Testicular Cancer

The testes are the two male sex organs that produce and store semen as well as the hormone testosterone. They are located in the scrotum. Testicular cancer occurs when abnormal cells grow out of control in the testes. It is highly treatable if detected early.

While not very common, the disease affects mostly young white males between the ages of 15 and 35.

There are two subtypes of testicular cancer. Seminoma (germ cell) tumors account for 40% of all testicular cancers. Nonseminoma subtypes, which are more aggressive, account for the rest, and include teratocarcinoma and embryonal cell carcinoma.

The exact causes of testicular cancer are unknown. Factors that may increase a man’s risk of testicular cancer, however, include a family history of the disease; the genetic disorder Klinefelter syndrome, which results in two or more X chromosomes; or an undescended testicle (cryptorchidism).

There are many symptoms of testicular cancer, but the most common include:

• Pain in one or both testicles
• Changes in the size or shape of one or both testes
• A heavy feeling in the scrotum
• A dull pressure or pain in the lower back, belly or groin, or in all three places

Many men find testicular cancer themselves during self-examination, though a physician may detect it during a routine physical exam. Because other problems can cause similar symptoms, the physician may order tests to determine another problem, or to be sure the cancer has not spread. These tests may include:

• Blood work: Blood samples examined for high levels of certain proteins that are often secreted by testicular cancer. These proteins include alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG).
• Imaging or X-ray tests:
  • CT scan: Performed to screen for and determine extent of disease, including involvement of surrounding tissues or other organs.
  • Ultrasound: Images of the testes are taken with a wand-like instrument called a transducer that emits sound waves and picks up the echoes as they bounce off organs.

Our testicular cancer treatment approach depends on each patient’s situation. Nearly all men with testicular cancer undergo radical inguinal orchiectomy to remove the affected testicle. This allows the physician to identify the type of cancer cells present, and to plan other necessary treatments. These post-surgery treatments may include:

• Surveillance: For early stage cancer, the physician closely watches to see what happens following surgery, with regular checkups to ensure the cancer is gone.
• Chemotherapy: For more advanced cancers, chemotherapy destroys cancer cells that remain after surgery.
• Radiation therapy: Mostly used to treat seminoma, a high dose of x-rays destroys cancer cells that remain after surgery or treats cancer that has spread beyond the testes.
• Retroperitoneal lymph node dissection (RPLND): This additional surgery removes potentially cancerous lymph nodes from the lower back and pelvis.