What is testicular cancer?

Related conditions:
Testicular tumors, germ-cell tumors, cryptorchidism, male infertility

Definition:

Testicular cancer is the development of tumors in the testicles, or male sex glands.

Risk factors: A significant risk factor associated with testicular cancer is a history of an undescended testicle (cryptorchidism). Research has shown that men who have any type of abnormal development of the testicles are at an increased risk of developing testicular cancer. A history of testicular cancer in an indivdual or their family is another strong risk factor. Male factor infertility has also been shown to be associated with a higher rate of testicular cancer. Some studies have suggested that exposure to the synthetic hormone diethylstilbestrol (DES) during fetal development can lead to increased risk of testicular cancer, though a consensus has not been reached.

Etiology and the disease process: Testicular tumors originate in the germ cells, or embryonic cells that develop into sperm cells, in 95 percent of cases. These tumors can be divided into seminomas or nonseminomas. Seminomas are responsible for 30–40 percent of all testicular cancers, are slow to grow, and usually remain in the testicle. These types of tumors are very responsive to both radiation therapy and chemotherapy. Nonseminomas are cancers that occur in combination with other types of cancers and arise from more mature germ cells. These cancers are more aggressive in growth and respond well to chemotherapy. Rarely tumors leading to testicular cancer include Leydig and Sertoli cell tumors, leiomyosarcoma, rhabdomyosarcoma, and mesothelioma.

Incidence: Approximately two to five men in one hundred thousand develop testicular cancer each year, accounting for 1–2 percent of all male cancer, but it is the most common malignancy in men between the ages of fifteen and thirty-four. Caucasians are more likely to be diagnosed than are Hispanics or African Americans. Male infants and men over sixty have also infrequently been diagnosed with the disease.

Symptoms: Symptoms of testicular cancer most often include a painless lump in one testicle or enlarged testicles, with painful swelling reported in 10–15 percent of cases. Other symptoms include an increase in fluid in the scrotum, a feeling of heaviness in the scrotum, a dull ache in the groin or lower abdomen, or enlargement or tenderness of the breasts (gynecomastia).

Screening and diagnosis: The most effective screening mechanism for testicular cancer is the testicular self-examination (TSE). It involves a manual exam of the testicles to feel for any suspicious lumps and can be performed at home.

If testicular cancer is suspected, the physician conducts a medical history and physical exam. In addition to carefully examining the scrotum, the physician will order an ultrasound, chest X-ray, and blood and urine tests.

A procedure called a serum marker test may be performed to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the blood. Certain substances, called tumor markers, are linked to specific types of cancer when found in increased levels in the blood. Three tumor markers are used in staging testicular cancer: alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-HCG), and lactate dehydrogenase (LDH) if ultrasound reveals a solid mass in the testicle.

Testicular tumors may easily be misdiagnosed as epididymitis, so if a lump or mass on the testicle if found it is very important to rule out testicular cancer early on. This may involve obtaining a second opinion if the patient is not offered an ultrasound at the first discovery of a lump in the testicle.

A procedure called a lymphangiography may also be used to X-ray the lymph system. In this procedure, a dye is injected into the lymph vessels in the feet to observe any possible blockages. This test helps determine whether cancer has spread to the lymph nodes.

The only way to confirm diagnosis of testicular cancer is by removal of the testis (orchiectomy). Biopsy of the tumor is not an option because of the risk of malignancy of any remaining cancerous cells in the testis.

After removal of the suspicious testicle, the tumor is staged by a pathologist. The size of the tumor is irrelevant to the stage of the cancer.

• Stage I: Cancer is only in the testis.





• Stage II: Cancer is in the testis and lymph nodes.





• Stage III: Cancer in the testis has spread to remote sites in the body (for example, the lungs, brain, liver, or bones).

Treatment and therapy: Almost all treatment involves surgically removing the testicle (orchiectomy). This is necessary because of the risk of any remaining cancer cells becoming malignant and spreading to other parts of the body. The risk of surgery is very low, and most men can maintain a normal reproductive life with one testicle. Sometimes surgery will include removing the lymph nodes in the abdomen if the cancer has spread.

Radiation therapy uses high-energy rays to kill localized cancer cells. Seminomas are highly sensitive to radiation, and most men will receive this therapy for their lymph nodes following surgery. Radiation is ineffective with nonseminomas.

Chemotherapy is a treatment whereby drugs are inserted into the bloodstream (either via a vein or taken orally) to treat the entire body. This treatment is used if the physician suspects cancer cells have spread, or if the cells are suspected to remain after surgery or radiation therapy.

Tumor-marker levels are measured again, after radical inguinal orchiectomy and biopsy, to determine the stage of the cancer. This helps to show if all the cancer has been removed or if more treatment is needed. Tumor-marker levels are also measured during follow-up as a way of checking if the cancer has come back.

Prognosis, prevention, and outcomes: Although testicular cancer is the most common malignancy in men between the ages of fifteen and thirty-five, it has a relatively high survival rate. It is almost always curable if discovered early on. It responds well to treatment even when it has spread to other parts of the body.

Men diagnosed with Stage I or II seminoma have a five-year survival rate of nearly 100 percent, while the overall rate is around 85–90 percent. Total cure rates are approximately 80 percent, but the aggressive anaplastic seminoma variation carries only a 10 percent cure rate.

Generally after removal of one testis, a man can lead a life of normal fertility because the remaining testis increases production of testosterone and sperm cells. In the case of men who have decreased fertility before surgery, it may be prudent to consider sperm banking (freezing sperm for later use) if he wants to have children.

Testicular cancer has a low recurrence rate, with most instances occurring within two years. If cancer is rarely found in the other testicle, but if so it may be treated in the same manner. The patient will then need to take hormone supplements such as testosterone (produced in the testes) and will be infertile but otherwise will lead a normal life.

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Parker, James N., and Philip M. Parker, eds. The Official Patient’s Sourcebook on Testicular Cancer: A Revised and Updated Directory for the Internet Age. San Diego: Icon Health, 2002. Print.

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