Testicular Cancer
Testicular cancer is cancer in one or both testicles. It usually occurs in young men. This type of cancer can be treated and very often cured.
Germ Cell Tumors
More than 9 out of 10 of cancers of the testicles start in the germ cells. As used here, "germ" means seed. These are the cells that make sperm.
The two main types of germ cell tumors are seminomas and nonseminomas.
Seminomas start from the sperm-producing germ cells of the testicle. Within this group there are also subtypes. Seminomas usually happen in men when they are between their late 30s and early 50s.
Nonseminomas tend to develop earlier in life than seminomas. They are often found in men between their late teens and early 40s. There are four main subtypes. Most tumors are mixed, having at least two different types. But all nonseminoma germ cell cancers are treated the same way, so the exact type is not that important.
Stromal Tumors
Tumors can also grow in the cells that make hormones and in the supportive tissues, or stroma, of the testicles. Stromal cell tumors are often benign (not cancer). They usually do not spread beyond the testicle and can be cured by surgical removal. But a few stromal cell tumors spread to other parts of the body (metastasize). Metastatic stromal cell tumors have a poor outlook because they do not respond well to chemotherapy or radiation therapy. The 2 main types of stromal tumors are Leydig cell tumors and Sertoli cell tumors.
Secondary Testicular Tumors
Secondary testicular tumors start in another organ and then spread to the testicle. Lymphoma is the most common cancer of this type. Among men over age 50, testicular lymphoma is more common than tumors that start in the testicle. The usual treatment is to remove the testicle. Surgery is followed by radiation and/or chemotherapy.
In children with acute leukemia, the leukemia cells can sometimes form a tumor in the testicle.
Cancers of the prostate, lung, skin, kidney, and other organs can also spread to the testicles. The outlook for these cancers is usually poor. That’s because these cancers have generally spread widely to other organs as well. Treatment depends on the exact type of cancer.
Risk Factors:
Cryptorchidism: The main risk factor for testicular cancer is a problem called cryptorchidism, or undescended testicle(s).
Family history: A family history of testicular cancer increases the risk.
HIV infection: There is some evidence that men infected with HIV (human immunodeficiency virus) have an increased risk of testicular cancer. This may be especially true for men who have AIDS. No other infections have been shown to increase testicular cancer risk.
CIS (carcinoma in situ): CIS is a condition in which germ cells grow into a tumor but do not yet invade normal tissues. CIS in the testicles may become cancer over a number of years. CIS does not cause a lump or any symptoms. It is sometimes found when a man is tested for infertility. It may also be found when a man has a testicle removed because of cryptorchidism.
Cancer of the other testicle: Men who have been cured of cancer in one testicle have an increased risk of getting cancer in the other testicle.
Race and ethnicity: White American men are about 5 to 10 times more likely to get testicular cancer than are African-American men. Whites have more than twice the risk of Asian-American men. The risk for Hispanics falls between that of Asians and non-Hispanic whites. The reason for this difference is not known. The testicular cancer rate has increased in both whites and blacks, although the rate of increase is greater in white men.
Body size: A recent study from Sweden found that body size was a risk factor. The highest risk was seen in tall, slim men. But testicular cancer is not a common disease. So the health benefits of being slim outweigh any concern about this cancer.
Prevention:
Cryptorchidism, white race, and a family history of the disease are the main known risk factors of this cancer. None of these factors can be prevented because they are present at birth. Also, many men with testicular cancer have no known risk factors. For these reasons, there is no way to prevent most cases of this disease.
But it is wise to correct cryptorchidism in boys. And knowing he has a risk factor may cause a young man to be more watchful and to check his testicles, making it more likely a cancer will be found early.
Early Detection:
Most testicular cancer can be found at an early stage. Most of the time a lump on the testicle is the first sign.
Signs and Symptoms of Testicular Cancer
Lump, swelling, or aching: In 9 out of 10 cases, the man has a lump on a testicle. The lump is often painless, but it can be uncomfortable. The man may notice the testicle is enlarged or swollen. Men with testicular cancer often feel heaviness or aching in the belly or scrotum.
Other symptoms: Less common symptoms may be due to excess hormones made by the cancer cells, and can include:
- breast growth, tender or swollen breasts
- loss of sex drive
- growth of hair on face and body at a young age (before puberty)
Signs of advanced testicular cancer: Even if the cancer has spread to other organs, few men have any symptoms. Lower back pain is a common symptom of later-stage testicular cancer. Signs that the cancer has spread to the lungs can include:
- shortness of breath
- chest pain
- coughing
- spitting blood
Causes of symptoms other than cancer: Other things can cause symptoms that look like testicular cancer. These conditions include:
- an injured testicle
- an infected testicle
History and Physical Exam
The first step is for the doctor to take a complete medical history to check for risk factors and symptoms. Then the doctor will do a physical exam. The doctor will feel the testicles for any sign of swelling, tenderness, or lumps. The doctor will also feel your belly for enlarged lymph nodes. These could be a sign that the cancer has spread to the lymph nodes in the back of the abdomen.
Ultrasound
This test uses sound waves to make images of internal organs. The computer displays the image on a screen. An ultrasound can help doctors tell if a mass is solid or filled with fluid. If the tumor is solid, then it is more likely to be cancer.
This is a very easy test to have done, and it uses no x-rays. You just lie on a table while a flat wand is moved over your skin. Usually, your skin is coated with oil first.
Blood Tests
Certain blood tests can help find testicular tumors. Many cancers make proteins that can be found in the blood. The levels of these substances might tell the doctor how much cancer is present, how well treatment is working, and whether a tumor has returned.
Surgery
Whenever they can, surgeons try to remove the entire tumor, the testicle, and the spermatic cord. The spermatic cord carries sperm, blood, and lymph. It can act as a pathway for cancer cells to spread. This is why the cord is tied off early in the operation. Doctors usually do this operation through a cut (incision) in the groin.
The complete specimen will be sent to the lab. A doctor with special training (a pathologist) will look at it under a microscope. If cancer cells are present, the pathologist sends back a report describing the cancer.
In rare cases, the doctor may take a tissue sample (biopsy) before removing the testicle. This is done when doctors are not sure if the tumor is cancer. The sample is looked at right away. If it is cancer, the doctor removes the testicle and spermatic cord.
Once testicular cancer is found, doctors use imaging tests to gather more information.
Imaging Tests
Chest x-ray: This test will be done to see if cancer has spread to lungs. If the x-ray is normal, then there was metastasis to lungs.
CT scan (computed tomography): This test is helpful in finding out if the cancer has spread to lungs, liver, or other organs. A CT scan uses x-rays to make detailed images of the body. Instead of taking just one picture, a CT scanner takes many as it rotates around the patient. A computer then combines these into an image of a slice of the body.
MRI (magnetic resonance imaging): MRI scans use radio waves and strong magnets instead of x-rays. MRI pictures look a lot like those of a CT scan, but MRIs are more detailed. An MRI scan can also show views from several angles. MRIs are helpful in looking at the brain and spinal cord.
PET scan (positron emission tomography): For a PET scan, a type of radioactive sugar is injected into a vein. The sugar collects in cancerous tissue. A scanner can spot these deposits. This test is useful for finding cancer that has spread beyond the testes. It is also helpful in telling whether enlarged lymph nodes contain scar tissue or active tumor.
Treatment:
The three main methods of treatment for testicular cancer are surgery, radiation therapy, and chemotherapy.
Treatment Centers in Georgia:
National Organizations and Web Sites
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