|Testicular cancer occurs in the testicles (testes), which are located inside the scrotum, a loose bag of skin underneath the penis. The testicles produce male sex hormones and sperm for reproduction.
Compared with other types of cancer, testicular cancer is rare. But testicular cancer is the most common cancer in American males between the ages of 15 and 34.
Testicular cancer is highly treatable, even when cancer has spread beyond the testicle. Depending on the type and stage of testicular cancer, you may receive one of several treatments, or a combination. Regular testicular self-examinations can help identify growths early, when the chance for successful treatment of testicular cancer is highest.
|Signs and symptoms of testicular cancer include:
Cancer usually affects only one testicle.
- A lump or enlargement in either
- A feeling of heaviness in the
- A dull ache in the abdomen or groin
- A sudden collection of fluid in the
- Pain or discomfort in a testicle or
- Enlargement or tenderness of the
See your doctor if you detect any pain, swelling or lumps in your testicles or groin area, especially if these signs and symptoms last longer than two weeks.
|It's not clear what causes testicular cancer in most cases. Doctors know that testicular cancer occurs when healthy cells in a testicle become altered. Healthy cells grow and divide in an orderly way to keep your body functioning normally. But sometimes some cells develop abnormalities, causing this growth to get out of control — these cancer cells continue dividing even when new cells aren't needed. The accumulating cells form a mass in the testicle.
Nearly all testicular cancers begin in the germ cells — the cells in the testicles that produce immature sperm. What causes germ cells to become abnormal and develop into cancer isn't known.
|Factors that may increase your risk of testicular cancer include:
- An undescended testicle (cryptorchidism).
testes form in the abdominal area during fetal development and
usually descend into the scrotum before birth. Men who have a
testicle that never descended are at greater risk of testicular
cancer in either testicle than are men whose testicles descended
normally. The risk remains even if the testicle has been surgically
relocated to the scrotum. Still, the majority of men who develop
testicular cancer don't have a history of undescended testicles.
- Abnormal testicle
that cause testicles to develop abnormally, such as Klinefelter's
syndrome, may increase your risk of testicular cancer.
- Family history.
family members have had testicular cancer, you may have an increased
cancer affects teens and younger men, particularly those between
ages 15 and 34. However, it can occur at any age.
cancer is more common in white men than in black men.
|Tests and diagnosis
|Most men discover testicular cancer themselves, either unintentionally or while doing a testicular self-examination to check for lumps. In other cases, your doctor may detect a lump during a routine physical exam.
To determine whether a lump is testicular cancer, your doctor may recommend:
Determining the type of cancer
testicular ultrasound test uses sound waves to create an image of
the scrotum and testicles. During an ultrasound you lie on your back
with your legs spread. Your doctor then applies a clear gel to your
scrotum. A hand-held probe is moved over your scrotum to make the
An ultrasound test can help your doctor determine the nature of any
testicular lumps, such as if the lumps are solid or fluid filled.
Ultrasound also tells your doctor whether lumps are inside or
outside of the testicle. Your doctor uses this information to
determine whether a lump is likely to be testicular cancer.
- Blood tests.
doctor may order tests to determine the levels of tumor markers in
your blood. Tumor markers are substances that occur normally in your
blood, but the levels of these substances may be elevated in certain
situations, including testicular cancer. A high level of a tumor
marker in your blood doesn't mean you have cancer, but it may help
your doctor in determining your diagnosis.
- Surgery to remove a testicle
(radical inguinal orchiectomy).
it's determined that the lump on your testicle may be cancerous,
surgery to remove the testicle may be recommended. Your removed
testicle will be analyzed in a laboratory to determine if the lump
is cancerous and, if so, what type of cancer.
Your extracted testicle will be analyzed to determine the type of testicular cancer. The type of testicular cancer you have determines your treatment and your prognosis. In general, there are two types of testicular cancer:
Sometimes both types of cancer are present in a tumor. In that case, the cancer is treated as though it is nonseminoma.
Seminoma tumors occur in all age groups, but if an older man develops testicular cancer, it is more likely to be seminoma. Seminomas, in general, aren't as aggressive as nonseminomas and are particularly sensitive to radiation therapy.
Nonseminoma tumors tend to develop earlier in life and grow and spread rapidly. Several different types of nonseminoma tumors exist, including choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumor. Nonseminomas are sensitive to radiation therapy, but not as sensitive as seminomas are. Chemotherapy is often very effective for nonseminomas, even if the cancer has spread.
Staging the cancer
Once your doctor confirms your diagnosis, the next step is to determine the extent (stage) of the cancer. To determine whether cancer has spread outside of your testicle, you may undergo:
After these tests, your testicular cancer is assigned a stage. The stage helps determine what treatments are best for you. The stages of testicular cancer are:
- Computerized tomography (CT).
CT scans take a series of X-ray images of your abdomen. Your doctor uses CT scans to look for signs of cancer in your abdominal lymph nodes.
- Blood tests.
Blood tests to look for elevated tumor markers can help your doctor understand whether cancer likely remains in your body after your testicle is removed.
- Stage I. Cancer is limited to the testicle.
- Stage II. Cancer has spread to the lymph nodes in the abdomen.
- Stage III. Cancer has spread to other parts of the body. Testicular cancer most commonly spreads to the lungs, liver, bones and brain.
|Treatments and drugs
|The options for treating your testicular cancer depend on several factors, including the type and stage of cancer, your overall health, and your own preferences. Treatment options may include:
Surgery to remove your testicle (radical inguinal orchiectomy) is the primary treatment for nearly all stages and types of testicular cancer. To remove your testicle, your surgeon makes an incision in your groin and extracts the entire testicle through the opening. A prosthetic, saline-filled testicle can be inserted if you choose. You'll receive anesthetics during surgery. All surgical procedures carry a risk of pain, bleeding and infection.
You may also have surgery to remove the lymph nodes in your groin (retroperitoneal lymph node dissection). Sometimes this is done at the same time as surgery to remove your testicle. In other cases it can be done later. The lymph nodes are removed through a large incision in your abdomen. Your surgeon takes care to avoid severing nerves surrounding the lymph nodes, but in some cases severing the nerves may be unavoidable. Severed nerves can cause difficulty with ejaculation, but won't prevent you from having an erection.
In cases of early-stage testicular cancer, surgery may be the only treatment needed. Your doctor will give you a recommended schedule for follow-up appointments. At these appointments — typically every few months for the first few years and then less frequently after that — you'll undergo blood tests, CT scans and other procedures to check for signs that your cancer has returned. If you have a more advanced testicular cancer or if you're unable to adhere closely to the recommended follow-up schedule, your doctor may recommend other treatments after surgery.
Radiation therapy is a treatment option that's frequently used in people who have the seminoma type of testicular cancer. Radiation therapy is also used in certain situations in people who have the nonseminoma type of testicular cancer. Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. During radiation therapy, you're positioned on a table and a large machine moves around you, aiming the energy beams at precise points on your body. Side effects may include fatigue, as well as skin redness and irritation in your abdominal and groin areas.
Chemotherapy treatment uses drugs to kill cancer cells. Chemotherapy drugs travel throughout your body to kill cancer cells that may have migrated from the original tumor. Your doctor might recommend chemotherapy after surgery. Chemotherapy may be used before or after lymph node removal. Side effects of chemotherapy depend on the drugs being used. Ask your doctor what to expect. Common side effects include fatigue, nausea, hair loss, infertility and an increased risk of infection. There are medications and treatments available that reduce some of the side effects of chemotherapy.