1. What is testicular cancer?
Testicular cancer is a disease in which cells become malignant (cancerous) in
one or both testicles.
The testicles (also called testes or gonads) are a pair of male sex glands.
They produce and store sperm, and are also the body's main source of male
hormones. These hormones control the development of the reproductive organs
and male characteristics. The testicles are located under the penis in a
sac-like pouch called the scrotum.
Testicular cancer can be broadly classified into two types: seminoma and
nonseminoma. Seminomas make up about 30 percent of all testicular cancers.
Nonseminomas are a group of cancers that include choriocarcinoma, embryonal
carcinoma, teratoma, and yolk sac tumors. A testicular cancer may have a
combination of both types.
An estimated 7,400 men in the United States were diagnosed with testicular
cancer in 1999. Although testicular cancer accounts for only 1 percent of all
cancers in men, it is the most common form of cancer in young men between the
ages of 15 and 35. Any man can get testicular cancer, but it is more common
in white men than in black men.
2. What are the risk factors for testicular cancer?
The causes of testicular cancer are not known. However, studies show that
several factors increase a man's chance of developing testicular cancer.
* Undescended testicle (cryptorchidism): Normally, the testicles
descend into the scrotum before birth. Men who have had a testicle
that did not move down into the scrotum are at greater risk for
developing the disease. This is true even if surgery is performed
to place the testicle in the scrotum.
* Abnormal testicular development: Men whose testicles did not
develop normally are also at increased risk.
* Klinefelter's syndrome: Men with Klinefelter's syndrome (a sex
chromosome disorder that may be characterized by low levels of male
hormones, sterility, breast enlargement, and small testes) are at
greater risk of developing testicular cancer.
* History of testicular cancer: Men who have previously had
testicular cancer are at increased risk of developing cancer in the
3. How is testicular cancer detected? What are symptoms of testicular
Most testicular cancers are found by men themselves. Also, doctors generally
examine the testicles during routine physical exams. Between regular
checkups, if a man notices anything unusual about his testicles, he should
talk with his doctor. When testicular cancer is found early, the treatment
can often be less aggressive and may cause fewer side effects.
Men should see a doctor if they notice any of the following symptoms:
* A painless lump or swelling in either testicle;
* Any enlargement of a testicle or change in the way it feels;
* A feeling of heaviness in the scrotum;
* A dull ache in the lower abdomen or the groin (the area where the
thigh meets the abdomen);
* A sudden collection of fluid in the scrotum;
* Pain or discomfort in a testicle or in the scrotum.
These symptoms can be caused by cancer or by other conditions. It is
important to see a doctor to determine the cause of any symptoms.
4. How is testicular cancer diagnosed?
To help find the cause of symptoms, the doctor evaluates a man's general
health. The doctor also performs a physical exam and may order laboratory and
diagnostic tests. If a tumor is suspected, the doctor will probably suggest a
biopsy, which involves surgery to remove the testicle.
* Blood tests measure the levels of tumor markers. Tumor markers are
substances often found in higher-than-normal amounts when cancer is
present. Tumor markers such as alpha-fetoprotein (AFP), human
chorionic gonadotropin (HCG), and lactase dehydrogenase (LDH) may
detect a tumor that is too small to be detected during physical
exams or imaging tests.
* Ultrasound is a diagnostic test in which high-frequency sound waves
are bounced off tissues and internal organs. Their echoes produce a
picture called a sonogram. Ultrasound of the scrotum can show the
presence and size of a mass in the testicle. It is also helpful in
ruling out other conditions, such as swelling due to infection.
* Biopsy. Microscopic examination of testicular tissue by a
pathologist is the only sure way to know whether cancer is present.
In nearly all cases of suspected cancer, the entire affected
testicle is removed through an incision in the groin. This
procedure is called inguinal orchiectomy. In rare cases (for
example, when a man has only one testicle), the surgeon performs an
inguinal biopsy, removing a sample of tissue from the testicle
through an incision in the groin and proceeding with orchiectomy
only if the pathologist finds cancer cells. (The surgeon does not
cut through the scrotum to remove tissue, because if the problem is
cancer, this procedure could cause the disease to spread.)
If testicular cancer is found, more tests are needed to find out if the cancer
has spread from the testicle to other parts of the body. Determining the
stage (extent) of the disease helps the doctor to plan appropriate treatment.
5. How is testicular cancer treated? What are the side effects of
Most men with testicular cancer can be cured with surgery, radiation therapy,
and/or chemotherapy. The side effects depend on the type of treatment and may
be different for each person.
