Testicular Cancer

Testicular cancer is a condition that begins in the tissue of the testicles.

The testicles are the oval-shaped organs that produce sperm in men. They are located inside the scrotum, below the penis.

Testicular cancer happens when the cells in the testicles multiply rapidly, forming a tumor. Testicular cancer can develop at a young age. It is most common in men between the late teens to 30s.

Symptoms include a change in the feeling or appearance of the testicles and scrotum, pain in this area, and a build-up of fluid around the testicles.

There are many options for diagnosing testicular cancer, and its progress or stage determines treatment options. Screening and self-monitoring for symptoms increases the likelihood of catching testicular cancer in its earlier, easier treated stages.

Testicular cancer definition, symptoms and complications

What is testicular cancer?

Testicles are the reproductive organ found in the scrotum, most often among biological men or people assigned male at birth. They are ovular glands that usually come as pairs, and they produce the sex hormones, semen, and sperm necessary for reproduction.

Cancer beginning in the testicle occurs when abnormal cells begin to grow out of control in this organ, often first detected as an unusual lump in the tissue or excessive fluid buildup in the scrotum. Tumors beginning in the testicles can spread to the scrotum, nearby lymph nodes, tissues, and other organs as it progresses.

Are there different types of testicular cancer?

There are different types of testicular cancer. The majority of testicular cancers start in the germ cells, which are the sperm within the testicles. The two main types of testicular germ cell tumors are:

• Seminomas: A seminoma is a germ cell tumor most often in the testicle but can spread to the lymph nodes. This is a slow-growing found in men in their 40s and 50s, and they are more sensitive to radiation therapy.
• Nonseminomas: This is a type of cancer that begins in cells that form sperm. Nonseminoma tumors are often made up of more than one type of cell. These are more common than seminomas and tend to be diagnosed is older men 45 to 60 years old, and grow and spread more quickly, usually requiring the removal of affected testicles.

Other types of testicular cancer include:

• Stromal tumors: These tumors can also develop from the supportive tissues around the germ cells in the testicle. These tumors are rare, making up less than 5 percent of testis cancers, and have an excellent prognosis if surgically resected.

What are the symptoms of testicular cancer?

Symptoms differ between patients, but those experiencing early stages of testicular cancer may experience the following:

• A change in how the testicle feels
• A painless lump or swelling in either testicle
• Pain or discomfort in a testicle or in the scrotum
• A sudden build-up of fluid in the scrotum
• A dull ache in the lower abdomen or the groin

Like other cancers, testicular cancer progresses in stages, during which symptoms may change or become more severe. The following stages are used to track the progress of testicular cancer:

• Stage 1: This is the earliest stage of testicular cancer, and the cancerous cells are only in the testicle and hasn’t spread to nearby lymph nodes or other organs. Stage 1 is split into 1A and 1B, depending on the size of the tumor.
• Stage 2: The cancer cells have spread from the testicle into nearby lymph nodes in your abdomen or pelvis. Stage 2 is also split into substages based on how many lymph nodes the cancer has spread to and the size of those lymph nodes.
• Stage 3: Stage 3 testicular cancer means that the cancer has spread to lymph nodes or other organs. It is also split into multiple stages referring to where the cancer has spread and levels of the tumor markers in the blood. Lymph nodes in the chest, lungs, liver, bones or brain may be affected by the cancer, as well as nearby or distant structures like the prostate or colon.

Are there complications to testicular cancer?

Common complications resulting from testicular cancer include infertility and erectile dysfunction, related back to the reproductive functions of the testes. Left undiagnosed and at later stages, testicular cancer can cause other problems, such as lower back pain if the cancer has spread to nearby lymph nodes. Chronic fatigue and unexplained weight loss are common signs of late-stage cancer, accompanied by metastatic cancer, which is the spread of cancerous cells to different areas of the body.

Testicular cancer causes, risk factors and prevention

What causes or contributes to the development of testicular cancer?

While there are no singular causes for any type of cancer, testicular cancer does seem related to development and family health history. If a patient has a family history of testicular cancer or has atypical development of the testicles (also usually genetic), they are more likely to develop testicular cancer.

Are there risk factors for developing testicular cancer?

Anything that increases the risk of getting a disease is called a risk factor. Having a risk factor does not mean that someone will get a particular type of cancer; not having risk factors doesn’t mean that someone will not get a particular type of cancer.

Risk factors for developing testicular cancer include:

• Having had an undescended testicle
• Having had abnormal development of the testicles
• Having a personal history of previous testicular cancer
• Having a family history of testicular cancer (especially in a father or brother)
• Being Caucasian

Can testicular cancer be prevented? How?

Unfortunately, due to the risks of testicular cancer being largely related to health history, inherited genetics and development, there is no way to prevent testicular cancer. Doctors do recommend regular testicle self-examinations to identify testicular cancer at an earlier stage.

Testicular cancer diagnosis and treatment

How is testicular cancer diagnosed?

Diagnosing testicular cancer requires more than one approach.

The following screenings, tests and procedures may be used to detect or diagnose testicular cancer and determine the stage of its progress:

• Physical exam and history: The doctor reviews and examines the patient’s medical history, treatments and any physical signs of disease, lumps, tenderness or other abnormalities in and around the testicle(s).
• Ultrasound exam: This painless procedure can show unusual dense tissues that may indicate a tumor around the testicles through an ultrasound scan over this area.
• Serum tumor marker test: A sample of blood is taken to measure any increased amounts of chemical substances called tumor markers that are released into the blood. Examples of tumor markers used to detect testicular cancer include alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-hCG) and lactate dehydrogenase (LDH). Alongside CT-PET scans and lymph node biopsies, tumor marker tests also help determine the stage of testicular cancer.
• Inguinal orchiectomy: This is a surgical procedure to remove the entire testicle through an incision in the groin. A tissue sample is biopsied from the testicle and viewed under a microscope to check for cancer cells. The procedure is conducted this way because if the surgeon cut into the testicle to remove a sample of tissue for biopsy when cancer is present, it could cause the cancer to spread into the scrotum and lymph nodes nearby.

What options are available for testicular cancer treatment? Are any more common or successful?

There are multiple factors of testicular cancer that require medical attention, and several methods of treatment may be necessary to address all patient symptoms. Treatment also depends on cancer stage.

Patients with testicular cancer are usually treated with surgery and follow-up chemotherapy and/or radiation, including standard therapies and novel therapies only available in clinical trials.

The mainstay of treating testicular cancer is removal of the affected testicle. Removal of some types or grades may be followed by chemotherapy or radiation.

Most people who get testicular cancer do not die of it, but certain treatments for testicular cancer can cause infertility that may be permanent. Because most testicular cancer patients are young, those who may wish to have children should consider sperm banking before having treatment. This is one of the many reasons why patients should get careful diagnosis and have discussions with their physician about treatment options.

What is the prognosis for testicular cancer? Is there a cure?

The prognosis and treatment options depend on the following:

• The stage of the cancer (whether it affects part of the testicular, involves the whole testicular, or has spread to other places in the body).
• Whether the tumor can be completely removed by surgery.
• The patient’s general health.

Prognosis for early stages of testicular cancer are very good, ranging from a 99-96% survival rate after five years, according to the American Cancer Society. Even when testicular cancer has spread to nearby tissues or organs, this survival rate is still higher than that of many other cancers.