Testicular Cancer

What Is It?

Testicular cancer is the uncontrolled growth of abnormal cells in one or both testicles, also called testes. The testicles are the male sex glands that are located behind the penis in the scrotum. They produce testosterone and other male hormones. They also produce and store sperm, the male reproductive cells.

Different types of testicular cancer start in different cells in the testicles:

• Germ cell tumors About 95% of testicular cancers develop in germ cells, cells that form sperm. There are two types of germ cell tumors. Seminomas (40% of all testicular cancers) tend to grow slowly, and they also tend to stay within the testicles for a long period without spreading. Nonseminomas form in more mature germ cells and are more likely to spread aggressively, especially to lymph nodes (bean-shaped structures throughout the body that produce and store infection-fighting cells).
• Tumors of supportive tissues About 5% of testicular cancers begin in the testicles' supporting tissues, tissue that does not produce sperm. These cancers are called Sertoli cell tumors and Leydig cell tumors.

Once testicular cancer develops, it can remain within the testicle, or it can spread to lymph nodes in the abdomen. If it remains undetected, testicular cancer eventually can spread to the lungs, brain, liver and elsewhere throughout the body.

Testicular cancer is uncommon. It accounts for only 1% of all cancers in men in the United States, and it strikes only 2 to 3 of every 100,000 American males each year. Testicular cancer can affect men of any age, but it is most common in men between the ages of 20 and 40. It occurs eight times more often in white men than in black men. Although the specific cause of testicular cancer is not known, the illness is more common in men who had an undescended testicle at birth. Roughly 10% of cases of testicular cancer occur in men who have had an undescended testicle, and one-quarter of these cases occur in the testicle that descended normally. Testicular cancer also appears more commonly in men with certain genetic conditions, such as Klinefelter's syndrome or Down syndrome; men who have a family history of testicular cancer; and possibly men with human immunodeficiency virus infection.

Symptoms

The most common symptom of testicular cancer is a painless lump in the testicle. This lump can be small or large, and it can be hard or soft. Some men also will have discomfort or swelling in the testicle that can mimic an infection. Breast swelling or tenderness also can occur. If cancer has spread beyond the testicle, there can be a variety of symptoms, including back or abdominal pain and shortness of breath.

Diagnosis

Your doctor will ask when you first noticed the problem and whether your symptoms have worsened over time. He or she will examine the testicle and feel for swollen lymph nodes. Be sure to tell the doctor if either of your testicles was not descended at birth. Your doctor may suspect that you have testicular cancer based on your symptoms or findings during your physical exam, such as a hard lump or area of tenderness. To determine whether a soft lump is solid or fluid filled, your doctor may use a small flashlight to see if light can be transmitted through the lump.

The physical examination may be followed by:

• Ultrasound In this procedure, high-frequency sound waves are used to check for a mass inside the testicle and for abnormal accumulations of fluid.
• Magnetic resonance imaging (MRI) or computed tomography (CT) scans These painless techniques use magnetic fields or X-rays to create images of the abdomen to check for abnormal masses and enlarged lymph nodes.
• Chest X-ray This will check whether the cancer has spread to the lungs.

The best way to confirm the diagnosis of testicular cancer is to remove the testicle in a procedure called an orchiectomy. After surgery, the testicle will be examined in the laboratory to determine if cancer is present, and if so, the specific type. Blood tests also will be done to measure levels of two tumor-marker proteins, alfa-fetoprotein (AFP) and beta-human chorionic gonadotropin (beta-hCG), that can help to gauge the extent of cancer.

Expected Duration

In many people, testicular cancer develops slowly and may remain undetected for years. Like all cancers, testicular cancer will continue to grow and possibly spread until it is treated.

Prevention

There is no way to prevent most cases of testicular cancer. Men who had an undescended testicle at birth should be monitored regularly for early signs of cancer.

Treatment

Treatment of testicular cancer depends on the cancer's stage, which indicates how far the cancer has spread. The stages of testicular cancer are:

• Stage I Cancer is found only in the testicles.
• Stage II Cancer has spread to nearby lymph nodes in the abdomen or pelvis.
• Stage III Cancer has spread beyond the local lymph nodes to the lungs, brain, liver or other parts of the body; or cancer has spread to nearby lymph nodes and levels of tumor-marker proteins in the blood are elevated markedly.
• Recurrent Cancer has returned after prior treatment.

The treatment for most stages of testicular cancer is to remove the testicle. In this procedure, the surgeon removes the testicle through an incision in the groin. Before the surgery and three weeks after surgery, blood tests will be done to measure levels of tumor markers, including beta-hCG and alfa-fetoprotein. In some patients, additional surgery (called retroperitoneal lymph node dissection) will be needed to check whether the cancer has spread to lymph nodes in the groin and lower back.

After surgery, the treatment of testicular cancer varies according to the cancer's stage. Most men will require additional treatment such as radiation or chemotherapy, but a few men may require only close observation.

After treatment, regular follow-up exams are critical to make certain that the cancer is gone. For the first two years, patients are examined every one to two months, and blood tests, X-rays and CT scans are done. Then, check-ups taper off to once or twice yearly.

When To Call A Professional

Contact your doctor if you discover any lumps on the testicles or in the scrotum, or if you develop persistent pain and swelling of either testicle.

Prognosis

Testicular cancer usually can be cured if it is detected and treated early. However, this type of cancer can spread silently and quickly, meaning that some men will not be diagnosed until the disease is in an advanced stage.

Most men with testicular cancer have an excellent prognosis. Men with Stage I disease are very likely to be cured with surgery and radiation therapy. Men with Stage II testicular cancer have a very good prognosis following surgery and radiation or chemotherapy. Even the small percent of men with the most advanced cases still have a 5-year survival rate of about 50%.

People who have been cured of testicular cancer involving 1 testicle have a 2% to 5% risk that they will develop cancer in the other testicle at some point in their lives.

Additional Info

National Cancer Institute (NCI)

U.S. National Institutes of Health

Public Inquiries Office

Building 31, Room 10A03

31 Center Drive, MSC 8322

Bethesda, MD 20892-2580

Phone: 301-435-3848

Toll-Free: 1-800-422-6237

TTY: 1-800-332-8615

Email: cancergovstaff@mail.nih.gov

http://www.nci.nih.gov/

American Cancer Society (ACS)

1599 Clifton Road, NE

Atlanta, GA 30329-4251

Toll-Free: 1-800-227-2345

http://www.cancer.org/