Seminomas and nonseminomas grow and spread differently, and each type may need
different treatment. Treatment also depends on the stage of the cancer, the
patient's age and general health, and other factors. Men are often treated by
a team of specialists, which may include a surgeon, a medical oncologist, and
a radiation oncologist.
* Surgery to remove the testicle through an incision in the groin is
called a radical inguinal orchiectomy. Men may be concerned that
losing a testicle will affect their ability to have sexual
intercourse or make them sterile (unable to produce children).
However, a man with one remaining healthy testicle can still have a
normal erection and produce sperm. Therefore, an operation to
remove one testicle does not make a man impotent (unable to have an
erection) and seldom interferes with fertility (the ability to
produce children). Men can also have an artificial testicle, called
a prosthesis, placed in the scrotum. The implant has the weight and
feel of a normal testicle.
Some of the lymph nodes located deep in the abdomen may also be
removed (lymph node dissection). This type of surgery does not
change a man's ability to have an erection or an orgasm, but it can
cause sterility because it interferes with ejaculation. Patients
may wish to talk with the doctor about the possibility of removing
the lymph nodes using a special nerve-sparing surgical technique
that may protect the ability to ejaculate normally.
* Radiation therapy, also called radiotherapy, uses high-energy rays
to kill cancer cells and shrink tumors. Radiation therapy is a
local therapy; it affects cancer cells only in the treated areas.
Radiation therapy for testicular cancer comes from a machine outside
the body (external beam radiation) and is usually aimed at lymph
nodes in the abdomen. Seminomas are highly sensitive to radiation.
Nonseminomas are less sensitive to radiation, so men with this type
of cancer usually do not undergo radiation.
Radiation therapy affects normal as well as cancerous cells. The
side effects of radiation therapy depend mainly on the treatment
dose. Common side effects include fatigue, skin changes at the site
where the treatment is given, loss of appetite, nausea, and
diarrhea. Radiation therapy interferes with sperm production, but
most patients regain their fertility within a matter of months.
* Chemotherapy is the use of anticancer drugs to kill cancer cells
throughout the body. Chemotherapy is given to destroy cancerous
cells that may remain in the body after surgery. The use of
anticancer drugs following surgery is known as adjuvant therapy.
Chemotherapy may also be the initial treatment if the cancer is
advanced; that is, if it has spread outside the testicle. Most
anticancer drugs are given by injection into a vein (IV).
Chemotherapy is a systemic therapy, meaning that drugs travel
through the blood stream and affect normal as well as cancerous
cells all over the body. The side effects depend largely on the
specific drugs and the dose. Common side effects may include
nausea, loss of hair, fatigue, diarrhea, vomiting, fever, chills,
coughing/shortness of breath, mouth sores, or skin rash. Other
common side effects are dizziness, numbness, loss of reflexes, or
difficulty hearing. Some anticancer drugs interfere with sperm
production. Although the reduction in sperm count is permanent for
some patients, many others recover their fertility.
Men with testicular cancer should discuss their concerns about sexual function
and fertility with the doctor. If a man is to have treatment that might lead
to infertility, he may want to ask the doctor about sperm banking (freezing
sperm before treatment for use in the future). This procedure can allow some
men to produce children after loss of fertility.
6. Is followup treatment necessary? What does it involve?
Regular followup exams are extremely important for men who have been treated
for testicular cancer. Like all cancers, testicular cancer can recur. Men
who have had testicular cancer should see their doctor regularly and should
report any unusual symptoms right away. Followup may vary for different types
and stages of testicular cancer. Generally, patients are checked frequently
by a doctor and have regular blood tests to measure tumor marker levels. They
also have regular x-rays and computed tomography, also called CT scans or CAT
scans (detailed pictures of areas inside the body created by a computer linked
to an x-ray machine). Men who have had testicular cancer have an increased
likelihood of developing cancer in the remaining testicle. They also have an
increased risk of certain types of leukemia, as well as other types of
cancers. Regular followup care ensures that any changes in health are
discussed, and any recurrent cancer can be treated as soon as possible.
7. Are clinical trials (research studies) available for men with testicular
Yes. Participation in clinical trials is an important treatment option for
many men with testicular cancer. To develop new, more effective treatments,
and better ways to use current treatments, the National Cancer Institute is
sponsoring clinical trials in many hospitals and cancer centers around the
country. Clinical trials are a critical step in the development of new
methods of treatment. Before any new treatment can be recommended for general
use, doctors conduct clinical trials to find out whether the treatment is safe
for patients and effective against the disease.
Patients who are interested in learning more about participating in clinical
trials can access NCI's
cancerTrials-R Web site at http://cancertrials.nci.nih.gov/ on the Internet.