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Questions And Answers About Testicular Cancer

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
         other testicle.

3. How is testicular cancer detected? What are symptoms of testicular cancer?

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 treatment?

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 cancer?

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.


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Editor: Susan K. Boyer, RN
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