Testicular Cancer

What is testicular cancer?

Cancer that develops in a testicle is testicular cancer. When testicular cancer spreads (metastasizes), the cancer cells are carried by the bloodstream or by lymph. (Lymph is an almost colorless fluid produced by tissues all over the body. The fluid passes through lymph nodes, which filter out bacteria and other abnormal substances such as cancer cells.) Surgeons often remove the lymph nodes deep in the abdomen to learn whether testicular cancer cells have spread.

How common is testicular cancer?

It depends on the age of the man. In young men between the ages of 15 and 34, testicular cancer is one of the most common forms of cancer. But the disease also occurs in other age groups, so all men should be aware of its signs and symptoms.

How is testicular cancer usually discovered?

Most testicular cancers are first found by the men themselves who have them. They encounter a tumor in their testicle by accident or when doing testicular self-examination. The testicles are smooth, oval-shaped, and rather firm. Men who examine themselves regularly become familiar with the way their testicles normally feel. Any changes in the way they feel from month to month should be reported without delay to a doctor.

What are the causes of testicular cancer?

Exactly what causes this disease is still unknown and seldom can it be explained why one man gets it while another doesn't.

Although any man can develop testicular cancer, testicular cancer accounts for only about 1 percent of all cancers in American men. Testicular cancer is, as noted, quite unusual in its age distribution. Whereas most other types of cancer affect mostly older men (or children), but testicular cancer most often occurs in young postadolescent men. (It is also inexplicably more common in white men than in black men.)

Testicular cancer is not contagious. No one can "catch" testicular cancer (or any other form of cancer) from another person.

Research has shown that some men are more likely than others to develop testicular cancer. For example, the risk is higher than average for boys born with their testicles in the lower abdomen rather than in the scrotum. The cancer risk for boys with this condition (called undescended testicles or cryptorchidism) is increased if the problem is not corrected in early childhood.

Some men whose mothers took a hormone called DES (diethylstilbestrol) during pregnancy to prevent miscarriage have testicular abnormalities. But scientists do not know whether prenatal exposure to DES (or any other female hormone) increases the risk of testicular cancer.

Some patients with testicular cancer have a history of injury to the scrotum. But no one knows whether such an injury can actually cause cancer. Many doctors think such an injury simply calls attention to a tumor that was already growing.

What are the signs and symptoms of testicular cancer?

Testicular cancer can cause a number of signs and symptoms. Listed below are warning signs that men should watch for:

These symptoms are not sure signs of cancer. They can also be caused by other conditions. However, it is important to see a doctor if any of these symptoms lasts as long as 2 weeks. Any illness should be diagnosed and treated as soon as possible. Early diagnosis of testicular cancer is especially important because the sooner cancer is found and treated, the better a man's chance for complete recovery.

How is testicular cancer diagnosed?

When a man's symptoms suggest that there might be cancer in a testicle, a personal and family medical history is taken a complete physical examination is conducted. In addition to checking general signs of health (temperature, pulse, blood pressure, and so on), the scrotum will be carefully examined. The patient will usually have a chest x-ray and blood and urine tests. If the physical exam and lab tests do not show an infection or another disorder, cancer is suspected because most tumors in the testicles are cancerous.

The only sure way to know whether cancer is present is for a pathologist to examine a sample of tissue under a microscope. To obtain the tissue, the affected testicle is removed through the groin. This operation is called inguinal orchiectomy. The surgeon does not cut through the scrotum and does not remove just a part of the testicle because, if the problem is cancer, cutting through the outer layer of the testicle might cause local spread of the disease.

The most common types of testicular cancer are seminoma and nonseminoma.

Seminomas make up about 40 percent of all cases. Nonseminomas are actually a group of cancers and comprise 60 percent of cases. They include choriocarcinoma, embryonal carcinoma, teratoma, and yolk sac tumors. Each of these two major types of testicular cancer grows and spreads differently, and they are treated differently.

