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Testicular Cancer

It is important to realize that with timely diagnosis, testicular cancer is highly treatable and usually curable. The following information addresses the most common questions about testicular tumors and serves as a supplement to the discussion that you have with your physician. 

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What happens under normal conditions?

The testicle is an egg-shaped structure with a firm, slightly spongy feel. At the top and outside edge is a separate rubbery tube-like structure, the epididymis, where sperm mature before eventually being ejaculated from the body. The consistency of the testicle should be uniform. The size of the testicles should be roughly the same.

What are the symptoms of a testicular tumor?

Until proven otherwise, any lump or firm area within the testicle should be considered a potential tumor. Of the many men who eventually hear a diagnosis of testicular cancer, 50 percent have complained of painless swelling or enlargement of the testicle. Another 25 percent to 50 percent may have pain or tenderness. Patients may also report a dull ache in association with the lump.

Unfortunately, it is common for men to delay reporting these symptoms (up to an average of 5 months). Since the tumor can spread during that time, it is important to contact a urologist immediately when you have a symptom.

The urologist may call for an ultrasound, a simple non-invasive radiologic procedure, to confirm any suspicious lump. In addition, he/she will probably ask for a blood sample to check for tumor markers, proteins produced by most testicular malignancies that show up if cancer is present.

What are the stages of testicular cancer?

• Stage 1: Cancer is found only in the testicle (testis).
• Stage 2: Cancer has spread to the lymph nodes in the abdomen
• Stage 3: Cancer has spread beyond the lymph nodes in the abdomen. There may be cancer in parts of the body far away from the testicles, such as the lungs and liver.

How are testicular tumors treated?

Suspicious tumors are treated initially by surgical removal of the testicle through a small groin incision. In some instances, a testicular prosthesis may be inserted at the time for cosmetic effect.

Subsequent treatment will depend on the tumor, since testicular cancers are categorized by their cell type, which determines both how they behave biologically and respond therapeutically. The most common cell type is seminoma, a tumor responsive to both radiation and chemotherapy. Radiation is commonly utilized for treating low stage seminomas.

All other cell types are called non-seminomatous tumors. Treatment options for non-seminomatous tumors include observation, surgery or chemotherapy, depending on the cell type and extent of spread. A urologist will use a variety of imaging tools — e.g., chest X-rays and CT scans — along with blood tumor markers to "stage" or assess the cancer for treatment.

Patients with more advanced testis cancer or more aggressive tumors may require surgical removal of lymph nodes in the abdomen from the area behind the peritoneum for assessing just how far the cancer has spread. If the disease is well-advanced, the patient may be put on chemotherapy as a primary treatment. Very often specialists prescribe a drug "cocktail" or combination of two or three agents — such as cisplatin, etoposide and bleomycin — to be delivered in three or four three-week cycles. Sometimes surgical removal of residual tumors may be required after completion of chemotherapy.

What can be expected after treatment for testicular tumors?

Removal of one testicle should not impair a patient's sexual potency or, in general, their fertility. They may experience a brief decrease in sperm production but the remaining gland should produce adequate amounts of testosterone.

After surgery to remove the lymph nodes, some patients' ability to ejaculate may be impaired, although this problem is uncommon with today's nerve-sparing techniques. Also, there are some medications available to help reverse ejaculation problems. Most patients are able to have a normal erection after the surgery.

However, because ejaculation can be impaired with surgery and because chemotherapy can lower sperm counts (usually only temporary), patients may wish to sperm bank prior to treatments. Once a patient has had a testicular tumor, he can expect to be followed for at least five years with periodic X-rays, CT scans and blood tests for tumor markers. Also, since he is at increased risk (approximately two percent) of developing a second tumor, it is important that he continue monthly testicular self-exams (TSE). A TSE is best done after a warm bath or shower when the skin of the scrotum is relaxed.   

Frequently asked questions:

How common are testicular tumors?

Testicular tumors are very uncommon. Approximately three in 100,000 men develop testicular tumors each year. But while those numbers are low, testicular cancer is the most common malignancy in men, ages 20 to 34. Olympic Gold Medalist, figure skater Scott Hamilton and Tour de France champion, cyclist Lance Armstrong have had testicular tumors.

Are there any risk factors for testicular cancer?

The only risk factor associated with testicular tumors is a history of an undescended testicle (cryptochidism), a testicle that has not dropped from the abdominal cavity (where they form in fetal development) down into the scrotum by birth. Five percent to ten percent of patients who have had an undescended testicle remedied through surgery may develop a testicular cancer. Self-examination is particularly important for these men since a tumor can occur in either testicle.

What is the cure rate for testicular tumors?

The good news for testicular cancer patients is that an effective strategy employing surgery, chemotherapy or radiation therapy (either alone or in combination) has created cure rates approaching 100 percent for low stage or early disease, and more than 85 percent for more advanced tumors.

How do I perform a testicular exam?

