Testicular cancer is a disease in which cells become malignant (cancerous) in one or both testicles.
The testicles (also called testes or gonads) are a pair of male sex glands. They produce and store sperm and are the main source of testosterone (male hormones) in men. These hormones control the development of the reproductive organs and other male physical characteristics. The testicles are located under the penis in a sac-like pouch called the scrotum.
Based on the characteristics of the cells in the tumor, testicular cancers are classified as seminomas or nonseminomas. Other types of cancer that arise in the testicles are rare and are not described here. Seminomas may be one of three types: classic, anaplastic, or spermatocytic. Types of nonseminomas include choriocarcinoma, embryonal carcinoma, teratoma, and yolk sac tumors. Testicular tumors may contain both seminoma and nonseminoma cells.
Testicular cancer accounts for only 1 percent of all cancers in men in the United States. About 8,000 men are diagnosed with testicular cancer, and about 390 men die of this disease each year. Testicular cancer occurs most often in men between the ages of 20 and 39, and is the most common form of cancer in men between the ages of 15 and 34.
It is most common in white men, especially those of Scandinavian descent. The testicular cancer rate has more than doubled among white men in the past 40 years, but has only recently begun to increase among black men. The reason for the racial differences in incidence is not known.
Most testicular cancers are found by men themselves. Also, doctors generally examine the testicles during routine physical exams. Between regular checkups, if a man notices anything unusual about his testicles, he should talk with his doctor.
Men should see a doctor if they notice any of the following symptoms:
- a painless lump or swelling in a testicle.
- pain or discomfort in a testicle or in the scrotum.
- any enlargement of a testicle or change in the way it feels.
- a feeling of heaviness in the scrotum.
- a dull ache in the lower abdomen, back, or groin.
- a sudden collection of fluid in the scrotum.
These symptoms can be caused by cancer or by other conditions. It is important to see a doctor to determine the cause of any of these symptoms.
How is testicular cancer diagnosed?
To help find the cause of symptoms, the doctor evaluates a man's general health. The doctor also performs a physical exam and may order laboratory and diagnostic tests.
These tests include:
• Blood tests that measure the levels of tumor markers. Tumor markers are substances often found in higher-than-normal amounts when cancer is present. Tumor markers such as alpha-fetoprotein (AFP), Beta-human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH) may suggest the presence of a testicular tumor, even if it is too small to be detected by physical exams or imaging tests.
• Ultrasound, a test in which high-frequency sound waves are bounced off internal organs and tissues. Their echoes produce a picture called a sonogram. Ultrasound of the scrotum can show the presence and size of a mass in the testicle. It is also helpful in ruling out other conditions, such as swelling due to infection or a collection of fluid unrelated to cancer.
• Biopsy (microscopic examination of testicular tissue by a pathologist) to determine whether cancer is present. In nearly all cases of suspected cancer, the entire affected testicle is removed through an incision in the groin. This procedure is called radical inguinal orchiectomy. In rare cases (for example, when a man has only one testicle), the surgeon performs an inguinal biopsy, removing a sample of tissue from the testicle through an incision in the groin and proceeding withorchiectomy only if the pathologist finds cancer cells. (The surgeon does not cut through the scrotum to remove tissue. If the problem is cancer, this procedure could cause the disease to spread).
If testicular cancer is found, more tests are needed to find out if the cancer has spread from the testicle to other parts of the body. Determining the stage (extent) of the disease helps the doctor to plan appropriate treatment.
The exact causes of testicular cancer are unknown.
Most men who get testicular cancer don't have any risk factors. But there are some things that may increase your chances of getting testicular cancer.
These risk factors include:
- An undescended testicle (cryptorchidism). This is a testicle that has not descended from the abdomen into the scrotum. Normally, the testes descend into the scrotum before the baby is born or during the first 3 months of infancy. A man is at a higher risk even if the testicle is moved down surgically.
- Klinefelter syndrome. This is a genetic disorder that affects males. Normally, males have one X and one Y chromosome. Males with Klinefelter syndrome have at least two X chromosomes and, in rare cases, as many as three or four.
- A personal or family history of testicular cancer.
Infertility from sperm problems has been linked to testicular cancer. Men with sperm problems have a higher rate of testicular cancer than men who do not. Experts don't yet know if the two problems share the same cause or if one causes the other.
If you are diagnosed with testicular cancer, your doctor will explain what type of cancer you have, whether it has spread beyond the testicle (metastasized), and the potential for curing it. You and your doctor will discuss your treatment options and possible outcomes of those treatments. Testicular cancer is considered a highly curable disease, especially when diagnosed at an early stage.
Treatment for testicular cancer begins with aradical inguinal orchiectomy, which is surgery to remove the affected testicle(s). After surgery, depending on which type of cancer cells are present and whether your cancer has spread to other areas of your body (stage), you may need only surveillance. Or you may need further treatment with chemotherapy, radiation therapy, or surgery to remove lymph nodes (RPLND).
If your cancer was found early, you may have a choice regarding further treatment. Talk with your doctor about the risks and possible side effects of each treatment option.
If testicular cancer is not found and treated during its early stages, it may spread (metastasize) to the lymph nodes and to the lungs, liver, brain, and bones. But often testicular cancer that has spread can still be treated successfully.
Regardless of the therapy you choose to treat your testicular cancer, it is important to receive follow-up care, which may lead to early identification and management of recurrent cancer (cancer that comes back).
Your regular follow-up program may include:
- Physical exams.
- Imaging tests, including X-rays, CT scans, and MRIs.
- Blood tests, to check tumor marker levels. Stable or increasing tumor marker levels after treatment may mean that your cancer is still present or has returned and that further treatment is needed.
A diagnosis of testicular cancer means that you will be seeing your doctor regularly for years to come, so it's a good idea to develop a relationship based on trust and the sharing of information. Your doctor may give you some advice on changes to make in your life to help treatment be successful.
Treatment if the condition gets worse
Testicular cancer that has come back (recurred) may be discovered during a physical exam, through an imaging test, or as a result of increasing tumor markerlevels. In some cases, treatment for recurrent testicular cancer may be successful, especially if the cancer has spread only to the lymph nodes in the pelvis, abdomen, or lower back and pelvis (retroperitoneum).
Recurrent testicular cancer may be treated with chemotherapy, surgery to remove lymph nodes, or radiation. Sometimes high doses of chemotherapy are needed. If these treatments don't work, then high-dose chemotherapy with autologous stem cell transplant may be tried.
In many cases of recurrent testicular cancer, chemotherapy treatment is followed by surgery to remove any remaining cancer as well as tissue damaged as a result of the chemotherapy.
What to think about
When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It is normal to have a wide range of feelings and for those feelings to change quickly. Some people find that it helps to talk about their feelings with their family and friends.
If your emotional reaction to cancer interferes with your ability to make decisions about your health, it is important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. You can also contact your local chapter of the American Cancer Society to help you find a support group.
Infertility. Some cancer treatments raise your risk of infertility. Unless you are sure you won't want to father a child in the future, talk to your doctor about sperm banking before any treatment for testicular cancer.
Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Your quality of life may be improved by having palliative careto manage your symptoms.
Testicular cancer has a very good cure rate, especially if it is found early. For some people who have advanced-stage cancer, a time comes when more treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice care.
It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care.