Testicular Cancer Treatment & Surgery in Singapore

Germ cell tumours originate from the cells that produce sperm and are divided into two main subtypes:

Seminomas (40-50% of germ cell tumours)

Seminomas typically grow slowly and remain localised to the testicle for longer periods. They occur most commonly in men between 30-40 years old and respond well to both radiation therapy and chemotherapy.

Non-seminomas (50-60% of germ cell tumours)

Non-seminomas comprise several subtypes including embryonal carcinoma, yolk sac tumours, choriocarcinoma, and teratomas. These tumours tend to grow more rapidly than seminomas and often occur in men in their 20s and early 30s. They may contain multiple cell types and have different treatment considerations compared to seminomas.

These rare tumours include Leydig cell tumours and Sertoli cell tumours, which arise from the supportive tissues of the testicle. Most are benign, but some can be malignant and require surgical removal.

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

• Back pain (indicating spread to retroperitoneal lymph nodes)
• Shortness of breath or cough (lung involvement)
• Breast tenderness or growth (hormonal effects)
• Headaches or confusion (brain metastases)
• Abdominal mass or bloating

• Sudden severe testicular pain (if tumour bleeding occurs)
• Rapid testicular enlargement
• Scrotal redness or warmth

The first line of treatment for both seminomas and non-seminomas involves surgical removal of the affected testicle through a groin incision (radical inguinal orchiectomy). This procedure is performed under general anaesthesia and typically takes about one hour. It is done through the groin rather than the scrotum to minimise the risk of spreading cancer cells. The surgeon removes the entire testicle and spermatic cord. This not only treats the primary tumour but also allows for histological confirmation of the diagnosis. Most patients can return home the same day or after an overnight stay. A prosthetic testicle may be placed during the same surgery if desired.

For some early stage (Stage I) testicular cancers, particularly seminomas, careful surveillance after orchiectomy may be appropriate, avoiding chemotherapy or radiotherapy. This approach involves regular physical examinations, blood tests for tumour markers every few months initially, and periodic CT scans. Surveillance avoids overtreatment in patients with a low risk of recurrence but requires strict adherence to follow-up schedules.

Chemotherapy is used when there is a higher risk of spread or recurrence, especially in non-seminomas or advanced seminomas. It involves anti-cancer drugs that destroy cancer cells throughout the body. Standard regimens include BEP (bleomycin, etoposide, cisplatin) or EP (etoposide, cisplatin), administered in cycles over 9 to 12 weeks. Chemotherapy may be given after surgery as adjuvant treatment or used as the primary therapy for metastatic disease. It is administered intravenously in an outpatient setting. Most patients respond very well, though temporary side effects such as nausea, hair loss, and fatigue are common.

Radiation therapy uses high-energy beams to destroy cancer cells and is particularly effective for seminomas. Treatment involves daily sessions over 2-3 weeks, targeting the retroperitoneal lymph nodes. Current techniques minimise radiation exposure to surrounding tissues. Side effects are generally mild and include temporary fatigue and mild gastrointestinal symptoms.

This specialised surgery removes lymph nodes from the back part of the abdomen where testicular cancer commonly spreads. The procedure may be performed using open or minimally invasive techniques. RPLND serves both diagnostic and therapeutic purposes, particularly for non-seminomas with residual masses after chemotherapy. Nerve-sparing techniques help preserve normal ejaculation when possible.