In this Article
Testicular Cancer
What Is Testicular Cancer?
Testicular cancer (also called cancer of the testicle, or cancer of the testis) is a malignant, or cancerous, growth of the testicle, one of the male sex organs.
Cancer of the testicle is rare, occurring most commonly in young to middle-aged men. It is very rare before puberty or in old age.
There are two basic types of testicular cancer:
- Seminoma: Made of a single type of cell-most likely from the same type of cell that produces sperm. Makes up about 40% of testicular cancers
- Nonseminoma: A group of cancers that consist of several different cell types. Makes up about 60 percent of testicular cancers
Other cancers affecting the testicle are extremely rare and develop from:
- Testicular tissue
- Lymphatic tissue (tissue associated with the lymph nodes of the immune system).
Testicular cancer is one of the most common cancers in young men between the ages of 15 and 34. However, other age groups are also susceptible, so all men should be aware of its symptoms.
In the fairly recent past, testicular cancer was considered a dangerous and difficult cancer to treat. Advances in treatment have drastically altered the picture.
Today, most men diagnosed with testicular cancer-especially when diagnosed at an early stage-can expect to survive the disease. In fact, when detected early, the overall cure rate for testicular cancer is greater than 90 percent.
Even for those men with advanced testicular cancer, the cure rate is about 70 percent.
What Is Cancer?
‘Cancer’ is the name for a group of diseases in which certain cells in the body have changed in appearance and function. Instead of dividing and growing in a controlled and orderly way, these abnormal cells can grow out of control and form a mass or ‘
A tumor is considered
Testicular cancer is a disease caused by the abnormal growth and division of a certain cell type that makes up the testicle.
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Nice To Know: Most testicular cancers are found by the man himself, his wife, or his sexual partner. The majority of testicular cancers are found by accident or when doing testicular self-examination. |
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Nice To Know: Q: Is a lump in the testicle always cancer? A: Not every lump in the testicle is cancer. There could be other causes, such as infection or a non cancerous growth. But there is a high chance it may be cancer. The earliest symptoms of testicular cancer are most often pain, swelling, or hardness in the testis, or some combination of these symptoms. Sometimes, the first symptom a man will notice is a small, painless lump on the testicle. Therefore, it is important to see a doctor if a man experiences any of these symptoms. |
About The Testicles
The testicles are the male sex organs. They are located behind the penis in a sac-like pouch of skin called the scrotum.
How The Testicles Develop
The testicles are formed within the abdomen, near the kidneys, early in the growth of a male fetus.
- Hormones produced by the mother, and those produced in the testicles themselves, cause the testicles to gradually descend before birth through a tunnel in the groin called the
inguinal canal. - At birth, the testicles have usually reached the outer surface of the body, where they hang suspended in the scrotum.
Structure of the Testicles
Within each of the testicles are:
- Delicate coiled tubes called seminiferous tubules that produce sperm
- The epididymis, a structure lying behind the testis where newly formed sperm mature
- Small ducts leading to the epididymis known as the vas deferens
Each testicle is:
- Protected by a capsule (called the tunica albuginea)
- Attached by the spermatic cord, the structure that connects the testicle to structures in the abdomen
The spermatic cord is composed of:
- The vas deferens, the tube that transports sperm from the epididymis to the urethra (the tube by which urine is excreted from the bladder)
- A number of blood vessels and nerves
The Testicles and Hormone Development
The testicles produce and store sperm, but they are also the main source of male hormones. These hormones control:
- The development of the reproductive organs
- Male characteristics, such as body and facial hair, low voice, and a muscular body
The male sex hormone,
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Facts About Testicular Cancer
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What Are The Symptoms of Testicular Cancer?
The earliest symptoms of testicular cancer are:
- Pain, swelling, or hardness in the testicle, or some combination of these symptoms
- A small, painless lump on the testicle
- A “heaviness” in the scrotum
- An ache in the lower abdomen or groin
- An accumulation of blood or fluid in the scrotum
- Any change in the way a testicle feels.
In rare cases, a man will feel tenderness in his breast area. When this happens, it is usually caused by one variety of testicular cancer, in which high levels of a particular hormone called human chorionic gonadotropin, or HCG, are secreted by the growth in the testicle.
None of these symptoms are positive signs of cancer. But if any of these symptoms last longer than two weeks, a doctor should be consulted.
