What is testicular cancer?

The two testicles are egg-shaped male reproductive glands. They are suspended in a pouch of loose skin called the scrotum below and behind the penis. In maturity, they are usually slightly smaller than a golf ball. It is normal for one testicle to be larger than the other

The testicles produce the hormone testosterone as well as sperm, the male reproductive cells.Testicular cancer is a disease in which cells become malignant (cancerous) in one or both testicles.

The testicles (also called testes or gonads) are a pair of male sex glands. They produce and store sperm and are the main source of testosterone (male hormones) in men. These hormones control the development of the reproductive organs and other male physical characteristics. The testicles are located under the penis in a sac-like pouch called the scrotum.

Based on the characteristics of the cells in the tumor, testicular cancers are classified as seminomas or nonseminomas. Other types of cancer that arise in the testicles are rare and are not described here. Seminomas may be one of three types: classic, anaplastic, or spermatocytic. Types of nonseminomas include choriocarcinoma, embryonal carcinoma, teratoma, and yolk sac tumors. Testicular tumors may contain both seminoma and nonseminoma cells.

Back to top

Why is testicular cancer a concern for American Indian men?

Testicular cancer accounts for only 1 percent of all cancers in men in the United States. About 8,000 men are diagnosed with testicular cancer, and about 390 men die of this disease each year (1). Testicular cancer occurs most often in men between the ages of 20 and 39, and is the most common form of cancer in men between the ages of 15 and 34. It is most common in white men, especially those of Scandinavian descent. The testicular cancer rate has more than doubled among white men in the past 40 years, but has only recently begun to increase among black men. The reason for the racial differences in incidence is not known.

Click here for more information.

• American Cancer Society, Inc. Cancer Facts and Figures 2005. Atlanta: American Cancer Society, Inc., 2005. Also available at here on the Internet.

Click here for more information.

Back to top

What causes testicular cancer?

Testicular cancer is more common in men who have a testicle that has failed to descend. In the unborn child the testicles develop inside the abdomen between the kidneys and descend into the scrotum at birth or during the first year of life. If this does not happen, the risk of a man developing testicular cancer is increased.

Men with a brother or father who has had testicular cancer are slightly more at risk of developing it (although the risk is still small). Research has shown that a particular gene is the cause of testicular cancer in some men. It is possible that this gene is inherited and may be the reason why testicular cancer sometimes occurs in brothers or sons of men who have had the disease.

Testicular cancer is more common in white men than African-Caribbean or Asian men. It occurs more commonly in wealthier social groups. The reasons for this are not known.
It is not clear whether injury to the testicle can cause a testicular cancer. Vasectomy does not increase the risk of a man developing testicular cancer.

Click here for more information.

Back to top

What are some of the various types of testicular cancer?

Ninety-five percent of testicular cancers arise from sperm-forming, or germ cells and are called germinal tumors. The remaining 5 percent are nongerminal tumors. About 40 percent of germinal tumors are categorized as seminomas. Several other types of germinal tumors are referred to collectively as non-seminomas.

These distinctions are important because each type grows and spreads differently, which influences treatment.

Seminomas- Germ cells become malignant at a very early stage in their development. They may be anaplastic, classic (or typical), or spermatocytic, depending on their origin. Eighty-five percent of seminomas are of the classic type. They occur most often in men in their 40s.
Anaplastic seminomas are more aggressive and are more likely to metastasize to other parts of the body. Spermatocytic seminomas usually occur in men over 50. The rate of metastasis for this type of cancer is low.

Non-seminomas- Cells, which are more mature and specialized than the germ cells give rise to non-seminomas. This type of testicular cancer affects men in their mid-30s; the aggressiveness of the disease varies. Twenty to 25 percent of the tumors are embryonal carcinomas, which are aggressive tumors; 25 to 30 percent are teratoma carcinomas, which are also aggressive; yolk-sac tumors, or choriocarcinomas, are extremely rare (about 1 percent of testicular cancers); and some tumors include more than one cell type.

Testicular cancers tend to spread via the spermatic cord and associated blood and lymph vessels into local lymph glands called the retroperitoneal the lymph nodes. Metastases of the right testis are more likely to affect the lymph nodes near the aorta, the major blood vessel leading away from the heart, called the para-aortic lymph nodes. When netastases beyond the lymph nodes occur, they are most likely to arise in the lungs, liver, bone, or brain.

Click here for more information.

Back to top

What are the risk factors of testicular cancer?

The exact causes of testicular cancer are not known. However, studies have shown that several factors increase a man’s chance of developing this disease.

• Undescended testicle (cryptorchidism): Normally, the testicles descend from inside the abdomen into the scrotum before birth. The risk of testicular cancer is increased in males with a testicle that does not move down into the scrotum. This risk does not change even after surgery to move the testicle into the scrotum. The increased risk applies to both testicles.
  
  
• Congenital abnormalities: Men born with abnormalities of the testicles, penis, or kidneys, as well as those with inguinal hernia (hernia in the groin area, where the thigh meets the abdomen), may be at increased risk.
  
  
• History of testicular cancer: Men who have had testicular cancer are at increased risk of developing cancer in the other testicle.
  
  
• Family history of testicular cancer: The risk for testicular cancer is greater in men whose brother or father has had the disease.

Click here for more information.

Back to top

What can you do to prevent getting testicular cancer?

