Testicular cancer is cancer in one or both testicles. The testicles are two organs contained in a sac of skin called the scrotum, which hangs beneath the base of the penis. The testicles produce and store sperm and are the main source of male hormones.
Testicular cancer usually occurs in young men. This type of cancer can be treated and very often cured.
The testicles have several kinds of cells. The different cells may develop into one or more types of cancer. These types of cancer are treated differently. They also differ in the chance of survival for the patient (prognosis). Below is an explanation of the three main types of testicular cancer.
Germ cell tumors: This is the most common type of testicular cancer. Germ cell tumors grow in the cells that make sperm. More than nine out of 10 of cancers of the testicles start in the germ cells. As used here, "germ" means seed. These are the cells that make sperm.
The two main types of germ cell tumors are seminomas and nonseminomas. Seminomas start from the sperm-producing germ cells of the testicle. Within this group there are also subtypes. Seminomas usually happen in men when they are between their late 30s and early 50s.
Nonseminomas tend to develop earlier in life than seminomas. They are often found in men between their late teens and early 40s. There are 4 main subtypes. Most tumors are mixed, having at least 2 different types. But all nonseminoma germ cell cancers are treated the same way, so the exact type is not that important.
Stromal tumors: These tumors grow in other parts of the testicles, such as the cells that make hormones. Tumors can also grow in the cells that make hormones and in the supportive tissues, or stroma, of the testicles. Stromal cell tumors are often benign (not cancer). They usually do not spread beyond the testicle and can be cured by surgical removal. But a few stromal cell tumors spread to other parts of the body (metastasize). Metastatic stromal cell tumors have a poor outlook because they do not respond well to chemotherapy or radiation therapy. The 2 main types of stromal tumors are Leydig cell tumors and Sertoli cell tumors.
Secondary testicular tumors: These tumors develop from cancer that has spread to the testicles from other parts of the body. Secondary testicular tumors start in another organ and then spread to the testicle. Lymphoma is the most common cancer of this type. Among men over age 50, testicular lymphoma is more common than tumors that start in the testicle. Their outlook depends on the type and stage of lymphoma. In children with acute leukemia, the leukemia cells can sometimes form a tumor in the testicle.
Cancers of the prostate, lung, skin, kidney, and other organs can also spread to the testicles. The outlook for these cancers is usually poor. That's because these cancers have generally spread widely to other organs as well. Treatment depends on the exact type of cancer.
In 2005, approximately 8,010 males were estimated to be diagnosed with testicular cancer and 390 males were estimated to die from the disease.
When found early, testicular cancer is one of the most treatable forms of cancer, with an overall cure rate above 90 percent.
Testicular cancer incidence has more than doubled among white Americans in the past four decades.
Cryptorchidism (undescended testicle), white race, and a family history of the disease are the main known risk factors of this cancer. None of these factors can be prevented because they are present at birth.
It is wise to correct cryptorchidism in boys. And knowing he has a risk factor for testicular cancer may cause a young man to be more watchful and to check his testicles, making it more likely a cancer will be found early.
All males are at risk of testicular cancer, regardless of age. However, some individuals are at greater risk for developing the disease. The main risk factor for the development of testicular cancer is cryptorchidism — undescended testicle(s).
Normally, the testicles descend into the scrotum before birth. However, in some cases, a testicle will remain in the abdomen area or partially descend before it becomes stuck in the groin area. About 14 percent of testicular cancer cases occur in men with a history of cryptorchidism. The risk remains even after surgery to correct undescended testicles. Research is underway to help explain this phenomenon.
In addition to having undescended testicles, you are also at greater risk if you:
Have a family history of testicular cancer
Have a personal history of testicular cancer: Men who have had cancer in one testicle are at increased risk for developing cancer in the other
- Are a white, American male: The risk of testicular cancer among white American men is five times higher than that of African-American men.
- Are between the ages of 15 and 40: However, males at any age can develop this disease.
- Have certain types of moles: Recent studies have shown that an unusual condition that causes many spots or moles is linked to an increased risk of testicular cancer. The moles are found on the back, chest, belly and face
Men who have testicular cancer may have the following symptoms:
- A lump on either testicle (The lump is often painless, but it can be uncomfortable.)
- Enlargement of either testicle
- Heaviness or aching in the lower abdomen or scrotum
- Pain or discomfort in a testicle or in the scrotum
- A collection of fluid in the scrotum
- Breast growth or breast tenderness
- Loss of sex drive
- Regardless of your age, if any of these symptoms last for more than two weeks, schedule an appointment with your health care provider immediately.
By practicing early detection, men can increase their chance of discovering testicular cancer in its earliest, most treatable stages. Your health care professional should perform an examination of your testicles during your yearly physical. And most health care professionals agree that self-examination is helpful and should be performed monthly after puberty.
Testicular self-exam (TSE): Once a month perform this self-exam during or after a bath or shower when the skin is relaxed. It is important for men to become familiar with their testicles and understand what feels normal so they can recognize a change that may signal a problem.
Stand in front of a mirror. Hold the penis away and look at each testicle separately. Look for any signs of swelling on the scrotal skin. It is normal for one testicle to be larger than the other.
Examine each testicle individually using both hands. Place your thumbs on top of the testicle, and your index and middle finders under the testicle.
Gently roll the testicle between the thumbs and fingers to feel for the epididymis, a soft tube-like structure that stores and carries sperm. Finding this is important so you will not mistake it for an abnormal lump.
Continue to feel for any abnormal hard lumps or smooth rounded masses on the testicle, particularly along the sides.
If you find a lump or change in the size, shape or consistency of the testicle, contact your health care professional immediately to determine whether or not it is testicular cancer.
Surgery is the primary treatment for testicular cancer. The extent of surgery depends on the stage of the disease and the cell type, either seminoma or a nonseminoma. Testicular cancer is staged from Stage 0 (the cancer is found only in the tiny tubes that produce sperm) all the way to Stage III (the cancer may have spread beyond the testicle to nearby or far away lymph nodes or to other organs of the body, such as the lungs). The testicle or testicles with cancer are removed from the scrotum through a cut in the groin (radical inguinal orchiectomy). Sometimes lymph nodes from behind the abdomen are also removed (retroperitoneal lymph node dissection). Nerve sparing surgery to preserve a man's ability to father children is performed when possible in younger men.
Radiation to lymph nodes in the abdomen and pelvis may follow surgery. Sometimes in cases in which the tumor is larger, surgery to remove the testicle is followed by combination chemotherapy or radiation therapy to lymph nodes in the abdomen and pelvis. In other cases, a second surgery is performed to be certain no cancer remains.
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