Cancer Information

Testicular Cancer…get the facts

Anatomy of Testicles

The testicles (also called testes or gonads) are a pair of male sex glands. They produce and store sperm and are the main source of testosterone (male hormones) in men. These hormones control the development of the reproductive organs and other male physical characteristics. The testicles are located under the penis in a sac-like pouch called the scrotum.

What is Testicular Cancer?

Testicular cancer is a disease in which cells become malignant (cancerous) in one or both testicles. Based on the characteristics of the cells in the tumor, testicular cancers are classified as seminomas (cancers that grow slowly and are sensitive to radiation therapy) or nonseminomas (different cell types that grow more quickly than seminomas). Testicular tumors may contain both seminoma and nonseminoma cells.

• Seminomas may be one of three types: classic, anaplastic, or spermatocytic.
• Types of nonseminomas include choriocarcinoma, embryonal carcinoma, teratoma, and yolk sac tumors.

Other types of cancer that arise in the testicles are rare.

Risk Factors for Testicular Cancer

The exact causes of testicular cancer are not known. However, studies have shown that several factors increase a man’s chance of developing this disease.
 

• Undescended testicle (cryptorchidism): Normally, the testicles descend from inside the abdomen into the scrotum before birth. The risk of testicular cancer is increased in males with a testicle that does not move down into the scrotum. This risk does not change even after surgery to move the testicle into the scrotum. The increased risk applies to both testicles.
• Congenital abnormalities: Men born with abnormalities of the testicles, penis, or kidneys, as well as those with inguinal hernia (hernia in the groin area, where the thigh meets the abdomen), may be at increased risk.
• History of testicular cancer: Men who have had testicular cancer are at increased risk of developing cancer in the other testicle.
• Family history of testicular cancer: The risk for testicular cancer is greater in men whose brother or father has had the disease.

Detection and Symptoms of Testicular Cancer

Most testicular cancers are found by men themselves and most testicular cancers can be found at an early stage. 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. In some men, early testicular cancers cause symptoms that lead them to seek medical attention. Generally, a lump on the testicle is the first sign. Unfortunately, however, some testicular cancers may not cause symptoms until after they have reached an advanced stage. Men should see a doctor if they notice any of the following symptoms:

• a painless lump or swelling in a testicle
• pain or discomfort in a testicle or in the scrotum
• 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, back, or groin
• a sudden collection of fluid 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 of these symptoms.

Diagnosis of Testicular Cancer

To help find the cause of symptoms, the doctor will evaluate a man’s general health. The doctor also performs a physical exam and may order laboratory and diagnostic tests. Here’s what to expect for a diagnostic test:
 

• Blood tests that 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), Beta-human chorionic gonadotropin (ßHCG), and lactate dehydrogenase (LDH) may suggest the presence of a testicular tumor, even if it is too small to be detected by physical exams or imaging tests.
• Ultrasound, a test in which high-frequency sound waves are bounced off internal organs and tissues. 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 or a collection of fluid unrelated to cancer.
• Biopsy (microscopic examination of testicular tissue by a pathologist) to determine 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 radical 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. 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 or extent of the disease helps the doctor to plan appropriate treatment.
Men with testicular cancer should discuss their concerns about sexual function and fertility with their doctor. It is important to know that men with testicular cancer often have fertility problems even before their cancer is treated.