Testicular Cancer
Definition
Testicular cancer is cancer that starts in the testicles, the male reproductive glands located in the scrotum.
Testicular cancer is the most common form of cancer in men between the ages of 15 and 35. It can occur in older men, and rarely, in younger boys. Testicular cancer is one of the most treatable and curable cancers. The survival rate for men with early-stage seminoma (the least aggressive type of testicular cancer) is greater than 95%.
There are two main types of testicular cancer: seminomas and non-seminomas. These cancers grow from germ cells, the cells that make sperm.
Seminoma: This is a slow-growing form of testicular cancer usually found in men in their 30s and 40s. The cancer is usually just in the testes, but it can spread to the lymph nodes. Seminomas are very sensitive to radiation therapy.
Non-seminoma: This more common type of testicular cancer tends to grow more quickly than seminomas. Non-seminoma tumors are often made up of more than one type of cell, and are identified according to these different cell types:
- Choriocarcinoma (rare)
- Embryonal carcinoma
- Teratoma
- Yolk sac tumor
A stromal tumor is a rare type of testicular tumor. They are usually not cancerous. The two main types of stromal tumors are Leydig cell tumors and Sertoli cell tumors. Stromal tumors usually occur during childhood.
Causes/Risk Factors
The exact cause of testicular cancer is unknown.
There is no link between vasectomy and testicular cancer.
Factors that may increase a man's risk for testicular cancer include:
- Abnormal testicle development
- History of testicular cancer
- History of undescended testicle
- Family history of testicular cancer may increase risk.
- Klinefelter syndrome
- Other possible causes include exposure to certain chemicals
- HIV infection.
- Race - White men are more likely than African-American and Asian-
American men to develop testicular cancer.
Warning Signs/Symptoms
- There may be no symptoms.
Symptoms that may occur can include:
- Discomfort or pain in the testicle, or a feeling of heaviness in the scrotum
- Pain in the back or lower abdomen
- Enlargement of a testicle or a change in the way it feels
- Excess development of breast tissue (gynecomastia), however, this can occur normally in adolescent boys who do not have testicular cancer
- Lump or swelling in either testicle
- Symptoms in other parts of the body, such as the lungs, abdomen, pelvis, back, or brain, may also occur if the cancer has spread.
Diagnosis
This will normally include some or all of the following:
- A full history paying particular attention to any possible trauma or infection of the testicles in the past. The patient should mention any previous operations on the testicles, especially surgery for an undescended testicle, or previous vasectomy.
- Physical examination (including examination of the scrotum, abdomen and lymph glands) typically reveals a firm lump in one of the testicles. Blood pressure will normally be measured as part of this examination.
- Tumor markers are specific blood tests to measure tumor markers alpha fetoprotein (AFP) human chorionic gonadotrophin (beta HCG) lactic dehydrogenase (LDH)
- General blood tests to measure kidney function & liver function, and to check the blood cells for anemia or other problems.
- Ultrasound of the scrotum to assess exactly where the swelling is in relation to the testicle.
- Abdominal pelvic and chest CT scan depending on scrotal ultrasound result as testicular cancer may spread to other parts of the body. The most common sites include the abdomen, lungs and retroperitoneal area (the area near the kidneys behind the other organs in the belly area)
- Chest x-ray or CT chest to assess for any spread to lung fields
- Surgical pathology. Examination of the testicle tissue is performed by the pathologist after the entire testicle is surgically removed.
Treatment Options
Treatment depends on the:
- Type of testicular tumor
- Stage of the tumor
Once cancer is found, the first step is to determine the type of cancer cell by examining it under a microscope. The cells can be seminoma, non-seminoma, or both. The next step is to determine how far the cancer has spread to other parts of the body. This is called "staging."
- Stage I cancer has not spread beyond the testicle.
- Stage II cancer has spread to lymph nodes in the abdomen.
- Stage III cancer has spread beyond the lymph nodes (it could be as far as the liver, lungs, or brain).
- Consider urgent sperm banking at a fertility unit
- The testicle should be surgically removed as soon as possible
- An artificial testicle can be inserted at the same time or at a later date, if the patient wishes.
- Prompt referral to a medical oncologist for any further treatment and for long-term follow up.
- The need for further treatment (radiotherapy or chemotherapy) is determined by the pathology results, the results of tumor marker blood tests & the findings on a CT scan.
Three types of treatment can be used.
- Surgical treatment removes the testicle (orchiectomy) and may also remove nearby lymph nodes (lymphadenectomy). This is usually performed in the case of both seminoma and non-seminomas.
- Radiation therapy using high-dose x-rays or other high-energy rays may be used after surgery to prevent the tumor from returning. Radiation therapy is usually only used for treating seminomas.
- Chemotherapy uses drugs such as cisplatin, bleomycin, and etoposide to kill cancer cells. This treatment has greatly improved survival for patients with both seminomas and non-seminomas.
Prevention
The United States Preventive Services Task Force recommends against routine screening for testicular cancer because there is no known effective screening technique. This recommendation does not apply if there is a personal history of an undescended testicle.
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