All cancers should be diagnosed and treated as soon as possible, but it is especially important in testicular cancer. The sooner cancer is found and treated, the better the chances of complete recovery.
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How To Information: Testicular Self-Examination (TSE) A simple procedure called testicular self-examination (TSE), undertaken just once a month, can improve the chance of finding a testicular TSE should be performed after a warm bath or shower, because heat relaxes the scrotum and makes it easier to find anything unusual. The National Cancer Institute recommends following these simple steps every month:
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Nice To Know: Regularly performed testicular self-examination is important for a man’s health, and shouldn’t be a source of embarrassment or distress. Only a doctor can make a positive diagnosis, and a man’s physician should check the testicles during a routine physical exam. This is also a good time to ask the doctor how to perform a proper testicular self-examination. |
What Causes Testicular Cancer?
The cause of testicular cancer is largely unknown. As yet, there is no identifiable link between testicular cancer and genetics, habits, lifestyles, or activities.
There is some evidence that the risk of testicular cancer is higher in men whose testicles failed to descend normally through the inguinal canal to the scrotum before birth or by the age of three.
Because of this slightly higher risk for testicular cancer, if a testicle has not descended by birth, or an undescended testicle is detected in a child,surgery is performed to place the testicle into its normal position soon after it is detected.
How Is Testicular Cancer Diagnosed?
One of the most effective ways of finding a tumor is by testicular self-examination on a monthly basis.
Most lumps in the testicle are cancerous, but noncancerous masses and cysts can arise from other causes, such as infection.
If a suspicious lump is found, the initial steps toward diagnosis include:
When symptoms suggest a cancer in a testicle, the doctor:
- Will ask about personal and family history
- Will perform a complete physical examination
- May order a blood test, urine test, and/or chest x-ray
These may include:
- Ultrasound of Testicles
The doctor also may order an ultrasound of the testicles. Ultrasound is a painless test that uses sound waves to produce images of the inner body, and can usually distinguish between normal and abnormal structures. It cannot tell whether any abnormal tissue is actually cancer.
- CT scan or
MRI , high tech tests in which computers are used to produce precise images of the inside of the testis.
For further information about
For further information about MRI, go to MRI.
If these tests are inconclusive, or if cancer is strongly suspected, an operation called an
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Need To Know: Q: If the doctor suspects testicular cancer, why can’t a simple biopsy (removal of tissue) be done? A: If a testicular tumor is found, biopsy by itself is usually rarely done. The proper procedure is removal of the testicle to confirm that cancer is present and to determine the exact type. Studies show that cutting through just the outer layer of a testicle to obtain a tissue sample can cause the spread of cancer, if present. |
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Nice To Know: Careful physical examination by a specialist in urology (a branch of medicine concerned with the urinary system in both sexes, and with the testicles, epididymis, prostate, seminal vesicles, and penis in males) can frequently distinguish cancerous lumps from noncancerous lumps, but further tests will be necessary to confirm the diagnosis |
What Is “Staging” Of Testicular Cancer?
One of the first things the doctor does when testicular cancer is diagnosed is to determine the stage of the disease. This investigation is called “staging” and was developed to describe the extent of the cancer growth. It allows the physician to customize the treatment.
Testicular cancer is “staged’ by information obtained from the surgical findings as well as from one or more of the following tests:
- Tumor marker tests
- Computed tomography (CT) scan
- Magnetic Resonance Imaging (MRI)
- Ultrasound
- Surgery
There are three stages of testicular cancer:
- Stage 1: The cancer is confined to the testicle only.
- Stage 2: The cancer has spread to the retroperitoneal lymph nodes, which are the lymph nodes located in the rear of the body, below the diaphragm (the muscular wall that separated the abdomen from the chest cavity).
- Stage 3: Cancer has spread beyond the lymph nodes to other areas of the body.
Tumor Marker Tests
Tumor markers are substances found in abnormal amounts in the blood in people with certain types of cancer. Specialized laboratory tests have been designed to identify tumor markers.
Tumor marker tests may help to determine the type of testicular cancer by identifying blood levels of the tumor markers present.
The tumor marker sought is HCG (human chorionic gonadotrophin), a hormone secreted by certain types of testicle tumors.
Computed Tomography (CT) Scan
CT scans are diagnostic techniques that use X-rays passed through the body at different angles to produce images.
A computer analyzes the images of the testis and shows them as cross-sections, or “slices,” of the tissue being studied.
