Testicular Cancer

Testicles (also called testes or gonads) are part of the male sex glands located under the penis in an external sac-like pouch called the scrotum. Testes are the main source of testosterone (a male hormone). Germ cells, located within the testicles, produce immature sperm and that sperm remains stored in the testes until it is ejaculated. Some 95 percent of all testicular cancers occur when germ cells in the testes become malignant. The other five percent of testicular cancers derive from Leydig cells (cells found adjacent to the testicles that secrete testosterone) or Sertoli cells (cells that support and nourish germ cells).

Testicular cancer is rare, affecting fewer than 10,000 men in the United States each year. Testicular cancer has a very high cure rate when detected early.


Staging of Testicular Cancer

After removal of a testicular tumor, a pathologist stages the cancer to aid the physician in the development of a treatment plan. Stages of testicular cancer include:

  • Stage I: Cancer remains localized to the testes
  • Stage II: Cancer has metastasized (spread) to the retroperitoneal or paraaortic lymph nodes
  • Stage III: Cancer has metastasized beyond and the retroperitoneal or paraaortic lymph nodes

Symptoms

Risk Factors for Testicular Cancer

Men between the ages of 15 and 35 are at increased risk of developing testicular cancer. The risk seems to rise again after age 60. Other risk factors for testicular cancer include:

  • A family or personal history of testicular cancer
  • Having an undescended testicle (cryptorchidism) or other abnormal testicle development.
  • Being Caucasian
  • Having an extra X chromosome (Klinefelter's syndrome)


Symptoms and Diagnosis for Testicular Cancer

Testicular cancer has an excellent prognosis if caught in the early stages. Men who perform regular testicular self-examinations have a good chance of discovering testicular cancer in its earliest stages. Though a lump or pain in the scrotum does not necessarily result in a diagnosis of cancer, men experiencing the following symptoms should seek medical attention:

  • Swelling, a lump, hardening or buildup of fluid in the testes, with or without pain
  • Unusual changes in the size of the testes
  • Irregular or bumpy testicles
  • A dull ache in the abdomen or groin
  • Loss of sexual activity
  • Blood in the semen

Diagnosis

Following a physical exam, a physician will use one or more of the following tests to confirm or eliminate a diagnosis of testicular cancer:

  • Blood tests to measure the presence of certain substances (tumor markets) linked to specific types of cancer
  • Ultrasound which creates a sonogram of the scrotum
  • Biopsy: Due to the possibility of releasing cancer cells into the scrotum, in nearly all cases where there is strong suspicion of cancer, a testicular biopsy includes the removal of the entire testicle (radical inguinal orchiectomy). If the patient has only one testicle, the physician will remove sample tissue through an incision in the groin (not through the scrotum)

Treatments

How to Perform a Self Examination

Testicular self examinations are best performed after a warm bath or shower because heat relaxes the scrotum making detection of an abnormality easier.

Stand facing a mirror, with the index and middle fingers under the testicle and the thumb placed on top. Roll the testicle gently between the thumb and forefinger to feel for any lumps, hardness, swelling or size differences. Both testicles are close to the same size but not exactly; look for an unusual size difference.

Find the soft structure (epidiymis) behind the testicle that collects and carries sperm. The structure feels like tubes. Typically, lumps in the epidiymis are not cancerous but require medical attention.

In addition to testicular cancer, other abnormalities to check for are:

  • A pimple or ingrown hair or rash
  • A free floating lump in the scrotum
  • A lump in the epidiymis


Treatment of Testicular Cancer

Depending on the stage of the cancer, treatment for testicular cancer may include surgery, radiation and/or chemotherapy.

In rare cases, the cancer may be removed surgically, leaving the testicle intact. In almost all cases, however, the testicle is removed entirely by inguinal orchiectomony, accessing the tumor through the groin.

In radiation therapy, targeted high-energy radiation is used to shrink a tumor. Radiation therapy is also used after surgical removal of the testes to destroy cancer cells that may not have been removed during surgery.

In chemotherapy, anti-cancer drugs are delivered intravenously to target any cancer cells that may have escaped into the bloodstream after surgical removal of the tumor.


Fertility and Sexual Function

With one healthy testicle, preservation of fertility may be possible, but not guaranteed.

Certain treatments for testicular cancer may result in reduced fertility or permanent infertility. Patients may consider banking their sperm prior to surgery, radiation therapy and chemotherapy.

Men with testicular cancer should discuss any concerns about sexual function with their doctor.