if desired.

For certain non-seminomas with residual masses after chemotherapy, surgical removal of retroperitoneal lymph nodes may be considered. This procedure requires specialisation and nerve-sparing techniques to help preserve ejaculatory function when possible.

Seminomas may respond to radiation therapy, particularly for early-stage disease involving retroperitoneal lymph nodes. Modern radiation techniques aim to minimise exposure to surrounding tissues while treating microscopic disease. Treatment typically involves daily sessions and may have side effects.

Chemotherapy regimens may include BEP (bleomycin, etoposide, cisplatin) or EP (etoposide, cisplatin), depending on disease stage and risk factors. Treatment cycles are administered with monitoring of blood counts and organ function to help ensure safe delivery of treatment.

Selected early-stage seminomas and non-seminomas may be managed with close observation following orchiectomy. This approach requires adherence to follow-up protocols, including physical examinations, tumour markers, and imaging studies.

For cases of relapsed or refractory disease, high-dose chemotherapy with stem cell transplantation may be considered. Novel targeted therapies and immunotherapy trials may offer additional options for cases resistant to standard care under the supervision of a urologist.