What Is Testicular Cancer?
Testicular cancer is the growth of malignant cells in the testicles, the male reproductive glands that produce sperm and testosterone. Most (95%) testicular cancer originates in undeveloped cells (germ cells) that produce sperm. [HC] In almost all cases only one testicle is involved.
While relatively rare, testicular cancer is the most common cancer among young men; incidence is highest between the ages of 15 and 34, and quite rare beyond age 40. The disease disproportionately affects white men. Prognosis is often good, though it depends heavily on whether the cancer has spread to other organs. The cure rate is very high when testicular cancer is detected and treated early.
Who Gets Testicular Cancer?
Incidence of testicular cancer is rising. According to the American Cancer Society, approximately 8,800 cases are diagnosed and about 400 men die of the disease each year in the United States. The disease is most prevalent in men between the ages of 18 and 32 and is approximately 5 times more common in Caucasians than African Americans. Germany, Scandinavia, and New Zealand have the highest incidence of testicular cancer and Asia and Africa have the lowest.
Testicular cancer does not always produce symptoms.
A firm, painless lump or nodule in one of the testicles is usually the first sign of the disease.
Other symptoms include hardness and a feeling of heaviness or aching in the scrotum or lower abdomen.
Rarely, testicular pain or hydrocele (fluid around the testes).
Breast growth or nipple tenderness, due to increased levels of the hormone human chorionic gonadotropin.
In advanced cases: swollen lymph glands; abdominal or back pain; urinary difficulty; fatigue; weight loss; cough or breathing difficulty (due to spread of cancer to the lungs).
The cause is unknown, but the incidence is significantly higher among men in whom one or both testicles failed to descend from the abdominal cavity into the scrotum before birth (cryptorchidism, or undescended testes).
Klinefelter's syndrome, a congenital disorder caused by an extra X chromosome that results in failure of the testicles and usually is diagnosed after puberty, is another risk factor.
Other predisposing factors include a history of testicular trauma or testicular inflammation that occurs in conjunction with mumps.
Family or personal history of testicular cancer and genetic abnormality of chromosome 12.
Patient history and physical examination are needed. A special bright light can be shined through the scrotum to aid in diagnosis; tumors will appear opaque, while most other abnormalities (such as a hydrocele or a spermatocele) will appear translucent.
Blood tests for specific biochemical markers of testicular cancer can be used to track the response to treatment and detect the recurrence of cancer.
An ultrasound scan can confirm the presence of a solid mass in the testes.
Chest x-rays and CT (computed tomography) scans of the abdomen and pelvis are used to evaluate the stage of any tumors and to determine whether cancer has spread beyond the testicle. Treatment strategy depends heavily upon results of these tests and the type of cell causing the cancer, determined by microscopic examination of testicular tissue.
Once a tumor is detected by diagnostic procedures, the affected testicle must be removed. (A biopsy to confirm diagnosis is not done since it may promote the spread of the cancer.)
Radical inguinal orchiectomy is the surgical removal of the testicle and the spermatic cord through an incision in the groin. Surgery is performed under general or regional anesthesia and takes approximately 1 hour. Most patients can return home the same day.
The course of further treatment depends on the cell type of the tumor. Seminomas are treated with radiation to pelvic and abdominal lymph nodes. Testicular seminoma typically requires a lower dose of radiation than other types of cancer. During treatment, a shield is placed over the remaining testicle to preserve fertility.
Other types of cancer (nonseminomas) may require surgical removal of these lymph nodes or chemotherapy.
Chemotherapy is used if either type of cancer has spread to other sites in the body.
Treatment may result in infertility. Men who discover they have testicular cancer and wish to have children in the future may consider preserving sperm in a sperm bank prior to treatment. The approximate two-week delay in therapy appears to have little effect on outcome for most people.
The removed testicle may be replaced with a prosthesis; fertility is maintained if the other testicle is unaffected. If need be, regular hormone injections can be given to preserve normal sexual functioning.
Prognosis for testicular cancer depends on the stage of the disease at diagnosis. More than 95% of cases are treated successfully.
There is no way to prevent testicular cancer, but vigilant monthly self-examination can aid in early detection, which promises a very favorable prognosis. The best time to perform self-examination is after a warm shower, when the scrotum is soft and pliable.
When To Call Your Doctor
Make an appointment with your doctor right away if you discover a lump on one of your testicles. While any testicular abnormality is cause for concern, an actual lump is frequently a sign of cancer, and the sooner treatment is sought, the greater the likelihood of a complete cure.
Reviewed by Sovrin M. Shah, M.D., F.A.C.S., Assistant Professor of Urology, Icahn School of Medicine at Mount Sinai, Pelvic Medicine and Reconstructive Surgery, Sol and Margaret Berger Department of Urology, Mount Sinai Beth Israel, and Phillips Ambulatory Care Center, New York, NY. Review provided by VeriMed Healthcare Network.