Monthly testicular self-exams (TSE) are the most important way to detect a tumor early. A TSE is best done after a warm bath or shower when the skin of the scrotum is relaxed. You should look for any changes in appearance and then carefully examine each testicle by rolling it between the fingers and thumbs of both hands to check for any lumps. While many lumps are benign, a high percentage of testicular masses are cancerous. It is critical to meet with a urologist to get an accurate diagnosis.

Reviewed April, 2007

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Glossary Terms

abdomen:
	Also referred to as the belly. It is the part of the body that contains all of the internal structures between the chest and the pelvis.
benign:
	Not malignant; not cancerous.
cancer:
	An abnormal growth that can invade nearby structures and spread to other parts of the body and may be a threat to life.
chemotherapy:
	Treatment with medications that kill cancer cells or stop them from spreading.
CT scan:
	Also known as computerized tomography, computerized axial tomography or CT scan. A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images of the body. Shows detailed images of any part of the body, including bones, muscles, fat and organs. CT scans are more detailed than general X-rays.
descended:
	Lowered.
diagnosis:
	The process by which a doctor determines what disease or condition a patient has by studying the patient's symptoms and medical history, and analyzing any tests performed (e.g., blood tets, urine tests, brain scans, etc.).
ejaculate:
	The fluid that is expelled from a man's penis during sexual climax (orgasm). To release semen from the penis during an orgasm.
ejaculation:
	Release of semen from the penis during sexual climax (orgasm).
epididymis:
	A coiled tube attached to the back and upper side of the testicle that stores sperm and is connected to the vas deferens
erection:
	Enlargement and hardening of the penis caused by increased blood flow into the penis and decreased blood flow out of it as a result of sexual excitement.
fertility:
	The ability to conceive and have children.
fetal:
	Relating to or characteristic of a fetus (unborn offspring after eight weeks of development).
gene:
	The basic unit capable of transmitting characteristics from one generation to the next.
gland:
	A mass of cells or an organ that removes substances from the bloodstream and excretes them or secretes them back into the blood with a specific physiological purpose.
groin:
	The area where the upper thigh meets the lower abdomen.
incision:
	Surgical cut for entering the body to perform an operation.
invasive:
	Having or showing a tendency to spread from the point of origin to adjacent tissue, as some cancers do. Involving cutting or puncturing the skin or inserting instruments into the body.
ions:
	Electrically charged atoms.
liver:
	A large, vital organ that secretes bile, stores and filters blood, and takes part in many metabolic functions, for example, the conversion of sugars into glycogen. The liver is reddish-brown, multilobed, and in humans is located in the upper right part of the abdominal cavity.
lymph:
	Fluid containing white cells. It can transport bacteria, viruses and cancer cells.
lymph nodes:
	Small rounded masses of tissue distributed along the lymphatic system most prominently in the armpit, neck and groin areas. Lymph nodes produce special cells that help fight off foreign agents invading the body. Lymph nodes also act as traps for infectious agents.
malignancies:
	Cancerous growths.
malignancy:
	A cancerous growth.
non-seminomatous:
	Classification of testicular cancer that arises in specialized sex cells called germ cells.
peritoneum:
	Strong, smooth, colorless membrane that lines the walls of the abdomen and covers numerous body organs including the bladder.
prosthesis:
	Artificial body part.
radiation:
	Also referred to as radiotherapy. X-rays or radioactive substances used in treatment of cancer.
radiation therapy:
	Also referred to as radiotherapy or radiation. X-rays or radioactive substances used in treatment of cancer.
radiologic:
	X-ray.
scrotum:
	Also referred to as the scrotal sac. The sac of tissue that hangs below the penis and contains the testicles.
seminoma:
	The most common malignant tumor of the testis believed to arise from epithelium or lining of the semen-producing and transporting tubules in the gland.
sperm:
	Also referred to as spermatozoa. Male germ cells (gametes or reproductive cells) that are produced by the testicles and that are capable of fertilizing the female partner's eggs. Cells resemble tadpoles if seen by the naked eye.
sperm count:
	The laboratory measurement of the number of sperm in the semen.
stage:
	Classification of the progress of a disease.
testicle:
	Also known as testis. Either of the paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.
testicular:
	Relating to the testicle (testis).
testicular cancer:
	Cancer of the testis.
testis:
	Also known as testicle. Either of the paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.
testosterone:
	Male hormone responsible for sexual desire and for regulating a number of body functions.
tumor:
	An abnormal mass of tissue or growth of cells.
ultrasound:
	Also referred to as a sonogram. A technique that bounces painless sound waves off organs to create an image of their structure to detect abnormalities.
undescended testicle:
	Also called cryptochidism. A condition seen in newborns whereby one or both of the male testes have not passed down into the scrotal sac.
urate:
	A salt of uric acid.
urge:
	Strong desire to urinate.
urologist:
	A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system. Click here to learn more about urologists. (Download the free Acrobat reader.)

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