• What is Testicular Cancer?
• Preventing and Detecting of TesticularCancer
• Treatment for Testicular Cancer
• General Questions

What is Testicular Cancer

Cancer of the testicle (also called the testis), a rare kind of cancer in men, is a disease in which cancer (malignant) cells are found in the tissues of one or both testicles. Sperm (the male germ cells that can join with a female egg to develop into a baby) and male hormones are made in the testicles. There are two testicles located inside of the scrotum (a sac of loose skin that lies directly under the penis). The testicles are similar to the ovaries in women (the small sacs that hold the female egg cells).

A doctor should be seen if there is any swelling in the scrotum. The doctor will examine the testicles and feel for any lumps. If the scrotum doesn't feel normal, the doctor may need to do an ultrasound examination, which uses sound waves to make a picture of the inside of the testes. The doctor may need to cut out the testicle and look at it under a microscope to see if there are any cancer cells. It is very important that this be done correctly.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the testicle or has spread to other places) and the patient's general state of health.

Stages of Testicular Cancer

Once cancer of the testicle has been found, more tests will be done to find out if the cancer has spread from the testicle to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the testicle:

Stage I - Cancer is found only in the testicle.

Stage II - Cancer has spread to the lymph nodes in the abdomen (lymph nodes are small, bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).

Stage III - 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.

Detection and Prevention of Testicular Cancer

Symptoms of testicle cancer:

• Uncomfortable lump on a testicle, or testicular enlargement or swelling.

• Sensation of heaviness or aching in the lower abdomen or scrotum.

• In rare cases, breast tenderness may be noticed.

Even when testicular cancer has spread to other organs, only about 1 man in 4 may experience symptoms related to the metastases prior to diagnosis. Lower back pain is a frequent symptom of later-stage testicle cancer.

Some men with testicular cancer have no symptoms at all, and their cancer is found during medical testing for other conditions.

Risk Factors for Testicular Cancer

• Age: Most testicular cancers occur between the ages of 15 and 40.

• Cryptorchidism: The main risk factor for testicular cancer is a condition called cryptorchidism, or undescended testicle(s). The testicles normally develop inside the abdomen and descend into the scrotum before birth. In about 3% of boys, however, the testicles do not make this descent. Sometimes the testicle remains in the abdomen; in other cases, the testicle starts to descend but remains stuck in the groin area. The risk of testicle cancer is somewhat higher for a testicle that was positioned in the abdomen, as opposed to one that descended at least part way.

• Family history: A family history of testicular cancer increases the risk. If one man has the disease, there is an increased risk that one or more of his brothers will also develop it.

• Occupational risks: A recent study, found that nonseminoma germ cell tumors occur more frequently among men with certain occupations (miners, oil and gas workers, leather workers, food and beverage processing workers, janitors, and utility workers). It may be that exposure to certain chemicals contributes to development of the disease. Studies have not yet identified any specific chemicals as being responsible.

• Injury: There is no convincing evidence that injury to the testicles increases the risk of developing cancer.

• HIV Infection: There is some evidence that men infected with the human immunodeficiency virus (HIV), particularly those with AIDS, are at increased risk. No other infections have been shown to increase testicular cancer risk.

• Carcinoma in situ: This condition does not produce a mass or cause symptoms. Carcinoma in situ (CIS) in the testicles almost always progresses to cancer. In some cases, CIS is detected in men who undergo a testicular biopsy during medical evaluation of infertility.

• Cancer of the other testicle: A history of testicle cancer is another risk factor. Men who have been cured of cancer in one testicle have an increased risk of developing cancer in the other testicle.

• Race and ethnicity: The risk of testicular cancer is higher among white Americans than it is among African-American, Hispanic, or Asian-American men.

• Maternal hormone use: Although men whose mothers took the synthetic estrogen, diethylstilbestrol (DES), during pregnancy have an increased risk of certain congenital (present at birth) reproductive system malformations, there is no convincing evidence that DES exposure significantly increased men’s risk for developing testicle cancer.

• Vasectomy: Some earlier studies raised the possibility that vasectomy (an operation to produce sterility) might increase the risk for testicle cancer. However, recent studies have not found any increased risk among men who have had this operation.

Unfortunately, there is no means of prevention of testicular cancer since the main risk factors, such as cryptorchidism, white race, and a family history of the disease, are unavoidable because they are present at birth. Many men with testicular cancer have no known risk factors.