How is testicular cancer treated?

Testicular cancer is almost always curable if it is found early. This disease responds well to treatment, even if it has spread to other parts of the body.

Staging

If a man has testicular cancer, it is important to find out the extent, or stage, of the disease (whether it has spread from the testicle to other parts of the body). Staging procedures include a thorough physical exam, blood tests, x-rays and scans, and, in some cases, additional surgery.

Most patients have computed tomography, also called CT or CAT scan, which is a series of x-rays of various sections of the body. Some have intravenous pyelography (IVP), x-rays used with a special dye to outline the urinary system. Some doctors recommend lymphangiography, x-rays taken with a special dye that outlines the lymph system in the abdomen. Ultrasonography, which creates a picture from the echoes of high-frequency sound waves bounced off internal organs, also may be useful.

Special lab tests can reveal certain substances in the blood. These substances are called tumor markers because they often are found in abnormal amounts in patients with some types of cancer. The levels of specific tumor markers in the blood can help the doctor determine what type of testicular cancer the patient has.

Surgery may be recommended to remove the lymph nodes deep in the abdomen. A pathologist then examines the nodes to determine whether they contain cancer cells. For patients with nonseminoma, removing the nodes helps stop the spread of their disease. Seminoma patients do not need this surgery because cancer cells in their lymph nodes can be destroyed with radiation therapy.

Methods of Treating Testicular Cancer

Testicular cancer can be treated with surgery, radiation therapy, and chemotherapy. One method or a combination of methods may used. Often, the patient is referred to medical centers that specialize in testicular cancer treatment.

Surgery

In most cases, surgery is performed to remove the testicle. Sometimes it also is necessary to remove lymph nodes in the abdomen. Additionally, tumors that have spread to other parts of the body may be partly or entirely removed by surgery.

Radiation Therapy

In radiation therapy (also called x-ray therapy, radiotherapy, cobalt treatment, or irradiation), high-energy rays are used to damage cancer cells and stop their growth. Like surgery, radiation therapy is a local treatment and affects only the cells in the treated area. The patient usually receives radiation therapy as an outpatient.

Seminomas are highly sensitive to radiation. Following surgery, men with seminomas generally have radiation therapy to their abdominal lymph nodes.

Nonseminomas are somewhat less sensitive to radiation. Patients with this type of cancer usually have other types of treatment.

Chemotherapy

The use of drugs to treat cancer is called chemotherapy. Anticancer drugs are recommended when there are signs that the cancer has spread. Chemotherapy is also sometimes used when the doctor suspects that undetected cancer cells remain in the body after surgery or irradiation. The use of anticancer drugs following surgery for early stage cancer is known as adjuvant therapy.

Chemotherapy may be given by mouth or injected into a muscle or a blood vessel. Chemotherapy is a systemic treatment, the drugs enter the bloodstream and reach cells all over the body. Depending on the specific drugs and the patient's general condition, chemotherapy may be taken as an outpatient at the hospital, at the doctor's office, or at home. However, some patients must be hospitalized for a time, so that effects of the treatment can be monitored.

What does the future hold for testicular cancer?

More than 8 million Americans living today have had some type of cancer. The outlook for men with testicular cancer is excellent . Because researchers have found better ways to diagnose and treat this disease, the chance of recovering has improved dramatically. Today, a large majority of testicular cancer patients are cured by their initial treatment, and many of those who have a recurrence can be cured too.

Scientists at hospitals and medical centers throughout the United States are studying testicular cancer. They are working toward a better understanding of its causes, prevention, diagnosis, and treatment. Researchers are looking for additional tumor markers that may be present in abnormal amounts in the blood or urine of a person with very early testicular cancer. If such markers are found, it might be possible to detect testicular cancer even before any symptoms are noticed. Several such markers have been studied, and research is continuing. Researchers are also looking for treatment methods that are more effective and easier for patients to tolerate. They are studying new drugs and drug combinations, varied doses, and different treatment schedules.