Cancer Treatment & Information

What are the symptoms of Testicular Cancer?

Most testicular cancers are discovered by the man himself when he notices a painless swelling (58%), lump (27%), or pain (33%) in a testicle.

• The lump may be small (the size of a pea) or large (the size of marble or even larger)
• Less common symptoms include a lasting ache or sensation of heaviness in the testicle.
• Significant shrinking of a testicle or a hardness of the testicle are other less common symptoms.
• Occasionally, a dull ache in the pelvis or groin is the only symptom.
• Rarely, the first symptom may be breast tenderness (3%), a result of hormonal changes brought on by the cancer.

Changes in the testicle can be detected early by practicing monthly testicular self-examination. Self-exam is easy to do. Testicular self-examination is key to recognizing testicular cancer early. Males older than 18 years should be encouraged to perform monthly inspections of each testicle. For more information on how to do a testicular self-exam, see Prevention. Notify your health care provider about any suspicious finding or concern.

How is Testicular Cancer diagnosed?

To help find the cause of symptoms, the doctor evaluates a man’s general health. The doctor also performs a physical exam and may order laboratory and diagnostic tests. These tests include:

• Blood tests that measure the levels of tumor markers. Tumor markers are substances often found in higher-than-normal amounts when cancer is present. Tumor markers such as alpha-fetoprotein (AFP), Beta-human chorionic gonadotropin (ßHCG), and lactate dehydrogenase (LDH) may suggest the presence of a testicular tumor, even if it is too small to be detected by physical exams or imaging tests.
• Ultrasound, a test in which high-frequency sound waves are bounced off internal organs and tissues. Their echoes produce a picture called a sonogram. Ultrasound of the scrotum can show the presence and size of a mass in the testicle. It is also helpful in ruling out other conditions, such as swelling due to infection or a collection of fluid unrelated to cancer.
• Biopsy (microscopic examination of testicular tissue by a pathologist) to determine whether cancer is present. In nearly all cases of suspected cancer, the entire affected testicle is removed through an incision in the groin. This procedure is called radical inguinal orchiectomy. In rare cases (for example, when a man has only one testicle), the surgeon performs an inguinal biopsy, removing a sample of tissue from the testicle through an incision in the groin and proceeding with orchiectomy only if the pathologist finds cancer cells. (The surgeon does not cut through the scrotum to remove tissue. If the problem is cancer, this procedure could cause the disease to spread.)

If testicular cancer is found, more tests are needed to find out if the cancer has spread from the testicle to other parts of the body. Determining the stage (extent) of the disease helps the doctor to plan appropriate treatment.

What is Testicular Cancer?

Testicular cancer is an abnormal growth of cells in the testicles. The testicles are the male reproductive organs (gonads), where sperm are produced.

• The 2 small glands lie in a pouch of skin behind the penis called the scrotal sac, or scrotum.
• They are attached to the ejaculatory duct in the lower pelvis by cords called spermatic cords, which contain the vas deferens, the narrow tube through which the sperm moves out of the testis.
• Besides producing and storing sperm, the testicles (or testes) are the main source of male hormones such as testosterone, which control reproduction and sex drive (libido) and impart male physical traits such as deep voice and body and facial hair.
• Cancer usually occurs in only one testicle. Less than 5% of the time, it occurs in both testicles. (Usually, the 2 tumors are found at different times, the second perhaps years later.)

Cancer occurs when normal cells transform and begin to grow and multiply without normal controls.

• This uncontrolled growth results in a mass of abnormal cells called a tumor.
• Some tumors grow quickly, others more slowly. Almost all tumors start to cause symptoms when they get large enough.
• Tumors are dangerous because they overwhelm surrounding healthy tissue, taking not only its space but also the oxygen and nutrients it needs to carry out its normal functions.

Not all tumors are cancer. A tumor is considered cancer if it is malignant. This means that, if the tumor is not treated and stopped, it will spread to other parts of the body.