Treatment of Testicular Cancer

There are treatments for all patients with cancer of the testicle, and most patients can be cured with available treatments. Four kinds of treatment are used:

• surgery (taking out the cancer in an operation)

• radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)

• chemotherapy (using drugs to kill cancer cells)

• bone marrow transplantation

Surgery is a common treatment of most stages of cancer of the testicle. A doctor may take out the cancer by removing one or both testicles through an incision (cut) in the groin. This is called a radical inguinal orchiectomy. Some of the lymph nodes in the abdomen may also be removed (lymph node dissection).

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation therapy for testicular cancer usually comes from a machine outside the body (external-beam radiation).

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the testicle.

Bone marrow transplantation is a newer type of treatment. For autologous bone marrow transplant, bone marrow is taken from the patient and treated with drugs to kill any cancer cells. The marrow is then frozen and the patient is then given high-dose chemotherapy with or without radiation therapy to destroy all of the remaining marrow. The marrow that was taken out is then thawed and given back to the patient through a needle in a vein to replace the marrow that was destroyed.

General Questions

1. What is testicular cancer?

   Cancer of the testicle (also called the testis), a rare kind of cancer in men, is a disease in which cancer (malignant) cells are found in the tissues of one or both testicles. Sperm (the male germ cells that can join with a female egg to develop into a baby) and male hormones are made in the testicles. There are two testicles located inside of the scrotum (a sac of loose skin that lies directly under the penis). The testicles are similar to the ovaries in women (the small sacs that hold the female egg cells).

2. What are the causes and risk factors for testicular cancer?

   The exact cause of most cases of testicular cancer is not known. However, researchers have found that the disease is often associated with a several conditions, which are listed below as risk factors. More and more research is being focused on changes in chromosomes and DNA that may cause some normal testicular cells to become cancerous.

   Risk factors are conditions that increase a person’s chance of getting a type of cancer. Risk factors are different for various types of cancer. Doctors have determined several risk factors for testicular cancer:

   Age: Most testicular cancers occur between the ages of 15 and 40.

   Cryptorchidism: The main risk factor for testicular cancer is a condition called cryptorchidism, or undescended testicle(s). The testicles normally develop inside the abdomen and descend into the scrotum before birth. In about 3% of boys, however, the testicles do not make this descent. Sometimes the testicle remains in the abdomen; in other cases, the testicle starts to descend but remains stuck in the groin area. The risk of testicle cancer is somewhat higher for a testicle that was positioned in the abdomen, as opposed to one that descended at least part way.

   Family history: A family history of testicular cancer increases the risk. If one man has the disease, there is an increased risk that one or more of his brothers will also develop it.

   Occupational risks: A recent study, found that nonseminoma germ cell tumors occur more frequently among men with certain occupations (miners, oil and gas workers, leather workers, food and beverage processing workers, janitors, and utility workers). It may be that exposure to certain chemicals contributes to development of thedisease. Studies have not yet identified any specific chemicals as being responsible.

   HIV Infection: There is some evidence that men infected with the human immunodeficiency virus (HIV), particularly those with AIDS, are at increased risk. No other infections have been shown to increase testicular cancer risk.

   Carcinoma in situ: This condition does not produce a mass or cause symptoms. Carcinoma in situ (CIS) in the testicles almost always progresses to cancer. In some cases, CIS is detected in men who undergo a testicular biopsy during medical evaluation of infertility.

   Cancer of the other testicle: A history of testicle cancer is another risk factor. Men who have been cured of cancer in one testicle have an increased risk of developing cancer in the other testicle.

   Race and ethnicity: The risk of testicular cancer is higher among white Americans than it is among African-American, Hispanic, or Asian-American men.

   Maternal hormone use: Although men whose mothers took the synthetic estrogen, diethylstilbestrol (DES), during pregnancy have an increased risk of certain congenital (present at birth) reproductive system malformations, there is no convincing evidence that DES exposure significantly increased men’s risk for developing testicle cancer.

   Vasectomy: Some earlier studies raised the possibility that vasectomy (an operation to produce sterility) might increase the risk for testicle cancer. However, recent studies have not found any increased risk among men who have had this operation.

3. What are the symptoms for testicular cancer?

Some men with testicular cancer have no symptoms at all, and their cancer is found during medical testing for other conditions. These symptoms might be caused by testicular cancer:

• Uncomfortable lump on a testicle, or testicular enlargement or swelling.

