What is Testicular Cancer?
Most testicular cancers develop in the germ cells, which produce sperm. These cancers are called germ cell tumors. There are two different types of germ cell cancers—seminomas, which are usually slow growing, and nonseminomas, which tend to grow more quickly. Testicular tumors may have both seminoma and nonseminoma cells.
Seminomas may be one of three types: classic, anaplastic, or spermatocytic.
Types of nonseminomas include choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumors.
These are common risk factors for the disease:
- Being born with abnormalities of the testicles, penis, or kidneys
- Inguinal hernia (hernia in the groin area)
- Having a brother or father who has had the disease
- Having a testicle that does not move down into the scrotum (called an undescended testicle). This risk does not change even after surgery to move the testicle into the scrotum.
Men who have had testicular cancer are at increased risk of developing cancer in the other testicle.
Signs & Symptoms
Most testicular cancers are found by men themselves. Between regular checkups, look for these symptoms:
- Dull ache in the lower abdomen, back, or groin
- Feeling of heaviness in the scrotum
- Pain or discomfort in a testicle or in the scrotum
- Painless lump or swelling in a testicle
- Sudden collection of fluid in the scrotum
Diagnosis and Staging
If you feel pain, heaviness, discomfort, swelling or any other changes in the testicles or scrotum, see a doctor. Routine physical exams include an exam of the testicles.
To find out the cause of these symptoms, the doctor will assess your overall health and may order one or more of these tests:
- Blood Test - The blood may be tested to measure the levels of tumor markers. These are substances found in above-average amounts when cancer is present. They include AFP (alpha-fetoprotein), BHCG (beta-human chorionic gonadotropin) and LDH (lactate dehydrogenase). Blood tests can detect tumor markers even if the tumor is too small to be seen by imaging tests or physical exams.
- Ultrasound - Sound waves and a computer are used to create a picture of the scrotum that can show the size and shape of a mass in the testicle. This test is good for ruling out other conditions not related to cancer.
- Biopsy - A pathologist looks at a sample of tissue from the testicle under a microscope to check for cancer cells. In almost all cases of suspected cancer, the doctor removes the affected testicle through an incision in the groin. In rare cases, the doctor removes a sample of tissue through the incision, and only removes the entire testicle if cancer cells are found.
- If testicular cancer is found, more tests are needed to find out if the cancer has spread from the testicle to other parts of the body. The stage of the cancer helps the doctor decide on the right treatment.
Treatment and Side Effects Management
Treatment options for testicular cancer depend on the cancer stage, the patient’s age, and overall health. You may want to get a second opinion. Talk through all of your options with your doctor to develop a treatment plan that best fits your needs.
Seminomas and nonseminomas are treated differently. Seminomas are more sensitive to radiation. If a tumor contains both types of cells, it is treated as a nonseminoma.
There are three types of standard treatment: surgery, radiation therapy and chemotherapy.
- Orchiectomy is the procedure for removing the testicle through an incision in the groin. A man with one healthy testicle can still have sex. This operation rarely affects a man’s ability to have children.
- Some men choose to have a fake testicle placed in the scrotum during or after surgery for cosmetic purposes.
A large machine directs radiation at the body. It uses high-energy rays to kill cancer cells. Radiation aimed at the lymph nodes in the abdomen is used to treat seminomas, usually after surgery. Men with nonseminomas usually do not undergo radiation therapy, since those tumors are less likely to respond to radiation.
This treatment uses drugs to kill cancer cells. In patients with testicular cancer, chemotherapy is usually given after surgery. In advanced cases, chemotherapy may be used as the first treatment. Most often, drugs are injected into the veins.
Recovery after testicular cancer depends on treatment type, spread of disease, and other factors. Follow-up care after treatment for testicular cancer is important. Even when the cancer seems to be gone, it can return if cancer cells remain in the body after treatment. You should see a doctor regularly. Your doctor will do regular blood tests, x-rays, and CT scans. Men who have had testicular cancer have an increased chance of developing the disease in the other testicle.
Stages of Testicular Cancer
Once testicular cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging tells the doctor whether the cancer has spread, and if so, to what parts of the body.
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the tiny tubules where the sperm cells begin to develop. These abnormal cells may become cancer and spread into nearby normal tissue. All tumor marker levels are normal.
