Testicular Cancer

Testicular cancer is cancer which develops in the testicles. It is the most common cancer for men younger than 40. Approximately 8,850 men are diagnosed with testicular cancer in the United States each year.

Risk Factors

• Race. White men develop testicular cancer more often than men of other races.
• Scandinavian ancestry.
• Age. Testicular cancer most often occurs in men between the ages of 20 and 39.
• Undescended testicle. If one testicle has not moved down into the scrotum before birth, both testicles have a greater risk of developing cancer.
• Certain congenital abnormalities. Men with abnormalities of the testicles, penis and/or kidneys have a greater risk of testicular cancer.
• Hernia in the groin.
• Previous testicular cancer. Men who have had cancer in one testicle have a greater risk of developing it in the other.
• Family history. Men with a father or brother who has had testicular cancer are at greater risk of developing the condition.

Warning Signs

• A lump in one or both testicles.
• Painful testicle or scrotum.
• Enlarged testicle.
• Change in the way a testicle feels.
• The scrotum feels heavy.
• Aching abdomen, lower back or groin.
• Fluid collects in the scrotum.

Detection, Diagnosis and Staging

Detection

Men between the ages of 15 and 39 should examine their testicles monthly. An abnormal lump or change in the way a testicle feels can indicate testicular cancer.

Diagnosis

When self-examination reveals an abnormality in a testicle, a doctor will perform or order examinations and/or tests to diagnose the condition.

• Physical examination. The doctor feels the testicle for abnormalities and examines the abdomen to determine if there are any swollen lymph nodes.
• Blood tests. A blood sample is analyzed to determine if tumor markers are present. Elevated levels of alpha-fetoprotein, beta human chorionic gonadotropin and lactate dehydrogenase are often – but not always – found in patients with testicular cancer.
• Ultrasound. Sound waves reflected off internal tissue create an image in which tumors can be differentiated from healthy tissue.
• Biopsy. The entire testicle is removed and examined by a pathologist. When the patient has only one testicle, a small sample of the affected tissue is removed and analyzed by a pathologist. If cancer is found, the surgeon proceeds with removal of the testicle.

Diagnostic tests will also determine which type of testicular cancer is present.

• Seminomas. These less-aggressive cancers respond well to radiation therapy.
• Non-seminomas. These faster-growing cancer are less susceptible to radiation therapy.
• Both type cells present. Some testicular cancer tumors contain both types of cells. These tumors are treated as non-seminomas, since those are the more aggressive cells.

Staging

Testicular cancer staging is determined by the extent to which the disease has spread.

• Stage 0: cancer has not spread beyond the testicle. This is also called carcinoma in situ.
• Stage IA: cancer is in the testicle and has spread to the membrane around the testicle.
• Stage IB: cancer is in the testicle and has spread to the blood or lymph nodes.
• Stage IIA: (also called nonbulky Stage II) cancer is in the testicle and has spread to five or fewer lymph nodes in the abdomen. No tumor is larger than two centimeters (slightly larger than ¾”).
• Stage IIB: (also called bulky Stage II) cancer is in the testicle and has spread to as many as five lymph nodes in the abdomen. One of the lymph node tumors is larger than 2 centimeters.
• Nonbulky Stage III: cancer is in the testicle and has spread to the lungs and/or lymph nodes in other parts of the body. No tumor is larger than two centimeters.
• Bulky Stage III: cancer is in the testicle and has spread to lymph nodes in other parts of the body and/or to organs other than the lungs. Some tumors are larger than two centimeters.
• Recurrent testicular cancer: cancer which returns either to the testicle or to another area after treatment.

Diagnostic procedures used to stage testicular cancer include:

• MRI. A magnetic resonance imaging scan provides precise images of areas of interest.
• CT. A computed tomography scan with contrast agent provides a precise structural image of the affected testicle.
• PET (positron emission tomography) scan to detect unusual metabolic activity at a molecular level.
• PET-CT. A combined PET and CT scan can simultaneously find microscopic cancers, determine how aggressive they are and map them precisely.

Treatment

Although treatment may vary depending on the type and stage of testicular cancer and the patient’s age and health, surgery is almost always recommended.

Surgery

In most cases the affected testicle is removed through an incision in the groin. Some abdominal lymph nodes may be removed at the same time. Removal of a single testicle does not cause impotence or sterility. Nerve-sparing surgical techniques are often used in removing lymph nodes to preserve the patient’s ability to ejaculate.

Chemotherapy

Chemotherapy for testicular cancer is usually done after surgery to destroy cancer cells that may still be in other parts of the body.

Chemotherapy attacks testicular cancer with drugs that either kill cancer cells or stop them from dividing or with drugs that prevent the growth of new blood vessels needed to sustain a tumor.

Chemotherapy for testicular cancer is a systemic treatment, in which drugs are injected into the bloodstream and effect all parts of the body.

Radiation therapy

Radiation therapy is used to treat seminomas after surgery.

Radiation therapy for testicular cancer uses external beams shaped to the contours of the area to be treated. This IMRT (intensity modulated radiation therapy) delivers an optimum dose to lymph nodes and other areas in which cancer cells may remain after surgery with minimum effect on other areas of the body.

High-dose chemotherapy and/or radiation

Advanced or recurrent testicular cancer is often treated with high-dose radiation therapy and/or high-dose chemotherapy.