• Sensation of heaviness or aching in the lower abdomen or scrotum.

• In rare cases, breast tenderness may be noticed.

Even when testicular cancer has spread to other organs, only about 1 man in 4 may experience symptoms related to the metastases prior to diagnosis. Lower back pain is a frequent symptom of later-stage testicle cancer.  

4. How will my doctor know if I have testicular cancer?

   A doctor should be seen if there is any swelling in the scrotum. The doctor will examine the testicles and feel for any lumps. If the scrotum doesn't feel normal, the doctor may need to do an ultrasound examination, which uses sound waves to make a picture of the inside of the testes. The doctor may need to cut out the testicle and look at it under a microscope to see if there are any cancer cells. It is very important that this be done correctly.

5. What about treatment, what should I ask?

    Three kinds of treatment are used to treat testicular cancer:

• surgery (taking out the cancer in an operation)

• chemotherapy (using drugs to kill cancer cells)

• radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)

• bone marrow transplantation

A doctor may use just one method or combine methods to treat the cancer most effectively. These are some questions a person may want to ask his/her doctor before treatment begins:

• What is my diagnosis?

• What is the stage of the disease?

• What are my treatment choices? Which do you recommend for me? Why?

• What are the chances that the treatment will be successful?

• Would a clinical trial be appropriate for me?

• What are the risks and possible side effects of each treatment?

• How long will my treatment last?

• Will I have to change my normal activities?

• What is the treatment likely to cost? 

6. What are the side effects of treatment?

   The side effects of cancer treatment vary, depending on the type of treatment. Also, each patient reacts differently. Because treatment often damages healthy cells and tissues, it can cause unpleasant side effects.

   The removal of one or both testicles by surgery affects different men in different ways. If both testicles are removed, a man can no longer produce sperm, and is infertile. If treatment requires the removal of nearby lymph nodes, the nerves controlling ejaculation may be damaged. Physicians have developed a type of nerve-sparing therapy, which is up to 98 percent effective when performed expertly. If the patient is a young man (as many testicular cancer patients are) who is interested in having a family in the future, he may want to discuss nerve-sparing therapy with his physician. He may also consider sperm banking (storing frozen sperm cells obtained before treatment).

   Surgery also causes a changes in appearance that men may or may not worry about. The removal of a testicle its cord makes that side of the scrum look empty. Young survivors of testicular cancer may be single, dating or in situations like athletics where they feel embarrassed by this change in appearance. It is possible to implant a testicular prosthesis made of silicon gel, which in some cases can restore normal appearance.

   Because chemotherapy drugs enter the bloodstream, the are able to reach all parts of the body, making this treatment useful for cancer that has metastasized, or spread, to organs beyond the stomach. Unfortunately, along with killing cancer cells, chemotherapy drugs also damage normal cells. This can lead to temporary side effects such as nausea and vomiting, loss of appetite, loss of hair, diarrhea, mouth sores, low blood count, increased chance of infection, bleeding or bruising after minor cuts/injuries, fatigue and shortness of breath.

   Side effects to radiation therapy can include nausea, vomiting, diarrhea. Uncommonly, the skin in the treated area may become red, dry, tender, and itchy. Patients should not use lotions or creams to relieve symptoms without a doctor’s advice.

   There are remedies for many of the side affects treatment and therapy can cause, and it is important for patients to communicate their side effects to their doctor and/or nurse.

   Some of the drugs used to treat testicular cancer can cause long-term side effects, including kidney damage, damage to small blood vessels causing sensitivity to cold temperatures, nerve damage causing numbness and abnormal tingling, hearing loss, and lung damage causing shortness of breath and reduced capacity for physical activity.

7. Will I be able to adjust to this disease well?

   Each cancer survivor’s recovery is different, and a person’s adjustment after cancer treatment depends on a number of factors.
   
   Because testicular cancer or its treatment can cause infertility, men who wish to father children may want to consider depositing sperm in a sperm bank before treatment. Be aware, however, that in many cases the disease can cause low sperm counts, which may make it hard to obtain an adequate specimen. In some cases, if one testicle remains, fertility returns temporarily or permanently following successful treatment of testicle cancer. For example, fertility typically returns two years after chemotherapy stops.

   It is important for people to seek support during and after cancer treatment. Taking advantage of a social support system, such as a cancer support group, helps patients by providing a forum of information and experiences. Maintain an open dialogue with your cancer care team to address any concerns you have.