• Malignant tumors can spread to neighboring structures, usually lymph nodes. They encroach on and invade these healthy tissues, impairing their function and eventually destroying them.
• Tumor cells sometimes enter the bloodstream and spread to distant organs. There, they can grow as similar but separate tumors. This process is called metastasis.
• The most common places for testicular cancer to spread are the lungs and the lymph nodes in the area around your kidneys (the retroperitoneum), called the retroperitoneal lymph nodes. It also can spread to the lungs and liver.
• Metastatic cancers are the most difficult to cure.

Testicular cancers comprise several different types of tumor. The types are based on the cell type from which the tumor arises.

• By far the most common type is germ cell carcinoma. These tumors arise from the sperm forming cells within the testes.
• Other types of testicular tumors include Leydig cell tumors, Sertoli cell tumors, primitive neuroectodermal tumors (PNET), leiomyosarcomas, rhabdomyosarcomas, and mesotheliomas. None of these tumors is very common.
• Most of the information presented here concerns germ cell tumors.

There are 2 types of germ cells tumors, seminomas and nonseminomas (sometimes called teratomas).

• Seminomas arise from only one type of cell: immature germ cells that have not yet specialized. They are usually slow growing and tend not to spread from the testicle for a very long time. These constitute about 40% of all testicular cancers.
• Nonseminomas are composed of mature cells that have already specialized. Thus, these tumors often are “mixed,” that is, they are made up of more than one tumor type. Typical components include choriocarcinoma, embryonal carcinoma, immature teratoma, and yolk sac tumor. These tumors tend to be faster growing and to spread more aggressively than seminomas.

Testicular cancer is the most common type of cancer in young men aged 15-35 years, but it can occur at any age.

• It is not a common cancer, accounting for only 1-2% of cancers in men.
• The American Cancer Society estimated that, in 2003, about 7600 new cases of testicular cancer would be diagnosed and about 400 men would die of the disease.
• Testicular cancer is most common in whites and least common in blacks and Asians.

Testicular cancer is one of the most curable of all cancers.

• The cure rate is greater than 90% for all stages. In men whose cancer is diagnosed in an early stage, the cure rate is nearly 100%. Even those with advanced disease have a cure rate of greater than 80%.
• These figures apply only to men who receive appropriate treatment for their cancer. Prompt diagnosis and treatment are essential.
• Because of its high cure rate, testicular cancer is considered the model of success for cancer treatment. In 1970, 90% of men with metastatic testicular cancer died of the disease. By 1990, that figure had almost reversed —nearly 90% of men with metastatic testicular cancer were cured.

What causes Testicular Cancer?

We do not know exactly what causes testicular cancers. Unlike many other cancers, testicular cancer does not seem to run in families. We know that certain factors, listed here, increase a man’s risk of developing a testicular cancer.

Cryptorchidism: The testicles form in the abdomen of the developing fetus. While the fetus is still in the womb, the testicles begin their gradual descent to the scrotum. Often times, this descent is not complete at birth but occurs during the first year of life. Failure of the testicle to appropriately descend into the scrotum is called undescended testicle, or cryptorchidism.

• It can occur on one or both sides.
• If the testicles do not fully descend, the infant usually undergoes surgery to bring the testicle(s) into the scrotum.
• The risk for testicular cancer is 3-5 times higher in males born with cryptorchidism, even after surgery to bring the testicle(s) into the scrotum.
• Because of this increased risk, men with this type of condition should be even more rigorous about performing regular testicular self-exams.

Exposure to diethylstilbestrol (DES) while in the womb: DES is an estrogen compound that was once used for women with breast cancer. It is no longer used very much. However, sons of women exposed to a high level of estrogen during pregnancy have an increased risk of cryptorchidism and testicular cancer.

Testicular atrophy: When a testicle fails to develop appropriately, it may not mature and grow to its expected size. Some causes of testicular atrophy include mumps, torsion (loss of blood supply after twisting of the spermatic cord), or trauma.

Exposure to chemicals and pollutants: Exposure to certain toxic substances may cause the testicles to develop abnormally. The increase in chemicals and other toxins in the environment may account for the increased frequency of testicular cancer over the past 30-40 years.

Other causes: Exposures to certain drugs may increase the risk of testicular cancer. Other proposed, but poorly proven, causes include decreased exercise, increased sexual activity, sitting with legs crossed (increases testicular temperature), and HIV infection.