For further information about
Magnetic Resonance Imaging (MRI)
Magnetic Resonance Imaging is a diagnostic technique that produces high-quality cross-sectional images of organs and structures within the body, in this case the testis, without x-rays or other radiation.
During the imaging, the patient lies within a large, hollow, cylindrical magnet and is exposed to short, harmless bursts of a powerful magnetic field.
For further information about
Ultrasound
Ultrasound is a technique that uses very high frequency sound waves inaudible to the human ear. After the sound waves are passed into the body, the reflected echoes are detected and analyzed by computer to produce a picture of the tissue or organ being studied.
For further information about ultra sound, go to Ultra Sound.
Surgery
When testicular cancer is suspected, the recommended procedure is to examine the suspicious tissue under a microscope. The tissue is obtained through an operation called an
A biopsy by itself is usually rarely done. The proper procedure is removal of the entire testicle to confirm that cancer is present and to determine the exact type. Studies show that cutting through just the outer layer of a testicle to obtain a tissue sample can cause the spread of cancer, if it is present.
The doctor also may recommend additional surgery to remove abdominal lymph nodes. After surgery, the nodes are sent to a pathologist to determine if the testicular cancer has spread.
How Is Testicular Cancer Treated?
No one treatment works for all testicular cancer. This is because the two basic types of testicular cancer-seminomas and nonseminomas-differ in:
- Their tendency to spread
- The way they spread
- How they respond to radiation therapy
Because of these different characteristics, seminomas and nonseminomas require different treatments. The treatment combinations are chosen depending on the tumor type and the stage of the disease.
Once the stage of testicular cancer has been determined, the cancer can be treated in several different ways:
- Surgery to remove the testicle
- Radiation therapy
- Chemotherapy
- A combination of the above
When testicular cancer is suspected, the affected testicle is removed and examined under a microscope. This procedure is called an
Presurgical preparations include:
- The patient is instructed to have nothing to eat or drink after midnight the night before the procedure.
- Sometimes (depending on the doctor and/or the insurance) the patient is admitted to the hospital the day or night before the procedure; on other occasions, the patient is admitted the day of the surgery.
The operation is performed either with general anesthesia (in which the patient is asleep) or local anesthesia (in which the area of surgery is numbed, and the patient is sedated but awake).
- An incision is made in the groin and the testicle is “delivered” from the scrotal sac up into the groin incision. This is to avoid an incision through the scrotum to the cancerous testicle, which may lead to spreading of the cancer.
- The testicle is “delivered” after the spermatic cord (which connects the testicle to structures within the abdomen) has been clamped. Once delivered, the testicle with its cord clamped can be more safely handled without spreading the cancer.
- The entire suspected testicle is removed because if the problem is cancer, cutting through the outer layer of the testicle to obtain a tissue sample might cause spreading of the disease.
- After removal of the testicle, the incision is closed with stitches.
After surgery:
- Complete healing can be expected without complications.
- The patient is advised to wear an athletic supporter and to avoid vigorous exercise for a month or so after the operation.
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Need To Know: Removal of one testicle does not affect sex drive, potency (the ability to have an erection), or the ability to father children. |
Radiation therapy (also called radiotherapy, cobalt treatment, or irradiation) uses high-energy x-rays to treat cancer. Like surgery, radiation therapy is a local treatment, only affecting cells in the treated area.
For further information about radiation therapy, go to Radiation Therapy.
Chemotherapy is the use of specialized drugs to treat cancer. Chemotherapy is used when:
- There are signs that the cancer has spread
- The doctor suspects that cancer remains after surgery or radiation
The drugs used for treatment are usually a combination of cisplatin andetoposide, two drugs that control the disease with minimal side effects.
Other drugs approved for use with testicular cancer include:
- Ifosamide (Ifex)
- Vinblastine sulfate (Velban)
- Bleomycin sulfate (Blenoxane)
Treatment For Seminomas
Seminomas are generally slow growing, with a tendency to stay localized-that is, in the testicle-so it is not usually necessary to remove lymph nodes.
Seminomas are especially susceptible to radiation, which effectively destroys any cancer cells that might be in the retroperitoneal lymph nodes.
When seminomas are diagnosed in Stage 1 or 2, treatment is usually a combination of:
- Testicle removal
- Radiation
- Chemotherapy
When seminomas are diagnosed in Stage 3, treatment is usually chemotherapy.
