What is Testicular Cancer in Children?

In children with testicular cancer, cancerous cells are found in the tissues of one or both testicles. Testicular tumors in children are rare, most likely treatable and most often curable.

The Testicles

Male Reproductive Organs
Male Reproductive System
Medical Illustration Copyright © 2015 Nucleus Medical Media,

The testicles (also known as testes or testis) are part of the male reproductive system. These 2 golf ball size glands are held in a sac (scrotum) below the penis. But up to 3 of every 100 full-term male children may be born with an undescended testicle (cryptorchidism). In these children 1 or both testicles have not dropped down into the scrotum from the abdomen.

The testicles make male hormones such as testosterone. This hormone controls the sex drive in men. It also triggers the development of male traits. The testicles are where sperm (male reproductive cells) mature before being delivered to the vas deferens and ejaculated. The firmness of the testicle should be the same throughout. The size of the testicles should also be about the same.

Rate of Testicular Cancer in Children

There are 2 peak ages when testicular tumors grow in children:

  • early boyhood
  • teen years

Testicular tumors rarely happen in boys before puberty. The odds of a boy having a testicular tumor are about 1 in 100,000. In infants and boys, testicular tumors make up about 1 to 2% of all tumors. On the other hand, testicular cancer is the most common cancer in young men 15 to 34 years old.



What are the Symptoms of Testicular Cancer in Children?

Signs of a testicular tumor in children are:

  • a painless lump in the testicle (the most common sign)
  • a feeling of weight in the scrotum
  • swelling of the testicle (with or without pain)
  • pain or a dull ache in the testicle, scrotum or groin

It is key to see a urologist right away, especially if these signs last for more than 2 weeks. The urologist must rule out other issues such as

  • epididymitis (swelling of the epididymis)
  • testicular torsion (twisting of the testicles)
  • inguinal hernia (when a section of intestine pokes through a weak part of the stomach muscles near the groin)
  • hydrocele (atypical fluid in the scrotum, may happen in 10 out of every 100 cases).


What Causes Testicular Cancer in Children?

Few causes have been found for testicular cancer that develops before puberty. Still, there are some risk factors.

Intersex Disorders

These complex cases with ambiguous (uncertain) genitalia and other abnormalities may have an atypical testicle that puts them at risk for tumors known as gonadoblastomas and dysgerminomas.

A History of Undescended Testes

How the testicles descend into the scrotum during pregnancy
How the testicles descend into the scrotum during pregnancy
Image © 2003 Fairman Studios, LLC.

An undescended testicle is mainly found and treated in boyhood. So, these boys should do a testicular self-exam monthly.

Age and Race

Young men  15 to 34 years old are at risk for testicular cancer. This cancer is also more common in white than in black males.



How is Testicular Cancer Diagnosed in Children?

Physical Exam and Ultrasonography

During a careful exam a doctor may find a firm lump in the testicles. An ultrasound (a noninvasive radiological test) of the scrotum can show tumors in the testicles and in nearby structures. Still, if there is suspicion of an abnormality, even a normal exam or ultrasound does not rule out a tumor.

Blood Tests

Blood tests to find tumor markers (proteins produced by most testicular cancers) are often done when a testicular tumor is suspected. Elevated levels of alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (less often) raise the clinical suspicion of specific malignant testicular tumors. The urologist may use levels of these tumor markers before surgery as a baseline.

Surgery

The only way to know if the swelling is cancer is for a surgeon to look at the testicle during surgery. Sometimes a small piece of tissue is removed and looked at under a microscope by a pathologist (a doctor who interprets the changes caused by disease in tissues and body fluid). This is known as a frozen section biopsy. If the biopsy shows that the lump is a cancer, then the testicle will be removed. This operation is known as orchiectomy. Further testing with a CT scan or MRI (magnetic resonance imaging) is not advised until after surgery, when the diagnosis of the tumor is complete.



What are the Stages of Testicular Cancer in Children?

Stages of Testicular Cancer and where it can spread throughout the body
Stages of Testicular Cancer and where it can spread throughout the body
Image © 2003 Fairman Studios, LLC.

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

What are the Types of Testicular Tumors in Children?

The most common testicular tumors in prepubescent males are yolk sac tumors and teratomas. These types make up about 80% of all testicular tumors in young boys.

Yolk Sac Tumors

These tumors look like the yolk sac of an early human embryo. In young children they are often treated with success. When these tumors grow in adults, they are more dangerous.

Teratomas

Under the microscope these germ cell tumors look like each of the 3 layers of a growing embryo. They are the most common benign tumors of the testicles. Most children show signs by age 14 months.

