Testicular cancer is a fairly rare form of cancer that develops in the testes, the male reproductive organs located in the scrotum, the loose-skinned pouch below the penis. The testes produce sperm and testosterone. Testicular cancer typically affects men aged 15 to 35. When detected early, it can be treated successfully in more than 95% of cases, so any lumps or changes in your testicles should immediately be reported to your doctor.
Risk Factors
While the cause of testicular cancer is not known, the following factors increase your risk:
- Age - young men aged 15 to 35 are at highest risk
- An undescended testicle, called cryptorchidism
- Klinefelter's Syndrome, where an extra X chromosome results in failure of the testicles
- Family or personal history of testicular cancer
- Race - Caucasian men are at higher risk
Types
Most (95%) testicular cancer originates in undeveloped cells (germ cells) that produce sperm. There are two main types of germ cell testicular cancer:
- Seminomas - tend to be less aggressive and are responsive to radiation therapy
- Nonseminomas - tend to grow and spread rapidly but are responsive to chemotherapy
A small percentage (5%) of testicular cancer develops in the stroma, the hormone producing tissue of the testicles.
Symptoms
Men with testicular cancer usually have no symptoms except for finding a lump in a testicle when performing a self exam or during a doctor’s visit. Symptoms may include:
- Testicular swelling, hardness or pain
- Heavy or aching feeling in the scrotum or lower abdomen
- Pain is not always a sign of cancer but should still be evaluated
Diagnosis
Your doctor will first perform a history and physical that includes feeling your testicles and abdomen for lumps, swelling or enlarged lymph nodes. He may order an ultrasound, CT scan, chest X-ray and blood tests to provide more information to make the diagnosis. Alpha-fetoprotein and HCG (human chorionic gonadotropin) blood tests look for high levels of “tumor markers” that often are coincident with testicular cancer.
Biopsy – when other tests are inconclusive, your doctor may make an incision in your groin and remove suspicious tissue fromthe testicle to examine under a microscope. Treatment with removal of the affected testicular is performed at the same time.
Stages
Once diagnosed with testicular cancer, your doctor will determine your cancer’s stage.
Stage 1 – cancer is confined to the testicle
Stage 2 – cancer has spread to abdominal lymph nodes
Stage 3 – cancer has spread to lymph nodes or organs in other parts of the body
Treatment
Surgery is the primary method of treatment and diagnosis and is usually performed immediately after finding a testis suspicious for cancer. Delay is not advisable. While surgery to remove one testis should not affect your fertility, you may wish to store your sperm in a sperm bank as a precaution. Both radiation and chemotherapy may cause temporary or permanent infertility.
Radical Inguinal Orchiectomy – the most common treatment is this outpatient procedure to remove the cancerous testicle and the attached spermatic cord. Men may elect to have a saline prosthesis, similar to a breast implant, implanted into the scrotum to look and feel like a real testicle.
Retroperitoneal Lymph Node Dissection – if the cancer has spread to your lymph nodes or the diagnosis of the tumor is high grade or unfavorable, your doctor may perform this procedure to remove affected nodes. It requires an incision and general anesthesia. In many cases, this procedure is performed laparoscopically, using several small incisions.
External Beam Radiation Therapy – the most common treatment for patients diagnosed with seminoma cancer. High energy X-rays are precisely targeted at any cancerous cells that have spread to lymph nodes.
Chemotherapy – drugs are given intravenously (IV), by mouth or by injections into a muscle to destroy any cancer cells that remain after surgery. This is done under the direction of an oncologist, a specialist in cancer chemotherapy.