Testicular cancer develops in the tissues of one or both testicles (also called testes). The testicles are the male sex glands that are located behind the penis in the scrotum. They produce several male hormones (primarily testosterone), and they also produce and store sperm, the male reproductive cells.
There are different types of testicular cancer. They are determined by the type of testicular cell from which the cancer originates:
- Germ cell tumors — About 95 percent of testicular cancers develop in germ cells, the special sperm-forming cells within the testicles. In seminomas (40 percent of all testicular cancers) the cancer arises from immature germ cells, and it tends to grow slowly. It also tends to stay within the testicles for a long period without spreading. Nonseminomas, on the other hand, arise from more mature germ cells and tend to spread aggressively, especially to lymph nodes (bean-shaped structures throughout the body that produce and store infection-fighting cells).
- Tumors of supportive tissues — About 5 percent of testicular cancers arise in the testicles’ supporting tissues (tissue that does not produce sperm). These cancers are called Sertoli cell tumors and Leydig cell tumors.
Once a testicular cancer develops, it can remain within the testicle, or it can spread to lymph nodes in the abdomen. If it remains undetected, testicular cancer eventually can spread to the lungs, brain, liver and elsewhere throughout the body.
Testicular cancer is uncommon. It accounts for only 1 percent of all cancers in American men, and it strikes only two to three of every 100,000 males in the United States annually. Testicular cancer is seen most commonly in younger men between the ages of 20 and 40. It occurs eight times more often in white men than in black men. Although the specific cause of testicular cancer remains unknown, the illness is more common in men who had an undescended testicle at birth (often the right testicle). There also may be a connection between certain genetic conditions (such as Klinefelter’s syndrome) and occupational exposures.
The most common symptom of testicular cancer is a painless lump in the testicle. This lump can be small or large. In some men, there also can be testicular discomfort or swelling that can mimic an infection. If cancer has spread beyond the testicle, there can be back pain, shortness of breath (due to lung involvement) and breast swelling or tenderness.
If you have come to the doctor because you noticed a lump in your testicle or other symptoms, your doctor will ask when you first noticed the problem and whether your symptoms have worsened over time. He or she will want to examine the testicle and feel for swollen lymph nodes. Be sure to tell the doctor if either of your testicles was not descended at birth. Your doctor also may examine your testicles at the time of a routine physical to make sure there are no lumps or areas of tenderness.
Your doctor may suspect testicular cancer based on your symptoms or findings during your physical exam, such as a hard lump or area of tenderness. To determine whether a soft lump is solid or fluid-filled, your doctor may use a small flashlight to see if light can be transmitted through the lump.
The physical examination may be followed by:
- Ultrasonography — In this procedure, high-frequency sound waves are used to check for a mass inside the testicle and for abnormal accumulations of fluid.
- Magnetic resonance imaging (MRI) or computed tomography (CT) scans — These painless techniques use magnetic fields or X-rays to create images of the abdomen, checking for abnormal masses and enlarged lymph nodes.
- Chest X-ray — This will check for the spread of cancer to the lung.
Ultimately, the best way to confirm the diagnosis of testicular cancer is to perform an orchiectomy (surgical removal of the affected testicle). After surgery, the testicle will be examined in the laboratory to determine if cancer is present, and if so, the specific type. Blood tests also will be performed to measure levels of two proteins, alfa-fetoprotein (AFP) and beta-human chorionic gonadotropin (HCG), which serve as chemical markers for the presence of testicular cancers.
In many patients, testicular cancer develops slowly and may remain undetected for years. Like all cancers, testicular cancer will continue to grow and possibly spread until treatment is provided.
Although there is currently no way to prevent testicular cancer, monthly testicular self-examination can detect cancer in its earliest stages. Self-examination is best performed after a warm shower when the testicles are most descended and the skin of the scrotum is relaxed.
To perform a testicular self-examination, roll each testicle between the thumb and fingers, being sure to feel the entire surface from top to bottom. Feel for any nodules, lumps, swellings or tenderness. Some men may feel the epididymis, a soft structure attached to the top and back of the testicle that is involved in sperm transport and storage. If you suspect that you have discovered something abnormal, make an appointment with your doctor to discuss your findings as soon as possible.
Treatment of testicular cancer depends on the cancer’s stage (extent of cancer spread). Testicular cancer is staged according to the following scheme:
- Stage I — Cancer is found only in the testicles.
- Stage II — Cancer has spread to local lymph nodes in the abdomen or pelvis.
- Stage III — Cancer has spread beyond the local lymph nodes to the lungs, brain, liver or other parts of the body.
- Recurrent — Cancer has returned after prior treatment.
A radical inguinal orchiectomy is the most common initial treatment for most stages of testicular cancer. In this procedure, the surgeon removes the testicle through an incision in the groin. Before and three weeks after surgery, blood levels of beta-HCG and alfa-fetoprotein are measured.
After surgery, the treatment of testicular cancer varies according to the cancer’s stage. Most men will require additional treatment such as radiation or chemotherapy, but a few men may require only close observation. If cancer has spread into lymph nodes within the abdomen it may be necessary to perform further surgery in addition to chemotherapy or radiation.
After treatment, regular follow-up exams are critical to make certain that the cancer is totally gone. For the first two years, patients are examined every one to two months, and blood tests, X-rays and CT scans are performed. Then, check-ups taper off to once or twice yearly.
When To Call A Professional
Contact your doctor if you discover any lumps on the testicles or in the scrotum, or develop persistent pain and swelling of either testicle.
Testicular cancer usually is curable if it is detected and treated early. Survival for all stages of testicular cancer is over 95 percent.
In patients who have been cured of testicular cancer involving one testicle, there is a 2 percent to 5 percent risk that they will develop cancer in the other testicle within 25 years.
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American Cancer Society (ACS)1599 Clifton Rd., NE Atlanta, GA 30329-4251 Toll-free: (800) 227-2345