In stage I, cancer has formed. Stage I is divided into stage IA, stage IB, and stage IS.
- Stage IA - Cancer is in the testicle and epididymis (a long, coiled tube at the back of each of a man's two testicles). It may have spread to the inner layer of the membrane around the testicle. All tumor marker levels are normal.
- Stage IB - All tumor marker levels are normal. Cancer is:
- In the testicle and the epididymis and has spread to the blood vessels or lymph vessels in the testicle OR
- It has spread to the outer layer of the membrane around the testicle, or is in the spermatic cord (a cord-like structure that contains a coiled tube that carries sperm out of the testicle) OR
- It has spread to the scrotum and may be in the blood vessels or lymph vessels of the testicle.
- Stage IS - Cancer is found anywhere within the testicle, spermatic cord, or the scrotum and either:
- All tumor marker levels are slightly above normal OR
- One or more tumor marker levels are somewhat above normal or high.
Stage II is divided into stage IIA, stage IIB, and stage IIC.
- In Stage IIA - Cancer is anywhere within the testicle, spermatic cord, or scrotum. It has spread to up to 5 lymph nodes in the abdomen. None of the lymph nodes are larger than 2 centimeters across. All tumor marker levels are normal or slightly above normal.
- In Stage IIB - Cancer is anywhere within the testicle, spermatic cord, or scrotum. All tumor marker levels are normal or slightly above normal.
- The cancer has spread to at least one nearby lymph node that is between 2 and 5 across OR
- It has grown outside of a lymph node OR
- More than 5 nodes contain cancer.
- In Stage IIC - Cancer is anywhere within the testicle, spermatic cord, or scrotum. It has spread to a lymph node in the abdomen that is larger than 5 centimeters. All tumor marker levels are normal or slightly above normal.
Stage III is divided into stage IIIA, stage IIIB, and stage IIIC.
- In Stage IIIA - Cancer is anywhere within the testicle, spermatic cord, or scrotum. It may have spread to one or more lymph nodes in the abdomen. It has spread to distant lymph nodes or to the lungs. Tumor marker levels may range from normal to slightly above normal.
- In Stage IIIB - Cancer is anywhere within the testicle, spermatic cord, or scrotum. It may have spread to one or more lymph nodes in the abdomen, to distant lymph nodes, or to the lungs. The level of one or more tumor markers is somewhat above normal.
- In Stage IIIC - Cancer is anywhere within the testicle, spermatic cord, or scrotum.
- It may have spread to one or more lymph nodes in the abdomen, to distant lymph nodes, or to the lungs. The level of one or more tumor markers is high OR
- Cancer is anywhere within the testicle, spermatic cord, or scrotum. It may have spread to one or more lymph nodes in the abdomen. It has not spread to distant lymph nodes or the lung but has spread to other parts of the body. Tumor marker levels may range from normal to high.
Treatment Side Effects of Testicular Cancer
Learn more about the side effects from your treatment before you begin, so you will know what to expect. When you know more, you can work with your health care team to manage your quality of life during and after treatment.
There are effective medications to treat side effects from cancer treatment (such as nausea, diarrhea, constipation and mouth sores.) Newer 'targeted therapies' tend to cause fewer of these side effects.
Everyone reacts differently to treatment. There are strategies that can help reduce side effects.
Side Effects From Treatment
Side effects from treatments vary. These are the most common symptoms:
Some men need lymph nodes removed from the abdomen. This can cause problems with fertility if it affects ejaculation.
Side effects depend on the dose of radiation. They include fatigue, loss of appetite, nausea, diarrhea and skin changes at the radiation site. Radiation therapy interferes with sperm production. Most men regain fertility 1 to 2 years after radiation.
Side effects depend on the specific drugs and the dose. Common side effects include:
- Hair loss
- Shortness of breath
- Mouth sores
- Skin rash
- Loss of reflexes
- Difficulty hearing
Because high does of chemotherapy can destroy bone marrow, men who receive high doses may need a bone marrow transplant.
Some cancer drugs reduce sperm count. Most patients recover their fertility, but low sperm count can be permanent for some patients. Men with testicular cancer often have fertility problems before their cancer is treated. Talk with your doctor about possible effects before starting treatment so you know the risks and what your options might be.