Testicular Cancer

Testicular Cancer

For most people, “cancer” is one of the scariest words on the planet. For a young man in his prime, discovering a suspicious lump in the testicles and knowing it could be cancerous may seem unreal. The experienced and caring specialists at Urology Partners help men overcome testicular cancer so they can enjoy long, healthy lives.

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Thanks to early detection and advanced treatments, only approximately one in 5,000 men will die from testicular cancer.

What is testicular cancer?

Testicular cancer is a lump or enlargement that develops in either testicle. Testicles are glands inside the scrotum that produce male sex hormones and sperm. Although it can be diagnosed in boys or men of any age, it is most often found in males between the ages of 15 and 44. Diagnosed early, it is very treatable and has a good cure rate.  

Warning signs and symptoms can include:

  • A painless lump in the testicle
  • Swelling of the testicle (with or without pain)
  • A feeling of weight in the scrotum
  • Pain or a dull ache in the testicle, scrotum or groin
  • Tenderness or changes in the male breast tissue

Men are encouraged to know the early warning signs, learn how to do a monthly self-exam, and talk with a doctor if they notice a suspicious lump, swelling or pain in their testicles.



What causes testicular cancer?

Several factors contribute to a higher risk for testicular cancer:

Family history - Men with a father or brother diagnosed with testicular cancer

Medical history - Men whose testes did not drop before birth (undescended testes)

Abnormal cells - Testicles that contain “germ cell neoplasia in situ” (most often found during an infertility test)

More than 90 percent of testicular cancers start in cells known as germ cells—cells that make sperm. The main types of germ cell tumors in the testicles are either seminomas or non-seminomas.

  • Seminomas are the most common cell type of testicular cancer and grow slowly.
  • Non-seminomas grow more quickly.

There are also rare testicular cancers from cells that support other roles. Leydig cell tumors form cells that make testosterone. Sertoli cell tumors come from cells that support normal sperm growth. However, testicular cancer may involve more than one cell type.


Diagnosing testicular cancer.

Testicular cancer is diagnosed using a combination of tools:

Medical history to assess overall general health and note any risk factors such as family history of testicular cancer or undescended testes.

Physical exam of the scrotum, abdomen and, lymph nodes to look for lumps, firmness or signs of swelling. Men should tell their physician if they have a history of undescended testes.

Testicular ultrasound to view the inside of the scrotum and check a suspicious lump. Other scans or x-rays of the chest or abdomen may also be done to see if cancer has spread to lymph nodes, lungs or liver.

Blood test to check for tumor markers—proteins and hormones made by some testicular cancers.


Staging testicular cancer.

If testicular cancer is detected, it is categorized as either a Stage 0, I, II or III cancer.   

Stage 0 - Also called “germ cell neoplasia in situ” (GCNIS), this stage is not really cancer, but rather a warning that cancer could possibly develop.

Stage I (IA, IB, IS) - Cancer is localized in the testicle, and has not spread to nearby lymph nodes.

Stage II (IIA, IIB, IIC) - Cancer has spread to one or more lymph nodes in the abdomen, but not spread to other parts of the body.

Stage III (IIIA, IIIB, IIIC) - Cancer has spread beyond the lymph nodes in the abdomen to distant lymph nodes or the lungs.

Treatment Depends on Several Factors

Treatment for testicular cancer is based on the cancer’s stage and whether it has spread beyond the testicles.

Active Surveillance Surgery Radiation Chemotherapy

Active Surveillance


Active surveillance involves the routine monitoring of  testicular cancer using a combination of regularly scheduled physical exams, tumor marker tests and imaging. The frequency and duration of exams, tumor marker tests and imaging depend on the cancer’s stage. Surveillance is recommended for Stage 0 and Stage I cancers. If the cancer shows any signs of growth, or if marker levels change, then more treatment may be recommended.


Surgery


Surgery is the most common treatment for testicular cancer. Three surgical procedures are commonly used.

  • Orchiectomy removes the entire testicle through a small incision in the groin, along with the spermatic cord. It is used to treat both early- and late-stage cancer. After surgery, men undergo regular surveillance to make sure the cancer doesn’t return.
     
  • Testis-sparing surgery only removes the tumor tissue, not the entire testicle. It is only recommended in select cases when the mass is very small and tumor markers are negative. Men with benign (non-cancerous) tumors are the best candidates. Afterward, regular surveillance ensures cancer does not develop. Infertility is a possible side effect.
     
  • Retroperitoneal lymph node dissection is a complex surgery used to limit the side effects of removing the lymph nodes in the back of the abdomen. It is a treatment option for men with Stage I cancer and a high risk for recurrence. It is typically recommended for men with non-seminoma cell tumors, and can be used rather than chemotherapy for patients with stage IIA or IIB non-seminoma tumors. Afterward, chemotherapy or surveillance may be recommended depending on the cancer's location, type and risk of recurrence.

Radiation


Radiationis used to kill cancer cells in the testicles or nearby lymph nodes. While some forms of non-seminomas are resistant to radiation, it works well for seminoma-cell cancers. Radiation is often prescribed when testicular cancer has spread to distant organs like the brain.



Chemotherapy


Chemotherapy drugs are given in three-week cycles (repeated three or four times), and used to fight cancers that have spread beyond the testicles. They are also used to help lower the risk of cancer coming back after surgery. Serum tumor markers and imaging tests help guide how much chemotherapy is used and monitor its effectiveness. In some cases, more than one chemotherapy drug may be combined for treatment.



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