Testicular Cancer

Introduction
Signs and Symptoms
Risk Factors
Screening and Diagnosis
Treatment
Prevention

Testicular cancer can result in a number of signs and symptoms. These may include:

• A lump or enlargement in either testicle
• A feeling of heaviness in the scrotum
• A dull ache in the abdomen or groin
• A sudden collection of fluid in the scrotum
• Pain or discomfort in a testicle or the scrotum
• Enlargement or tenderness of the breasts
• Unexplained fatigue or a general feeling of not being well

Cancer usually affects only one testicle.

Researchers don't know what causes testicular cancer. Risk factors may include:

An undescended testicle. Usually the testes form in the abdominal area during fetal development and later descend into the scrotum. Men who have a testicle that never descended are at greater risk of testicular cancer than other men are. The risk remains even if the testicle has been surgically relocated to the scrotum. Still, the majority of men who develop testicular cancer don't have a history of undescended testicles.

Age. Testicular cancer affects teens and younger men, particularly those between ages 15 and 34.

Race. Testicular cancer is more common in white men than in black men. The reason for racial differences in the incidence of testicular cancer is unknown.

HIV infection. Some research has shown that men infected with the human immunodeficiency virus (HIV), especially those with AIDS, are at increased risk of developing testicular cancer.

Most men discover testicular cancer themselves, either unintentionally or while doing a testicular self-examination to check for lumps.

If you bring signs and symptoms of testicular

cancer

to your doctor's attention, or your doctor discovers a lump during a routine office visit, your doctor will likely do a physical exam and order lab tests to see if an infection or something else is the cause. You may also undergo an ultrasound examination. This painless test passes sound waves through your scrotum to make an image of your testicles.

The testicles contain several types of cells, and each may develop into several types of cancer. Each type grows and spreads differently. Treatment and prognosis also vary according to type.

Classifying the cancer
Doctors classify testicular cancer as one of two types:

Seminoma. This type of testicular cancer usually occurs in men between their late 30s and early 50s. If it's discovered and treated early, nearly all men recover from this type of cancer.

Nonseminoma. This group of cancers includes choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumors. These types of testicular cancer tend to develop earlier in life than seminomas, usually occurring in men between their late teens and early 40s.

If you have a testicular lump and an ultrasound examination doesn't rule out cancer, a biopsy must be performed to determine the presence of cancer. A testicular biopsy should be done through a small incision in the groin (inguinal incision). A biopsy taken from the scrotum with a needle may spread the cancer to a new area.

Once tissue has been obtained, a pathologist can check the tissue taken from the affected testicle to see if cancer cells are present. If the lump is noncancerous, there's usually no need to remove the testicle. If the lump is a cancerous (malignant) tumor, the entire testicle should be removed. The pathologist will then determine what type or types of cancer cells are present in the testicle.

After the type of cancer has been established, you'll need blood tests, X-rays, computerized tomography (CT) or magnetic resonance imaging (MRI) scans, and other tests to determine if the cancer has spread to other parts of your body.

Staging the cancer
With these test results, your doctor classifies the cancer according to its stage. These include:

Stage I. Testicular cancer is confined to the testicle.

Stage II. Testicular cancer has spread to the lymph nodes in the abdomen.

Stage III. Testicular cancer has spread beyond the lymph nodes to other regions of your body, such as your lungs or liver.

If cancer is confirmed, your surgeon will remove the entire affected testicle through a surgical incision in your groin.

Generally, doctors use four kinds of treatments for testicular cancer. They are:

Radical inguinal orchiectomy. This surgical procedure involves removing one or both testicles through a cut in the groin. Lymph nodes in the abdomen also may be removed (lymph node dissection). If just one cancerous testicle is removed, there's a small chance that the other will become cancerous at some point. As a result, your doctor will likely recommend regular follow-up exams with a urologist.

External beam radiation therapy. This treatment uses high-dose X-rays or other high-energy radiation to kill cancer cells. Seminomas are highly sensitive to radiation therapy, but nonseminomas are not.

Chemotherapy. Chemotherapy is used to kill cancer cells outside the testicle. This drug therapy is usually given by infusions into your veins (intravenous), typically done on an outpatient basis.

Bone marrow transplant. In this procedure, bone marrow is taken from you, treated with drugs to kill any cancer cells and then frozen. You then undergo chemotherapy, with or without radiation, to destroy the remaining cancer cells in your body. The chemotherapy also destroys your remaining bone marrow. The frozen marrow is then thawed and injected back into you through a needle in a vein. This relatively new treatment for testicular cancer has shown some promising initial results. Yet doctors don't routinely recommend it because traditional chemotherapy treatments are typically very successful. Bone marrow transplant is used only in rare cases of the disease.

Surgery may be in combination with radiation therapy or chemotherapy or both. It depends on the type and the stage of your cancer. Your age and overall health also are factors in choosing treatment options.

Post-treatment implications
You may wonder how treatment for testicular cancer will affect your appearance and sex life. Keep the following in mind:

Artificial implants. After the surgical removal of a testicle, you can have an artificial testicle (prosthesis) placed inside your scrotum. The artificial implant has the weight and feel of a normal testicle.

Surgery and your sex life. The surgical removal of lymph nodes won't affect your ability to achieve an erection or an orgasm. However, this surgery may cause sterility by interfering with ejaculation. Some men recover the ability to ejaculate without treatment; medication may help others. If you undergo surgery, ask about special techniques that may protect your ability to ejaculate.

Radiation therapy and your sex life. Radiation therapy probably won't change your ability to have sex. However, radiation does interfere with sperm production. The effect is usually temporary, and most men regain their fertility within a few months. As a precaution, many men store sperm at a special facility (sperm bank) before treatment, where it can be preserved for later use.

Chemotherapy and your sex life. Chemotherapy doesn't have to interfere with a normal sex life. The fatigue caused by chemotherapy, however, may decrease your interest in sexual activity during the months of treatment. Some anti-cancer drugs affect sperm production. Although the effect can be permanent, many men regain their fertility later. Men concerned about their fertility can have their sperm frozen and preserved (cryopreserved) before beginning chemotherapy.

Because the cause is unknown, there's no way to prevent testicular cancer. However, a simple procedure called testicular self-examination (TSE) can improve your chances of finding a tumor. Beginning in your midteenage years, and continuing throughout your life, examine your testicles regularly.

A good time to examine your testicles is after a warm bath or shower. The heat from the water relaxes your scrotum, making it easier for you to find anything unusual. Do this once a month.

To do this examination, follow these steps:

Stand in front of a mirror. Look for any swelling on the skin of the scrotum.

Examine each testicle with both hands. Place the index and middle fingers under the testicle while placing your thumbs on the top.

Gently roll the testicle between the thumbs and the fingers. Remember that the testicles are usually smooth, oval shaped and somewhat firm. It's normal for one testicle to be slightly larger than the other. Also, the cord leading upward from the top of the testicle (epididymis) is a normal part of the scrotum. By regularly performing this exam, you will become more familiar with your testicles and aware of any changes that might be of concern.

If you find a lump, call your doctor as soon as possible. Testicular cancer is highly treatable, especially when identified early.

Regular self-examination is an important health habit. But it can't substitute for a doctor's examination. Your doctor should check your testicles whenever you have a physical exam. If you have an undescended testicle - less than two testicles in your scrotum - be sure to tell your doctor, who may refer you to a urologist for treatment or a more specialized exam.