Treatment For Nonseminomas
Most nonseminomas are diagnosed in the later stages. Even so, when confined to the testicle, this type of cancer is usually treated with:
- Testicle removal
- Careful follow-up for at least two years
About 10% of Stage 1 nonseminomas recur (come back again). If this happens, treatment includes chemotherapy.
When nonseminoma cancer is diagnosed in Stage 2, and patients have had testicle and lymph node removal, they may need no further therapy. However, some specialists recommend a short course of chemotherapy to reduce the risk of recurrence.
Stage 3 nonseminomas is usually treated with chemotherapy.
What Are The Side Effects Of Treatment Of Testicular Cancer?
Of chief concern to most men, especially young men, is how treatment might affect their sexual or reproductive abilities.
After Surgery
An operation to remove one testicle:
- Does not cause impotency
- Seldom interferes with fertility (the ability to father a child)
Men with one healthy testicle can still:
- Have a normal erection
- Produce sperm
Surgery that removes the lymph nodes in more advanced cases does not alter the ability to have an erection or an orgasm. However, the operation can interfere with and/or disrupt the nerve pathways that control ejaculation. When this happens, infertility can result.
Some men can recover the ability to ejaculate without treatment, while others can be helped with medication.
Special surgical techniques called “nerve-sparing” techniques have been developed that may protect a man’s ability to ejaculate, or at the least increase the odds of retaining fertility.
With such techniques, ejaculation can be preserved in as many as 80% of cases.
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Nice To Know:
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After Radiation Therapy
Radiation therapy doesn’t change the ability to have sex, but it does interfere with sperm production. Usually this is a temporary effect, and most men with one testicle regain their fertility after treatment.
Radiation affects both normal and cancerous cells in the radiated area. The body itself can repair cells and tissues injured by treatment, but during this process men may feel very tired and should try to rest as much as possible.
Some of the other effects of radiation therapy, which can be controlled or alleviated with medication, include
- Nausea
- Vomiting
- Diarrhea
Another effect is a reddening of the skin in the area being treated. Lotions and/or creams to relieve this “sunburn” effect should only be used with the doctor’s knowledge and permission.
After Chemotherapy
The different drugs used for cancer therapy can cause various side effects, such as:
- Nausea
- Vomiting
- Hair loss
- Lowered resistance to infection
- Loss of appetite
- Mouth sores.
To alleviate these side effects, treatment is given in cycles. Treatment periods are alternated with rest periods so the body can recover.
Most men who receive chemotherapy for testicular cancer can continue to function sexually, although (as with radiation) the drugs can interfere with sperm production.
While decreased or absent sperm production is permanent for some men, many others recover their fertility after treatment.
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Need To Know: The Importance of Proper Nutrition Chemotherapy (and radiation) can often cause appetite loss.
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Follow-Up Care After Treatment For Testicular Cancer?
Regular follow-up examinations are extremely important for anyone who has been treated for testicular cancer.
After treatment:
- The doctor will monitor the man for several years to be sure the cancer has been completely eliminated. If the cancer does recur, it is extremely important to detect it immediately and start additional treatment.
- Follow-up care varies, depending on the type and stage of testicular cancer. As a general rule, men are examined every month for the first two years after diagnosis and treatment.
- Follow-up exams usually include x-rays and various scans, and blood tests to measure tumor marker levels.
- After the two-year period has passed, check-ups may be reduced to one or two times a year.
- Testicular cancer seldom recurs after a man has been tested free of the disease for three years.
“Surveillance” After Surgery
Some physicians recommend observation after surgery-waiting to see if there is a relapse-before starting any further treatment. This approach is usually followed when:
- Diagnosis was a nonseminoma
- There was no sign of cancer spread beyond the testicle
When the main tumor is removed early, testicular cancer has a high cure rate even if there is a relapse. So there may be no clear advantage (and obvious disadvantages) to treatment if there is no evidence the disease has spread.
Will The Testicular Cancer Come Back After Treatment?
Men who have been treated for cancer in one testicle have about a 1% chance of developing cancer in the remaining testicle.
If cancer recurs, it is almost always a new disease rather than a spread from the previous cancer. Because of this tendency, a man should:
- Be checked regularly by his doctor
- Continue to do a testicular self-examination every month
Any unusual symptoms should be reported to the doctor immediately. It is extremely important for treatment and cure to detect a new cancer as early as possible.
The Outlook For Testicular Cancer
The outlook for testicular cancer is excellent.
