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Testicular Cancer

Testicular cancer occurs when cells in the testicles, or testes, grow and multiply uncontrollably, damaging surrounding tissue and interfering with the normal function of the testicle. If the disease spreads, it is still called testicular cancer. Testicular cancer occurs most often in younger men. It is the most common cancer in men between ages 20 and 34. However, it accounts for only 1 percent of all cancers that occur in men. When testicular cancer is detected early, there is nearly a 99 percent chance for cure.

Types

There are two basic types of testicular cancer, each with several subtypes:

Germ cell tumors occur in the cells that produce sperm. Tumor types include:
Seminomas, responsible for 50 percent of all testicular cancer cases. They are generally slow-growing and very responsive to treatment.

Nonseminomas tend to grow and spread faster than seminomas. Tumor types include embryonal carcinoma (about 20 percent of all testicular cancers); yolk sac carcinoma (most common in infants and young boys); choriocarcinoma, a rare and extremely aggressive cancer; and teratomas.

Stromal tumors occur in the testicular tissue where hormones are produced. Stromal tumor types include Leydig cell tumors, which occur in the cells that produce male sex hormones, and Sertoli cell tumors, which occur in the cells that provide nourishment to germ cells.

Symptoms

Symptoms of testicular cancer vary and may include any of the following:

  • Small, hard lump that is often painless
  • Change in consistency of the testicles
  • Feeling of heaviness in the scrotum
  • Dull ache in the lower abdomen or the groin
  • Sudden collection of fluid in the scrotum
  • Pain or discomfort in a testicle or in the scrotum

Many of these symptoms are not cancer, but if you notice one or more of them for more than two weeks, see your doctor.

Diagnosis

Diagnosing testicular cancer almost always involves surgical removal of the testicle (orchiectomy). An incision is made in the groin rather than the scrotum, to avoid possibly spreading cancer cells. A tissue sample from the testicle is examined under a microscope to determine the presence of cancer cells and the stage of the disease.

Special blood tests that detect certain protein "markers" are used to diagnose and stage testicular cancer both before and after orchiectomy. These tests include:

  • Alpha-fetoprotein (AFP): elevated levels of this protein, which is normally produced by a fetus in the womb, may indicate the presence of a germ cell tumor in men. Beta human chorionic gonadotropin (b-HCG): increased levels of this protein, normally found in pregnant women, can indicate the presence of several types of cancer, including testicular cancer.
  • Lactate dehydrogenase (LDH): this enzyme is related to increased energy production by the body's cells and tissues, which can sometimes indicate cancer. Ultrasound may also be used before surgery to determine the presence of a mass on the testicle.

Treatment

Surgery

Surgery to remove a cancerous testicle is called orchiectomy. In most cases, orchiectomy is performed during testicular cancer diagnosis. The testicle is removed through an incision in the groin, and tissue samples are examined to determine the stage of the cancer.

For some patients, especially those with nonseminoma testicular cancers, surgery may also involve removal of lymph nodes in the abdominal area.

Retroperitoneal lymph node dissection, or RPLND, is either done at the same time as the orchiectomy, or in a second surgical procedure. Standard RPLND requires a large abdominal incision and several days of recovery time in a hospital. This procedure can also be done with laparoscopy, a minimally invasive surgery technique that uses much smaller incisions.

Because both surgical procedures may affect fertility, and because most testicular cancers occur in young men, it's important for patients to discuss sperm-banking with their doctor. If the patient wants to start a family at some point, their sperm cells are collected before cancer treatment and frozen for future use.

For men who may be uncomfortable with their appearance after orchiectomy, they can have a prosthesis implanted in their scrotum that provides the look and feel of a real testicle.

Radiation Therapy

Seminomas, which are the most common form of testicular tumor, are very sensitive to radiation treatment. In fact, the treatment dosage is only about one-third of that required for prostate cancer, and the treatment cycle is only two weeks.

Radiation is performed after surgery to remove the testicle (orchiectomy). If the tumor was a seminoma, the oncologist may choose "active surveillance" to see if the cancer returns, or use radiation to treat the lymph nodes along the spine, where 20 percent of recurrences are located. Even if the cancer comes back, it is still very treatable with either radiation or chemotherapy in the majority of cases. Radiation treatment has an average recurrence rate of about 5 percent. Radiation can also be used after chemotherapy if any cancer remains.

Other types of testicular cancers are more resistant to radiation, and are more commonly treated with orchiectomy and removal of affected lymph nodes.

Chemotherapy

Chemotherapy is most often used in conjunction with surgery to remove the testicle. For men with advanced tumors that have spread beyond the testicle or metastasized to distant areas of the body, chemotherapy is administered after surgery to make sure all of the cancer cells have been destroyed.