About Testicular Cancer
The testicles (also called the testes) are a pair of male sex glands located under the penis in a sac-like pouch called the scrotum. They produce male sex hormones and sperm. Testicular cancer is a disease in which malignant cells are found in one or both testicles. It accounts for only 1 percent of all cancers in men, but it is the most common type of cancer in young men between the ages of 15 and 35.
Testicular cancer is highly treatable and often curable.
What are the different types of testicular cancer?
There are many different forms of testicular cancer, but most types begin in immature cells called germ cells, which develop into sperm. The two main types of germ cell tumors are seminomas and nonseminomas. Many testicular tumors have features of both forms.
The various types of testicular cancers differ in their prognosis (survival outlook) and in the ways they are treated. Seminomas are the most curable of testicular cancers, as they grow very slowly and do not spread to other parts of the body. They account for about 30 percent of all testicular cancers and are typically found in men in their 30s through 50s.
Nonseminomas are made up of more specialized cells. They usually develop earlier in life, most often occurring in men in their 20s. The main types of nonseminoma germ cell tumors are teratoma, embryonal carcinoma, yolk sac carcinoma, and choriocarcinoma.
What are the risk factors associated with testicular cancer?
The specific causes of testicular cancer are not known. However, research has revealed several factors that increase a man’s risk of developing the disease. These include:
Cryptorchidism (undescended testicles): About 14 percent of testicular cancers occur in men with a history of cryptorchidism, making this condition the most significant risk factor for testicular cancer. In a normal fetus, the testicles develop in the abdomen and descend into the scrotum before birth. But, in about 3 percent of boys, one or both testicles remain in the abdomen or do not descend all the way into the scrotum. Cryptorchidism often corrects by itself during the child’s first year of life, but sometimes surgery is performed to place the testicle in the scrotum. Even when the condition is corrected, however, there is still a greater risk of testicular cancer.
Family history: A family history of testicular cancer increases the risk. If one man has the disease, there is an increased risk that one or more of his brothers will also develop it.
Race and ethnicity: For reasons unknown, white American men have a risk of developing testicular cancer four-to-five times higher than African-American men and about two times higher than Asian-American men. The risk of Hispanic men falls between that of Asians and whites. Over the past 40 years, the risk of testicular cancer has more than doubled for white American men but has not changed for African-American men.
Carcinoma in situ (CIS): Carcinoma in situ (CIS) refers to cancer that is limited to the layer of tissue where it originated. It does not produce a mass or any symptoms. However, CIS in the testicles almost always spreads. In some cases, CIS is detected in men who undergo a testicular biopsy during medical evaluation for infertility.
Cancer of the other testicle: Men who have been cured of cancer in one testicle are at increased risk of developing cancer in the other testicle.
Can injury to the testicles cause cancer?
There is no convincing evidence that injury to the testicles increases the risk of developing cancer.
Does getting a vasectomy raise the risk of testicular cancer?
Some earlier studies did suggest that vasectomy (an operation to produce sterility) might increase the risk of testicular cancer. However, recent studies have not found any increased risk among men who have had the operation.
Can anything be done to prevent testicular cancer?
Unfortunately, we have no control over the known risk factors for testicular cancer, such as cryptorchidism, white race, and a family history of the disease.What’s more, many men with testicular cancer don’t even have any of the known risk factors. It is therefore not currently possible to prevent most cases of this disease. Fortunately, testicular cancer can often be cured.
How is testicular cancer detected? What are the symptoms?
Most testicular cancers are found by men themselves, and some are found during routine physical exams, when the doctor examines the testicles. If a man notices any of the following signs or symptoms between checkups, he should see his doctor immediately:
- A painless lump or swelling in either testicle;
- 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 or the groin;
- Pain or discomfort in a testicle or in the scrotum.
These symptoms can be caused by conditions other than cancer (for example, testicle injury or inflammation of the testicle, known as orchitis, usually caused by viral or bacterial infections), but it is important to see a doctor to evaluate the cause.
What diagnostic tests are used to identify testicular cancer?
To investigate the cause of any symptoms, the first step is a physical exam by a doctor, who can feel for a hard lump, swelling, or tenderness, as well as the size and location of any mass. The doctor may then order several diagnostic tests.
Ultrasound: During an ultrasound, sound waves are bounced off tissues and organs. Their echoes produce an image called a sonogram. Ultrasound can show the presence and size of a mass in the testicle and can be used to rule out other conditions and to distinguish some benign growths from malignancies.