- Researchers have found more and better ways to diagnose and treat this disease, and recovery has dramatically improved.
- The majority of men treated for testicular cancer today are cured by their initial treatment.
- Many of those who experience a recurrence can be cured as well.
- Doctors emphasize that, while the cure rate is very high for all types and stages of testicular cancer, many of the drastic measures undertaken to cure later-stage disease can be avoided if the cancer is diagnosed early.
The best way to find testicular cancer is through regular self-examination.
Testicular Cancer: Frequently Asked Questions
Here are some frequently asked questions related to testicular cancer.
Q: Will testicular cancer affect my sex life, or make me infertile?
A: No. Men with one healthy testicle can still have a normal erection and produce sperm. An operation to remove one testicle does not make a man impotent and seldom interferes with fertility. For those men concerned with esthetic appearances, an artificial testicle (prosthesis) can be placed in the scrotum. The prosthesis has the weight and feel of a normal testicle.
Q: Is a lump in the testicle always cancer?
A: Not every lump in the testicle is cancer. There could be other causes, such as infection or a non-cancerous growth. The earliest symptoms of testicular cancer are most often pain, swelling, or hardness in the testis, or some combination of these symptoms. Sometimes, the first symptom a man will notice is a small, painless lump on the testicle. But there is a high chance it may be cancer. Therefore, it is important to see a doctor if a man experiences any of these symptoms
Testicular Cancer: Putting It All Together
Here is a summary of the important facts and information related to testicular cancer.
- Cancer that develops in a testicle is called testicular cancer.
- The testicles (also called the testes or gonads) are the male sex organs. They produce sperm and are the main source of male hormones.
- Testicular cancer is one of the most common cancers in young men between the ages of 15 and 34.
- When cancer is suspected, and other tests (x-rays, scans, blood tests) have ruled out other causes, the only sure way to know if cancer is present is to remove the testicle through an operation called the
inguinal orchiectomy . - Testicular cancer is almost always curable if found early. Treatment depends on what kind of cancer it is, and what stage it is when found.
- Treatments for testicular cancer include surgery, radiation therapy, and chemotherapy.
- Follow-up care is extremely important in men who have had testicular cancer. Men who have been treated for cancer in one testicle have about a 1% chance of developing cancer in the remaining testicle.
- Although any man can get testicular cancer, the disease itself is rare, accounting for about 1% of all cancers in American men.
- One of the best ways to find testicular cancer in the early stages is through testicular self-examination (TSE) every month.
- Men with one healthy testicle can still have a normal erection and produce sperm. An operation to remove one testicle does not make a man impotent and seldom interferes with fertility.
- For those men concerned with esthetic appearances, an artificial testicle (prosthesis) can be placed in the scrotum. The prosthesis has the weight and feel of a normal testicle.
Testicular Cancer: Glossary
Here are definitions of medical terms related to testicular cancer.
Benign: Not cancerous. A growth that is not cancerous
CT scan: A painless high-tech procedure that uses x-rays to produce images of organs and body structures.
Inguinal: Relating to the groin, the area between the abdomen and thigh.
Impotence: The inability to achieve or maintain an erection. Impotence is the most common male sexual disorder, affecting most men at some time in their lives.
Malignant: Cancerous. An uncontrolled growth that can spread into the surrounding tissues and around the body.
MRI: A painless and safe high-tech diagnostic procedure that uses powerful magnets and radiowaves that are converted by a computer into images of organs and body structures without the use of x-rays or radiation.
Orchiectomy: Surgical removal of a single testis or of both the testes.
Testosterone: The most important of the male sex hormones, responsible for stimulating bone and muscle growth and sexual development.
Tumor: an abnormal mass of tissue that results from excessive cell division. A tumor may be benign (not cancerous) or malignant (cancerous).
Undescended testis: A testis that has failed to fully descend from the abdomen into the scrotum in the growing baby, while still in the womb.
Testicular Cancer: Additional Sources Of Information
Here are some reliable sources that can provide more information on testicular cancer.
American Cancer Society (ACS)
Phone: (800) ACS-2345(toll-free hotline)
National Cancer Institute (NCI), Cancer Information Service
Phone: (800) 4-CANCER
Phone: 800-422-6237
Internet sources:
National Health Information Center http://www.health.gov/nhic/
National Institutes of Health http://www.nih.gov
healthfinderTMhttp://www.healthfinder.gov