Although testicular cancer is relatively rare in the general population of men, it is the most common cancer diagnosed in men between the ages of 15 to 34. Testicular cancer develops in the testicles (testes), the male reproductive glands. The testicles are located in the membranous pouch (scrotum) below the penis and are suspended from the body by the spermatic cord. They normally produce sperm and testosterone (male hormone). It is a highly treatable cancer with more than 90% of all such cancers being labeled as cured following therapy. The cure rate is nearly 98% when the cancer is detected early.
As with all cancers, testicular cancer evolves from a disruption in one or more genes in a cell’s DNA. Genes control all cell activities including division and growth. When cells die, a normal and common event, they are replaced by new cells as the body needs them. However, when the genes that orchestrate this natural replacement process are disrupted by chemicals, illness, or other unknown factors, control over cell division and growth is lost. The resultant uncontrolled growth of tissue becomes a tumor. The vast majority of testicular cancer arises in germ cells, the reproductive cells of the body. In women these cells are the ova. In men they are the sperm.
There are two primary types of testicular cancers: seminoma and non-seminoma. Seminoma arises from young germ cells, grows slowly and stays relatively immobile. Between 30% and 40% of testicular cancers are seminoma. Non-seminoma evolves from more mature germ cells. These tend to be more aggressive tumors. There are also testicular cancers that are a blend of both seminoma and non-seminoma.
A lot of publicity has been given to women and self examination for breast cancer over the years but self examination for men checking for testicular cancer has been scant. It works the same way. The testes are palpated (felt) for any suspicious lumps. In 90% of instances of cancer, they will note a small, pea-sized lump that may be uncomfortable but not necessarily painful. One or both testicles may be enlarged. Some men report an awkward feeling of heaviness or generalized ache in the lower abdomen or scrotum. A few may note breast growth or tenderness in their breasts. This is because some testicular tumors may secrete high levels of human chorionic gonadotropin (HCG), which stimulates breast development.
In some men the cancer may spread (metastasize) via the lymphatic system or bloodstream to other parts of the body. About 25% of those with metastatic testicular cancer may note lower back pain, shortness of breath, chest pain or cough depending on where the metastatic cells have spread and lodged. There may be central abdominal pain due to enlarged lymph nodes or liver involvement. Most men will have no symptoms at all other than the lump in their testes. It is important to consult a urologist when any of these symptoms are noted because the earlier the cancer is detected, the more likely it will be cured.
Unlike other cancer in which risks have been tied to smoking, drinking or exposure to environmental chemicals, there are few known risk factors for testicular cancer. The main risk factors are cryptorchidism (undescended testicle) and Klinefelter’s syndrome, a congenital disorder. Men with a family history of testicular cancer are at higher risk.
Diagnostic procedures are initiated when the symptoms already described appear. The physician will take a thorough medical history and conduct a physical examination in which he or she will feel for lumps in the scrotum, back and abdomen to see if the potential cancer has spread. One or more imaging studies will be conducted along with blood testing.
Ultrasound – Ultrasound imaging, a type of imaging that uses sound waves rather than radiation, will detect testicular tumors and determine whether they are solid or filled with fluid.
Blood tests – Some testes tumors make "markers" which are detectable in the blood. Measurement of these helps determine the type cancer, the stage (how far it has spread), and the best treatment.
A diagnosis can be confirmed by a procedure called inguinal orchiectomy. During this procedure, a cut is made in the groin and the testicle is displaced for examination and to allow a small portion of tissue to be removed for study if necessary. If a pathologist reports that the tissue appears normal, the testicle is replaced. If the tissue is obviously cancerous, the testicle is removed. This insures that the primary tumor is no longer a threat.
When cancer is detected, the primary cancer is removed as described. But a number of tests must follow to allow the disease to be staged, that is to determine if it has spread.
There are three stages of testicular cancer. They are:
These stages are divided into a number of subcategories that contain information about the extent of the cancer. Staging helps determine the type and mix of therapies that should be applied.
Among the imaging tests that may be conducted are chest x-rays, computed tomography (CT), magnetic resonance imaging (MRI), lymphangiograms, and positron emission tomography (PET).
CT scans – CT scans are similar to x-rays but are tied to sophisticated computer programs that analyze signals to produce detailed cross-sectional images. These precision images identify potential tumors and can be used to guide thin needles into suspicious areas to take tissue samples for examination.
Positron Emission Tomography – PET involves injecting slightly radioactive glucose (sugar) into a vein and allowing it to be absorbed by cells within tissue before recording the image. Because cancer cells are growing, they use more sugar than normal cells and produce a stronger image. PET is especially useful in determining the status of lymph nodes.
There are three primary treatments: surgery, radiation therapy and chemotherapy. There are also a variety of combinations of these three:
The majority of surgical interventions are rather simple. Healing is rapid and often a patient will return home on the same day as the procedure. Radiation and chemotherapy can have strong side effects. Many men with testicular cancer have oligospermia (insufficient sperm) when they are diagnosed and virtually all of those who complete a course of chemotherapy will become oligospermic. However, many recover and go on to father children. Some radiation treatments also inhibit sperm production but again, sperm counts in many will return to normal in the course of time. There are a host of other temporary side effects that are related to the nature of the radiation treatments or the individual character of the chemotherapy regimens. These pass soon after treatments are completed.
Testicular cancer does return in about 2% to 5% of treated men during the 25 years following treatment. Because of this, checkups and blood tests are taken at regular intervals to monitor for any abnormalities.