Cryptorchidism, white race, and a family history of the disease are the main known risk factors of this cancer. None of these factors can be prevented because they are present at birth. Also, many men with testicular cancer have no known risk factors. For these reasons, there is no way to prevent most cases of this disease.

But it is wise to correct cryptorchidism before puberty. And knowing he has a risk factor may cause a young man to be more watchful and to check his testicles, making it more likely a cancer will be found early.

Click here for more information.

Back to top

What are the signs / symptoms of testicular cancer?

Signs and symptoms of testicular cancer include:

• Asymptomatic mass--firm to hard, usually not tender
• Testicular pain--result of bleeding or infarction of tumor
• Acute epididymitis--25% of mixed teratoma-embryonal cell cases
• Night sweats and fever
• Gynecomastia (enlargement of male breasts due to high HCG secretion)
• Infertility
• Weight loss
• Sensation of heaviness or dragging in the lower abdomen or scrotum
• Rarely, breast tenderness or enlargement due to high levels of hormone called human chorionic gonadotropin (HCG)
• Abdominal pain, cough, or bloody sputum if metastasis has occurred

Click here for more information.

Back to top

How is testicular cancer detected?

Most testicular cancers are found by men themselves. Also, doctors generally examine the testicles during routine physical exams. Between regular checkups, if a man notices anything unusual about his testicles, he should talk with his doctor. Men should see a doctor if they notice any of the following symptoms:

• a painless lump or swelling in a testicle
• pain or discomfort in a testicle or in the scrotum
• any enlargement of a testicle or change in the way it feels
• a feeling of heaviness in the scrotum
• a dull ache in the lower abdomen, back, or groin
• a sudden collection of fluid in the scrotum

These symptoms can be caused by cancer or by other conditions. It is important to see a doctor to determine the cause of any of these symptoms.

Click here for more information.

Back to top

What treatments are available for testicular cancer?

Although the incidence of testicular cancer has risen in recent years, more than 95 percent of cases can be cured. Treatment is more likely to be successful when testicular cancer is found early. In addition, treatment can often be less aggressive and may cause fewer side effects.

Most men with testicular cancer can be cured with surgery, radiation therapy, and/or chemotherapy. The side effects depend on the type of treatment and may be different for each person.

The three types of standard treatment are described below.

• Surgery to remove the testicle through an incision in the groin is called a radical inguinal orchiectomy. Men may be concerned that losing a testicle will affect their ability to have sexual intercourse or make them sterile (unable to produce children). However, a man with one healthy testicle can still have a normal erection and produce sperm. Therefore, an operation to remove one testicle does not make a man impotent (unable to have an erection) and seldom interferes with fertility (the ability to produce children). For cosmetic purposes, men can have a prosthesis (an artificial testicle) placed in the scrotum at the time of their orchiectomy or at any time afterward.

Some of the lymph nodes located deep in the abdomen may also be removed (lymph node dissection). This type of surgery does not usually change a man’s ability to have an erection or an orgasm, but it can cause problems with fertility if it interferes with ejaculation. Patients may wish to talk with their doctor about the possibility of removing the lymph nodes using a special nerve-sparing surgical technique that may preserve the ability to ejaculate normally.

• Radiation therapy(also called radiotherapy) uses high-energy rays to kill cancer cells and shrink tumors. It is a local therapy, meaning that it affects cancer cells only in the treated areas. External radiation (from a machine outside the body), aimed at the lymph nodes in the abdomen, is used to treat seminomas. It is usually given after surgery. Because nonseminomas are less sensitive to radiation, men with this type of cancer usually do not undergo radiation therapy.

Radiation therapy affects normal as well as cancerous cells. The side effects of radiation therapy depend mainly on the treatment dose. Common side effects include fatigue, skin changes at the site where the treatment is given, loss of appetite, nausea, and diarrhea. Radiation therapy interferes with sperm production, but many patients regain their fertility over a period of 1 to 2 years.

• Chemotherapy is the use of anticancer drugs to kill cancer cells. When chemotherapy is given to testicular cancer patients, it is usually given as adjuvant therapy (after surgery) to destroy cancerous cells that may remain in the body. Chemotherapy may also be the initial treatment if the cancer is advanced; that is, if it has spread outside the testicle at the time of the diagnosis. Most anticancer drugs are given by injection into a vein.

Chemotherapy is a systemic therapy, meaning drugs travel through the bloodstream and affect normal as well as cancerous cells throughout the body. The side effects depend largely on the specific drugs and the doses. Common side effects include nausea, hair loss, fatigue, diarrhea, vomiting, fever, chills, coughing/shortness of breath, mouth sores, or skin rash. Other side effects include dizziness, numbness, loss of reflexes, or difficulty hearing. Some anticancer drugs also interfere with sperm production. Although the reduction in sperm count is permanent for some patients, many others recover their fertility.

Some men with advanced or recurrent testicular cancer may undergo treatment with very high doses of chemotherapy. These high doses of chemotherapy kill cancer cells, but they also destroy the bone marrow, which makes and stores blood cells. Such treatment can be given only if patients undergo a bone marrow transplant. In a transplant, bone marrow stem cells are removed from the patient before chemotherapy is administered. These cells are frozen temporarily and then thawed and returned to the patient through a needle (like a blood transfusion) after the high-dose chemotherapy has been administered.

Click here for more information.

Back to top