Seminoma Testicular Cancer in Singapore

Discovering a testicular abnormality can be deeply concerning, and receiving a diagnosis of seminoma testicular cancer may feel overwhelming. As the most common type of testicular cancer, seminoma is highly treatable when detected early, with positive outcomes for most patients. Understanding your condition, available treatment options, and what to expect during your journey can help you make informed decisions about your health care in Singapore.

Classical Seminoma

Classical seminoma represents about 85% of all seminoma cases and typically occurs in men between 30-40 years old. This type grows relatively slowly and responds well to radiation therapy. The tumour cells appear uniform under microscopic examination and rarely spread beyond nearby lymph nodes.

Anaplastic Seminoma

Anaplastic seminoma accounts for 5-10% of seminomas and displays more aggressive cellular features. Despite its more aggressive appearance under the microscope, it responds similarly to treatment as classical seminoma. This variant may present with slightly larger tumours at diagnosis.

Spermatocytic Seminoma

This rare variant comprises less than 5% of seminomas and typically affects older men above 50 years. Spermatocytic seminoma grows very slowly and rarely spreads to other parts of the body. The prognosis for this type is good, with surgical removal alone often being curative.

Causes

The exact cause of seminoma remains unknown, though researchers believe it results from genetic mutations in germ cells. These mutations cause normal cells to grow uncontrollably, forming tumours. Environmental and developmental factors during foetal development may contribute to these cellular changes.

Risk Factors

• Undescended testicle (cryptorchidism) – Men with a history of undescended testicles have 3-5 times higher risk
• Family history – Having a father or brother with testicular cancer increases risk
• Previous testicular cancer – 3-4% chance of developing cancer in the opposite testicle
• Klinefelter syndrome – Genetic condition associated with increased risk
• Age – Most common between 25-45 years for seminoma
• Race – Higher incidence in Caucasian men compared to Asian populations
• Testicular dysgenesis syndrome – Conditions affecting testicular development
• HIV infection – Slightly elevated risk in HIV-positive individuals

Immediate medical attention is necessary if you notice any lump, swelling, or change in your testicles. Early detection significantly improves treatment outcomes and may allow for less intensive therapy. You should seek prompt evaluation for persistent testicular or groin pain lasting more than two weeks, sudden fluid collection in the scrotum, or any unexplained back pain combined with testicular changes.

During your first consultation, the urologist will perform a thorough physical examination and discuss your medical history. Blood tests for tumour markers and ultrasound imaging will likely be ordered immediately. Most specialists can provide same-day ultrasound results, allowing for rapid diagnosis and treatment planning. Early intervention for seminoma often means simpler treatment with fewer side effects and better preservation of fertility.

Physical Examination

The urologist performs a careful examination of both testicles, abdomen, and lymph nodes. This examination helps identify the primary tumour and detect any obvious spread. The affected testicle typically feels firm and cannot be separated from the tumour mass.

Scrotal Ultrasound

High-frequency sound waves create detailed images of the testicular tissue. This non-invasive test can distinguish between solid tumours and fluid-filled cysts with over 95% accuracy. Results are usually available immediately, guiding further management decisions.

Blood Tumour Markers

Specific blood tests measure alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-hCG), and lactate dehydrogenase (LDH). Pure seminomas typically show normal AFP levels, while β-hCG may be slightly elevated in 10-20% of cases. These markers help with diagnosis, staging, and monitoring treatment response.

CT Imaging

Computed tomography scans of the chest, abdomen, and pelvis determine the cancer’s extent. These scans identify lymph node involvement and distant metastases. Post-surgery CT scans guide additional treatment decisions and long-term surveillance protocols.

Histopathological Examination

Following surgical removal, the tumour undergoes microscopic analysis by a pathologist. This examination confirms the seminoma diagnosis and identifies specific subtypes. The pathology report provides crucial information for treatment planning and prognosis.

Radical Inguinal Orchiectomy

This surgical procedure involves removing the affected testicle through an incision in the groin. The surgery takes approximately one hour under general anaesthesia. The surgeon removes the entire testicle along with the spermatic cord up to the internal inguinal ring. This approach prevents cancer cell spillage and provides tissue for accurate diagnosis. Most patients return home the same day or after an overnight stay.

Active Surveillance

Following orchiectomy for early-stage seminoma, active surveillance involves regular monitoring without immediate additional treatment. Patients undergo blood tests every 1-2 months initially, CT scans every 3-6 months, and physical examinations. This approach suits patients with stage I disease and avoids unnecessary treatment side effects. Approximately 80% of patients remain disease-free with surveillance alone.

Radiation Therapy

External beam radiation targets lymph nodes in the abdomen and pelvis where seminoma cells might have spread. Treatment typically involves daily sessions over 2-3 weeks using precisely focused radiation beams. Modern techniques minimise exposure to surrounding healthy tissue. Seminomas show sensitivity to radiation, with cure rates exceeding 95% for early-stage disease.

Chemotherapy

Systemic chemotherapy uses medications to destroy cancer cells throughout the body. Standard regimens include carboplatin (single agent) or combination therapy with etoposide and cisplatin (EP) or bleomycin, etoposide, and cisplatin (BEP). Treatment cycles last 3-4 weeks, with most patients requiring 1-4 cycles depending on disease stage. Chemotherapy achieves good cure rates even in advanced seminoma.

Retroperitoneal Lymph Node Dissection

This surgical procedure removes lymph nodes from the back of the abdomen. Though less common for seminoma than non-seminoma tumours, it may be necessary for residual masses after chemotherapy. The surgery requires specialised expertise to preserve nerve function and minimise complications. Most patients stay in hospital for 3-5 days post-surgery.

Salvage Therapy

For rare cases of recurrent or refractory seminoma, high-dose chemotherapy with stem cell transplant offers potential cure. Alternative chemotherapy regimens using different drug combinations target resistant cancer cells. These intensive treatments require careful patient selection and specialised cancer centre expertise.

Without treatment, seminoma progressively spreads through predictable pathways. The cancer initially spreads to retroperitoneal lymph nodes, causing back pain and potential kidney obstruction. Further progression leads to lung metastases, causing respiratory symptoms and reduced exercise capacity. Advanced disease may spread to the liver, bones, or brain, significantly impacting quality of life and survival.

Untreated seminoma can cause hormonal imbalances leading to gynaecomastia (breast enlargement) and fertility issues. Large tumours may undergo haemorrhage or infarction, causing acute severe pain. Metabolic complications from extensive disease burden can affect multiple organ systems. The psychological impact of untreated cancer creates significant anxiety and depression. Early treatment prevents these complications and offers good long-term outcomes.

While seminoma cannot be completely prevented, certain measures may reduce risk or enable early detection. Boys with undescended testicles should undergo orchiopexy (surgical correction) before age one to reduce cancer risk. Regular testicular self-examination, performed monthly after a warm shower, helps detect changes early. Men with risk factors should discuss screening protocols with their urologist.

Maintaining overall health through regular exercise and balanced nutrition supports immune function. Avoiding anabolic steroid use may reduce testicular cancer risk. Genetic counselling benefits men with strong family histories of testicular cancer. Prompt treatment of testicular infections and trauma prevents chronic inflammation. Awareness of risk factors and symptoms enables timely medical consultation when concerns arise.