Blood tests: Tumor markers are substances often found at elevated levels in the blood when cancer is present in the body. Blood tests to measure levels of these markers may detect a tumor that is too small to be felt or picked up by ultrasound. Tumor markers for testicular cancer include alphafetoprotein (AFP), beta human chorionic gonadotropin (B-HCG), and lactate dehydrogenase (LDH).
These blood tests can be used both to screen for cancer and to monitor treatment. If levels of the proteins rise after treatment, it may indicate a recurrence.
Surgery: When a cancerous tumor is suspected, the doctor will recommend a biopsy, which involves surgery to remove the testicle so that the tissue can be examined microscopically by a pathologist. The surgery, performed by a urologist, is the only way to know for sure if cancer is present. In almost all cases, the entire testicle is removed through an incision in the groin (not through an incision in the scrotum, because if cancer is found, this approach could cause the disease to spread). The biopsy procedure is
called radical inguinal orchiectomy.
What are the stages of testicular cancer?
Once cancer is found, the doctor will perform more tests to determine whether the cancer has spread beyond the testicle to other parts of the body. This process is called staging.
The basic stages of testicular cancer are:
Stage I: cancer growth is limited to one or both testicles.
Stage II: cancer has spread to the lymph nodes in the abdomen.
Stage III: cancer has spread beyond the lymph nodes into the abdomen, chest, or pelvis. There may be cancer in the lungs or the liver.
Recurrent: Recurrent disease means the cancer has come back after it has been treated. It can recur in the same place or in another part of the body.
How is testicular cancer treated?
Treatment for testicular cancer depends on the stage and cell type of the
disease, as well as the patient’s overall health. Four kinds of treatment are used:
Surgery to remove the cancerous growth is the primary method of treatment and is performed at the same time as the initial, diagnostic surgery (radical inguinal orchiectomy). The entire testicle is removed. The other testicle is not removed, allowing the patient to make adequate levels of male hormones and sperm, and the patient can still have a normal erection.
If both testicles need to be removed, surgery will cause infertility, but it will not make a man impotent. The patient will need life-long hormone replacement therapy.
With certain types of tumors, the lymph nodes in the abdomen may also be removed (retroperitoneal lymph node dissection), because the cancer tends to spread there first. This type of surgery may damage nearby nerves, causing retrograde ejaculation, in which semen is ejaculated into the bladder. This will cause infertility. (It does not affect the ability to have an erection or orgasm.) New nerve-sparing surgical techniques can prevent
retrograde ejaculation, and patients should ask their doctors whether they are candidates for such surgery.
Radiation therapy may also be used for treatment, especially for a seminoma. (Seminomas are highly sensitive to radiation; nonseminomas are less responsive.) Radiation therapy usually targets the lymph nodes in the abdomen to try to destroy cancer cells that have spread. For testicular cancer, the radiation comes from a machine outside the body (externalbeam radiation).
Chemotherapy is used for testicular cancer that has spread outside the testicle. The prognosis depends on the type and extent of the tumor, but advanced testicular cancer can frequently be cured with a combination of surgery and chemotherapy.
Most men with testicular cancer can be cured with surgery, radiation therapy, and/or chemotherapy. This is a testament to the significant strides made in cancer therapies.
Bone marrow transplantation is a newer, somewhat controversial type of treatment in which bone marrow is taken from the patient and treated with drugs to kill any cancer cells. The marrow is then frozen while the patient undergoes high-dose chemotherapy with or without radiation therapy to destroy all the remaining marrow. The frozen marrow is then thawed and transplanted back into the patient.
Does testicular cancer cause impotence or infertility?
Diagnostic surgery in which one testicle is removed should preserve normal sexual function and fertility. If both testicles are removed, sexual function should be preserved but fertility will be lost. When surgery includes removal of lymph nodes in the abdomen, there may be damage to nearby nerves. This will lead to infertility but will not cause impotence.
Sperm banking – storing sperm at a facility – is recommended for men diagnosed with testicular cancer, because treatment may affect fertility.
Testicular Cancer Self-detection Guide
Monthly self-examination for testicular cancer
- Take a warm bath or shower to relax the scrotal skin and stand in front of a mirror.
- Look for any swelling on the skin of the scrotum.
- Examine each testicle gently with both hands. The index and middle fingers should be placed underneath the testicle while the thumbs are placed on the top. Roll the testicle gently between the thumbs and fingers. Find the epididymis – a cord-like structure on the top and back of the testicle that stores and transports sperm. Do not confuse the epididymis with an abnormal lump.
Feel for a small lump about the size of a pea on the front or side of the testicle. These lumps are usually painless. If you do find a lump, contact your doctor right away. The lumpmay be due to an infection, and a doctor can determine the proper treatment. If the lump is cancer, remember that testicular cancer is highly curable – especially when