Testicular Cancer

Testicular cancer occurs in the testicles. The testicles produce male sex hormones and sperm for reproduction. Compared with other types of cancer, testicular cancer is rare. But it is the most common cancer in American males between the ages of 15 and 34. Testicular cancer is highly treatable, even when cancer has spread beyond the testicle. Depending on the type and stage of testicular cancer, you may receive one of several treatments, or a combination. Regular testicular self-examinations can help identify growths early, when the chance for successful treatment of testicular cancer is highest. Most men discover testicular cancer themselves, either unintentionally or while doing a testicular self-examination to check for lumps. In other cases, your doctor may detect a lump during a routine physical exam. Cancer usually only affects one testicle. Risk factors include an undescended testicle or abnormal development of the testicle(s).

To determine whether a lump is testicular cancer, your doctor may recommend an ultrasound. An ultrasound test can help your doctor determine the nature of any testicular lumps, such as if the lumps are solid or fluid filled. Ultrasound also tells your doctor whether lumps are inside or outside of the testicle. Your doctor uses this information to determine whether a lump is likely to be testicular cancer. Your doctor may also order tests to determine the levels of tumor markers in your blood. Tumor markers are substances that occur normally in your blood, but the levels of these substances may be elevated in certain situations, including testicular cancer.

In order to diagnose testicular cancer, your doctor will need to perform surgery to remove the testicle. Your testicle will be analyzed in a laboratory to determine if the lump is cancerous and, if so, what type of cancer.

Determining the type of cancer
In general, there are two types of testicular cancer:

• Seminoma. Seminomas, in general, aren't as aggressive as nonseminomas and are particularly sensitive to radiation therapy.
• Nonseminoma. Nonseminoma tumors tend to develop earlier in life and grow and spread rapidly. Several different types of nonseminoma tumors exist, including choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumor. Nonseminomas are sensitive to radiation therapy, but not as sensitive as seminomas are. Chemotherapy is often very effective for nonseminomas, even if the cancer has spread.

Sometimes both types of cancer are present in a tumor. In that case, the cancer is treated as though it is nonseminoma.

Staging the cancer
Once your doctor confirms your diagnosis, the next step is to determine the extent (stage) of the cancer. To determine whether cancer has spread outside of your testicle, you may undergo CT scans to look for signs of cancer in your lymph nodes or blood tests to see if cancer is present on a microscopic level. After these tests, your testicular cancer is assigned a stage. The stage helps determine what treatments are best for you. The options for treating your testicular cancer depend on several factors, including the type and stage of cancer, your overall health and your own preferences. Treatment options may include:

Surgery
Surgery to remove your testicle (radical inguinal orchiectomy) is the primary treatment for nearly all stages and types of testicular cancer. To remove your testicle, your surgeon makes an incision in your groin and extracts the entire testicle through the opening. You may also have surgery to remove the lymph nodes in your abdomen (retroperitoneal lymph node dissection). In some cases of early-stage testicular cancer, surgery may be the only treatment needed. Your doctor will give you a recommended schedule for follow-up appointments. At these appointments — typically every few months for the first few years and then less frequently after that — you'll undergo blood tests, CT scans and other procedures to check for signs that your cancer has returned.

Radiation therapy
Radiation therapy is a treatment option that's frequently used in people who have the seminoma type of testicular cancer. Radiation therapy is also used in certain situations in people who have the nonseminoma type of testicular cancer.

Chemotherapy
Chemotherapy treatment uses drugs to kill cancer cells. Chemotherapy drugs travel in the blood stream throughout your body to kill cancer cells that may have migrated from the original tumor. Your doctor might recommend chemotherapy after surgery. Chemotherapy may be used before or after lymph node removal.