Facts & Figures
Doctors do not know the exact cause of testicular cancer
Testicular cancer is highly curable when detected early
Most testicular cancers are found by men themselves
95% of patients with testicular cancer are alive after a five-years
50% of men seek treatment after cancer has spread beyond the testicles to other locations in the body
Young men between the ages of 15 and 39
White men are affected more than men of other races
Men who have an undescended testicle (cryptorchidism)
Genetic condition known as Klinefelter's Syndrome
Relatives with testicular cancer
Signs & Symptoms
Pain or swelling in testicle and/or scrotum
Lumps or nodules in testicle, painful or not
Enlargement of the testicle
Change in the way a testicle feels
Pain in the lower abdomen, back, or groin
Collection of fluid within the scrotum
Shrinking of a testicle
Enlargement or tenderness of the breasts
How is Testicular Cancer Diagnosed?
To help find the cause of symptoms, the doctor evaluates a man's general health.
The doctor also performs a physical exam and may order laboratory and diagnostic tests.
- Blood tests that measure the levels of tumor markers. Tumor markers are substances often found in higher-than-normal amounts when cancer is present. Tumor markers such as alpha-fetoprotein (AFP), Beta-human chorionic gonadotropin (ßHCG), and lactate dehydrogenase (LDH) may suggest the presence of a testicular tumor, even if it is too small to be detected by physical exams or imaging tests.
- Ultrasound, a test in which high-frequency sound waves are bounced off internal organs and tissues. Their echoes produce a picture called a sonogram. Ultrasound of the scrotum can show the presence and size of a mass in the testicle. It is also helpful in ruling out other conditions, such as swelling due to infection or a collection of fluid unrelated to cancer.
- Chest X-rays: Simple chest x-rays are often used to determine if the cancer has spread to the lungs
- Computed Tomography (CT) scanning: This machine uses a rotating X-ray beam to create a series of pictures of the body from many different angles. A computer processes the information and produces a detailed cross-sectional image of selected parts of the body. Sometimes, a dye is injected into a vein to highlight details on the scan. A CT scan is especially valuable for identifying the spread of tumors to lymph nodes. If the tumor markers are high enough, a CT scan may also be done of the brain. Keep in mind, however, that it is hard to see into areas like the abdomen, and just because a CT scan says everything is normal does not mean that the cancer has not spread at all.
- Biopsy to determine whether cancer is present. In nearly all cases of suspected cancer, the entire affected testicle is removed through an incision in the groin. This procedure is called radical inguinal orchiectomy. In rare cases (for example, when a man has only one testicle), the surgeon performs an inguinal biopsy, removing a sample of tissue from the testicle through an incision in the groin and proceeding with orchiectomy only if the pathologist finds cancer cells. (The surgeon does not cut through the scrotum to remove tissue. If the problem is cancer, this procedure could cause the disease to spread.)
Standard Treatment Options
Surgery to remove the testicle through an incision in the groin is called a radical inguinal orchiectomy. Men may be concerned that losing a testicle will affect their ability to have sexual intercourse or make them sterile. However, a man with one healthy testicle can still have a normal erection and produce sperm. Therefore, an operation to remove one testicle does not make a man impotent (unable to have an erection) and seldom interferes with fertility (the ability to produce children). For cosmetic purposes, men can have a prosthesis (an artificial testicle) placed in the scrotum at the time of their orchiectomy or at any time afterward. Some of the lymph nodes located deep in the abdomen may also be removed (lymph node dissection). This type of surgery does not usually change a man's ability to have an erection or an orgasm, but it can cause problems with fertility if it interferes with ejaculation. Patients may wish to talk with their doctor about the possibility of removing the lymph nodes using a special nerve-sparing surgical technique that may preserve the ability to ejaculate normally.
Radiation Therapy uses high-energy rays to kill cancer cells and shrink tumors. It is a local therapy, meaning that it affects cancer cells only in the treated areas. External radiation (from a machine outside the body), aimed at the lymph nodes in the abdomen, is used to treat seminomas. It is usually given after surgery. Because nonseminomas are less sensitive to radiation, men with this type of cancer usually do not undergo radiation therapy. Radiation therapy affects normal as well as cancerous cells. The side effects of radiation therapy depend mainly on the treatment dose. Common side effects include fatigue, skin changes at the site where the treatment is given, loss of appetite, nausea, and diarrhea. Radiation therapy interferes with sperm production, but many patients regain their fertility over a period of 1 to 2 years.
Chemotherapy is the use of anticancer drugs to kill cancer cells. When chemotherapy is given to testicular cancer patients, it is usually given as adjuvant therapy (after surgery) to destroy cancerous cells that may remain in the body. Chemotherapy may also be the initial treatment if the cancer is advanced; that is, if it has spread outside the testicle at the time of the diagnosis. Most anticancer drugs are given by injection into a vein. Chemotherapy is a systemic therapy, meaning drugs travel through the bloodstream and affect normal as well as cancerous cells throughout the body. The side effects depend largely on the specific drugs and the doses. Common side effects include nausea, hair loss, fatigue, diarrhea, vomiting, fever, chills, coughing/shortness of breath, mouth sores, or skin rash. Other side effects include dizziness, numbness, loss of reflexes, or difficulty hearing. Some anticancer drugs also interfere with sperm production. Although the reduction in sperm count is permanent for some patients, many others recover their fertility.
Testicular Cancer Staging
Stage I: Cancer is found only in the testicle. Removing the testicle alone should cure the patient, though many will choose some form of additional treatment just to be sure...
Stage II: Cancer has spread to the lymph nodes in the abdomen. Removing the testicle alone will not cure the patient, and more treatment is necessary.
Stage III: Cancer has spread to areas above the diaphragm such as the lungs, neck or brain. There may be also be cancer in parts of the body such as the bones or liver. In this situation, chemotherapy is absolutely required. Surgery may also be needed.
Stage IV: To the best of my knowledge, there is no such thing as Stage IV testicular cancer. However, it is possible that Stage IV may still be used in some places in Europe. Suffice to say that Stage IV is probably very similar to Stage III.
Recurrent: Recurrent disease means that the cancer has come back after it has been treated. It may recur in the same place or in another part of the body.
- Regular follow-up exams are extremely important for men who have been treated for testicular cancer. Like all cancers, testicular cancer can recur.
- Men who have had testicular cancer should see their doctor regularly and should report any unusual symptoms right away.
- Follow-up varies for different types and stages of testicular cancer. Generally, patients are checked frequently by their doctor and have regular blood tests to measure tumor marker levels. They also have regular x-rays and computed tomography, also called CT scans or CAT scans.
- Men who have had testicular cancer have an increased likelihood of developing cancer in the remaining testicle.
- Patients treated with chemotherapy may have an increased risk of certain types of leukemia, as well as other types of cancer. Regular follow-up care ensures that changes in health are discussed and that problems are treated as soon as possible.