Testicular cancer is an abnormal, rapid, and invasive growth of cancerous (malignant) cells in the testicles (male sex glands adjacent to the penis).

Causes

• The cause of Testicular Cancer is not known.  However, there are certain factors that increase the chance of developing it.

• Men with an undescended testicle have a higher risk of developing this cancer, even if the condition has been corrected by surgery.

• Studies suggest that boys born to women who took estrogen while pregnant may have a higher risk of developing Testicular Cancer.

• Testicular Cancer can be divided into 2 major categories:

1. Non-seminoma -- this includes embryonal cell carcinomas, teratomas, Choriocarcinomas, and mixed cell Testicular Cancers.

2. Seminoma -- this is the other major type of Testicular Cancer.

3. There is a third group called non-germinal cancer, but these are not very common.

• The treatment and long-term outlook depends on the stage of the disease.

1. Staging for non-seminoma-in Stage A, the cancer is limited to the testicle.  In Stage B, it has spread to the lymph nodes in the surrounding area.  In Stage C, it has spread to distant sites in the body.

2. Staging for seminoma-in Stage I, the cancer is limited to the testis (gonad).  In Stage II, it has spread to the lymph nodes.  This is further divided into Stage IIa (if the lymph nodes are less than 10 centimeters in size) or IIb (if the lymph nodes are larger than 10 centimeters).  In Stage III, it has spread all over the body or to any of the organs.

• Enlargement of a testicle or a change in the way it feels

• Lump or swelling in either testicle

• Dull ache in the back or lower abdomen

• Gynecomastia (excessive development of male breast tissue), this can also occur normally in adolescent males, in whom it is not a symptom of testicular cancer

• Testicular discomfort/pain or a feeling of heaviness in the scrotum

• Occasionally, the initial symptoms are related to the spread of the cancer to other parts of the body, such as the lungs, abdomen, pelvis, or brain

     Note: There may be no symptoms.

Screening and Diagnostics

     A physical examination typically reveals a firm, non-tender testicular mass that does not "trans-illuminate" (light from a flashlight held to the scrotum does not pass through the mass).

     Other tests include:

• Scrotal ultrasound is used to confirm solid mass.

• Blood tests for tumor markers: alpha-fetoprotein (AFP), human chorionic gonadotrophin (beta HCG), and lactic dehydrogenase (LDH). Approximately 85% of non-seminomas will have elevations of either AFP or beta HCG. Seminomas will have elevations only in beta HCG or LDH. These tests can also be used to monitor the response to treatment.

• A chest X-ray is done to look for potential metastasis (spreading of cancer) to the lungs.

• An abdominal CT scan may be done to look for potential metastasis.

     Tissue biopsy is usually by surgical removal of the testicle. After the testicle is removed, the tissue is examined.

Treatment

• Treatment and long-term survival depend on the type of cancer and the stage.

• Treatment begins with surgical removal of the testicle. Surgery should be done through the groin and not through the scrotum.

• Treatment for seminoma cancers:

1. Stage I or IIa is treated with surgical removal of the testicle and radiation therapy.  Cure rate is 98% for Stage I disease and 92-94% for Stage IIa disease.

2. Stage IIb or III is treated with removal of the testicle and chemotherapy.  95% of people with stage III disease treated with this combination will achieve complete response.

3. If there are large amounts of tumor in the abdomen, then surgery to remove some of the cancer may need to be done.

• Treatment for non-seminoma cancers:

1. Stage A and some Stage B patients are treated with removal of the testicle alone.  However, some of the men in this group may need to have their lymph nodes examined.  Others need to be followed very, very closely.  Discuss this with your doctor.  Men with Stage A disease usually have a cure rate of nearly 98%, and those with Stage B have a cure rate of nearly 90%.

2. Men with a lot of lymph node involvement, or those with Stage C disease need to be treated first with chemotherapy, and then surgical removal of the testicle may be required.  Removal of some of the lymph nodes may also be advised. If this fails, they may need another round of chemotherapy.  The cure rate for men with this advanced level of disease is usually 55-80%.

     Metastasis (spreading) to other parts of the body may occur with testicular cancer. The most common sites include the retroperitoneal area, the abdomen, the spine, and the lungs.

     If both testicles are removed, the man becomes infertile (unable to have children) because no sperm cells will be produced. If surgery is done to remove lymph nodes, there can be damage to nerves that control ejaculation. This can also cause infertility as well as impotence. There is a newer type of surgery that has a better chance of preserving the nerves that maintain erection while still removing the lymph nodes.

     Since testicular cancer affects men at the ages they may want to father children, nerve-sparing surgery and sperm banking (to save sperm and freeze it for use in artificial insemination) before any treatment should be discussed with the doctor.