Gonadal Stromal Tumors

Together these rare tumors (Sertoli cell tumors, Leydig cell tumors and juvenile granulosa cell tumor) make up 8% of all testicular tumors in the Prepubertal Testis Tumor Registry. Older children have a slightly higher risk of these tumors spreading. So, they should have an in-depth exam with CT and chest x-ray.

Gonadoblastoma and Dysgerminoma

These tumors are rare, and happen most often in children with intersex disorders. The tumor grows in children with testicles that did not develop normally. Gonadoblastomas are benign, but they can change into malignant dysgerminomas in 50% of cases. Most cases show signs after puberty.



How is Testicular Cancer Treated in Children?

Testicular cancer can be treated with:

  • inguinal exploration
  • testis sparing surgery
  • total orchiectomy

Inguinal Exploration

This is recommended for any child with a testicular tumor. It is most often performed on an outpatient basis. It is used to find and likely cure the cancer. An inguinal cut (on the skin crease just above the pubic bone) is made and the testicle is guided out of the scrotum. The surgeon can then look at the exposed gland.

Testis Sparing Surgery

This can be an option when the surgeon suspects the tumor is benign based on:

  • how it looks
  • normal tumor markers (found on blood tests)
  • ultrasonography

Surgically removed tumor tissue is sent for rapid pathological analysis known as a frozen section.

Total Orchiectomy (surgical removal of the testicle)

This is needed if disease is suspected based on:

  • frozen section biopsy results
  • elevated tumor markers (found on blood tests)
  • large tumor on ultrasonography
  • testicular tumor in a postpubertal child

Further Treatment

Further care is sometimes needed, and can include:

  • retroperitoneal lymph node dissection (surgery in which small cuts are made in the midline of the belly to remove the lymph nodes)
  • radiation therapy
  • chemotherapy (treatment with drugs that kill cancer cells or stop them from spreading)

This treatment would depend on the final pathological analysis of the tumor and on the signs of tumor spread. Tumor spread is based on radiological studies that may be needed based on the tumor cell type.



What Can be Expected after Treatment?

Patients without signs of metastatic disease (cancer that spreads) and a normal AFP after surgery must be checked closely for at least 2 years. There are several types of follow-up. For example, after orchiectomy for a malignant yolk sac tumor, a patient could have a physical exam with chest x-ray and serum AFP level every 6 weeks, and a CT scan of the abdomen and pelvis every 3 months for 2 years.



More Information

Frequently Asked Questions

What will become of my son's other testicle after removal of the affected one?

The remaining testicle will not be negatively affected. It may become larger to offset the removed testicle. However, your son should tell the doctor about anything unusual from his routine monthly self-exam.

Will my son still be able to have children in the future?

Long-term data on patients who had orchiectomy in childhood for a testicular tumor are not clear. Still, it is generally agreed that normal sperm growth occurs in the other testicle after puberty. Assisted reproductive techniques make paternity a real option.

What will my son look like after the procedure? Will he be noticeably different from other boys?

Most often boys do not look different after orchiectomy. The scrotum is not cut and the other testicle keeps growing. If a boy does not like the result, a prosthesis may be placed into the scrotum. This is most often done after puberty.

How long will it take for my son to heal physically after inguinal orchiectomy?

The procedure is performed on an outpatient basis and most children return home on the same day. Your son should avoid contact sports for at least 2 weeks, but should be able to return to school within 1 week.

What are the chances that the cancer will grow in the other testicle?

No new tumors in the remaining normal testicle have been reported yet in the Society of Pediatric Urology Prepubertal Tumor Registry. This registry is made up of 307 patients with testicular tumors. In adults there is a 2 to 3% incidence of a bilateral tumor (on the opposite side) occurring at the same time or right after the first tumor.

How is a testicular self-exam performed?

Boys can start monthly testicular self-exams during their teen years. Monthly testicular self-exams are the most important way to detect a tumor early. The best time to examine the testicles is right after a hot bath or shower. The scrotal skin is most relaxed at this time and the testicles can be felt more easily. The exam should be done while standing and it only takes a few minutes.

  • Look for swelling in the scrotum or any changes in appearance.
  • Gently feel the scrotal sac to find a testicle.
  • Examine the testicles one at a time. Firmly and gently roll each testicle between the thumb and fingers of both hands to feel the whole surface.
  • Note that it is normal for one testicle to be slightly larger than the other. It is also normal to feel a cord-like structure (the epididymis) on the top and back of each testicle.
  • If you find a lump, swelling, pain or other change, get it checked out right away. Changes are not always cancer. If it is cancer and you catch it early, you have the best chance for a cure.