Testicular Cancer

Testicular cancer at a glance

• Testicular cancer results from the abnormal growth of cells in a man’s testicles, the organs that produce sex hormones and sperm.
• Testicular cancer is the most common cancer in Caucasian men under the age of 40.
• It typically has a high treatment response rate, and curing the cancer is a goal of treatment.
• Signs of this cancer often include a noticeable lump in either of the testicles, painful testicles and/or a dull ache in the abdomen.

What is testicular cancer?

Cancer is defined by where it begins, and testicular cancer starts in one or both of the two egg-shaped male glands known as testicles or testes, which produce male sex hormones and sperm. Normally, healthy cells grow and divide in a way that keeps a body functioning. Sometimes, our cells develop abnormalities and grow out of control, which can accumulate and form a cancerous mass.

Though it can affect men at any age, testicular cancer typically occurs in men aged 15 to 44 years and often only in one testicle.

Compared to many forms of cancer it is a very rare and treatable cancer, especially with an early diagnosis. Around 9,500 American men are diagnosed with testicular cancer each year and approximately 440 die as a result, according to the American Cancer Society.

The testicles are made up of many different types of cells, each of which can develop into one or more types of cancer. However, more than 90% of testicular cancers develop from cells known as germ cells (the cells that make sperm). These are classified as either seminoma or non-seminoma germ cell cancers. This categorization helps oncologists with evaluation and treatment recommendations.

• Seminoma: This cancer develops from young germ cells. This form grows and spreads more slowly. Between 30% and 40% of testicular cancers are seminomas.
• Non-seminoma: This cancer develops from more mature germ cells and occurs in men between their late teens and early 30s. These tend to be more aggressive tumors.

Causes of testicular cancer

Causes of testicular cancer are unknown and untraceable to any particular event or predisposition. Nearly all testicular cancers begin in the germ cells in the testicles that produce immature sperm. What causes germ cells to become abnormal and grow into cancer is undetermined.

That said, several factors can increase a man’s likelihood for developing a tumor in the testicle including:

• Having family members who have, or had, testicular cancer.
• Being age 20-40.
• Being Caucasian.
• Having undescended testicles or other abnormal testicle growth and development.

Symptoms of testicular cancer

Signs and symptoms of testicular cancer can often be mistaken for general discomfort or inflammation. As a result, there is often a delay in getting treatment. Men should consult a doctor if experiencing any of these symptoms, especially if lasting longer than two weeks:

• A painless lump or enlargement in either testicle.
• Swelling or a sudden collection of fluid in the scrotum.
• A feeling of heaviness in the scrotum.
• A dull ache in the abdomen or groin.
• Pain or discomfort in the scrotum or a testicle.
• A shrinking testicle.
• Tenderness or changes in the breast tissue.

Diagnosing testicular cancer

Testicular cancer is most often diagnosed as a result of prevailing symptoms, the most common of which is a lump in either testicle.

While the American Cancer Society does not have a specific recommendation for self-exams, they can aid in early detection. In fact, most cases of this cancer are not initially found by physicians, but by the individual or his partner.

Men who have higher risk factors of developing testicular cancer, such as an undescended testicle, prior germ cell tumor in a testicle, and/or a family history, should perform regular self-exams. If they notice any changes or have any of the above symptoms, they should tell their primary care doctor, who may then refer the man to a urologist or oncologist for a physical exam and possible ultrasound.

The doctor will feel the testicles for swelling or tenderness and for the size and location of any lumps. The doctor will also examine the abdomen, lymph nodes and other parts of the body carefully to look for signs of cancer spread. Often the results of the exam are normal other than the changes in the testicles.

If a lump or other sign of testicular cancer is found, blood testing and a biopsy can confirm the diagnosis.

Testicular tumor treatment options

Treating cancer in the testicles is highly effective, even when it is advanced or spreads beyond the testis. Treatment options vary depending on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health.

Surgery is generally the first-line treatment for testicular cancer. This can be removal of the whole testicle or the lymph nodes or tumor surrounding a testicle as well. This is called a radical orchiectomy. Because most cases of testicular cancer only involve one testicle, a man may continue to have children after testicular cancer surgery.

After surgery, radiation and chemotherapy may also be recommended.

Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. Radiation therapy is particularly effective in treating early-stage seminoma or cancer that has spread to the brain.

Chemotherapy is a cancer treatment that uses strong drugs to stop the growth of cancer cells. It has shown great success in most forms of testicular cancer. However, it may cause temporary infertility in men and should be carefully considered through a discussion with the oncologist. Men wishing to have families after treatment may also consider freezing their sperm before chemotherapy is administered.

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Risks & effects of testicular cancer treatment

Risks and side effects of testicular cancer treatment vary depending on the chosen course.

All surgeries carry risks. These general surgical risks include blood loss, pain, scaring, risk of infection, blood clotting, pneumonia, damage to tissue or organs, and negative reaction to anesthesia.

Radiation therapy and chemotherapy also carry side effects, primarily due to damage to healthy tissue. Oncologists can control these side effects with medications, diet changes and lifestyle management. Over time and after treatment, these side effects disappear. Sometimes long-term side effects, such as infertility due to chemotherapy drugs, may remain.