Testicular Cancer
(Cancer of the Testicle)
What are the testicles?
The testicles (also called the testes or gonads) are the male sex glands. They are located behind the penis in a pouch of skin called the scrotum. The testicles produce and store sperm, and they are also the body's main source of male hormones. These hormones control the development of the reproductive organs and other male characteristics, such as body and facial hair, low voice, and wide shoulders. 
What is cancer?
Cancer is not one disease. It is a group of well over 100 distinct diseases. Although each kind of cancer differs from the others in many ways, every type of cancer is a disease of some of the body's cells. Healthy cells that make up the body's tissues grow, divide, and replace themselves in an orderly way. This process helps keep the body in good repair. Sometimes, however, certain cells may lose the ability to limit and direct their growth. They grow too rapidly and without any order. Too much tissue is produced, and tumors are formed.
Tumors can be either benign or malignant. The distinction is crucial.
Benign tumors are not cancer. They do not spread to other parts of the body. They are seldom a threat to life (unless they are "malignant by position" -- in a spot such as the brain or heart where a mass, even a benign one, can cause death). Benign tumors can often be removed by surgery, and they are not likely to return.
Malignant tumors are cancer. They can invade and destroy nearby healthy tissues and organs. Cancerous cells can also spread, or metastasize, to other parts of the body and form new tumors.
What is testicular cancer?
Cancer that develops in a testicle is testicular cancer. When testicular cancer spreads (metastasizes), the cancer cells are carried by the bloodstream or by lymph. (Lymph is an almost colorless fluid produced by tissues all over the body. The fluid passes through lymph nodes, which filter out bacteria and other abnormal substances such as cancer cells.) Surgeons often remove the lymph nodes deep in the abdomen to learn whether testicular cancer cells have spread.
How common is testicular cancer?
It depends on the age of the man. In young men between the ages of 15 and 34, testicular cancer is one of the most common forms of cancer. But the disease also occurs in other age groups, so all men should be aware of its signs and symptoms.
How is testicular cancer usually discovered?
Most testicular cancers are first found by the men themselves who have them. They encounter a tumor in their testicle by accident or when doing testicular self-examination. The testicles are smooth, oval-shaped, and rather firm. Men who examine themselves regularly become familiar with the way their testicles normally feel. Any changes in the way they feel from month to month should be reported without delay to a doctor.
What are the causes of testicular cancer?
Exactly what causes this disease is still unknown and seldom can it be explained why one man gets it while another doesn't.
Although any man can develop testicular cancer, testicular cancer accounts for only about 1 percent of all cancers in American men. Testicular cancer is, as noted, quite unusual in its age distribution. Whereas most other types of cancer affect mostly older men (or children), but testicular cancer most often occurs in young postadolescent men. (It is also inexplicably more common in white men than in black men.)
Testicular cancer is not contagious. No one can "catch" testicular cancer (or any other form of cancer) from another person.
Research has shown that some men are more likely than others to develop testicular cancer. For example, the risk is higher than average for boys born with their testicles in the lower abdomen rather than in the scrotum. The cancer risk for boys with this condition (called undescended testicles or cryptorchidism) is increased if the problem is not corrected in early childhood.
Some men whose mothers took a hormone called DES (diethylstilbestrol) during pregnancy to prevent miscarriage have testicular abnormalities. But scientists do not know whether prenatal exposure to DES (or any other female hormone) increases the risk of testicular cancer.
Some patients with testicular cancer have a history of injury to the scrotum. But no one knows whether such an injury can actually cause cancer. Many doctors think such an injury simply calls attention to a tumor that was already growing.
What are the signs and symptoms of testicular cancer?
Testicular cancer can cause a number of signs and symptoms. Listed below are warning signs that men should watch for: - A lump in either testicle;
- Any enlargement of a testicle;
- A feeling of heaviness in the scrotum;
- A dull ache in the lower abdomen or in the groin;
- A sudden collection of fluid in the scrotum;
- Pain or discomfort in a testicle or in the scrotum;
- Enlargement or tenderness of the breasts.
These symptoms are not sure signs of cancer. They can also be caused by other conditions. However, it is important to see a doctor if any of these symptoms lasts as long as 2 weeks. Any illness should be diagnosed and treated as soon as possible. Early diagnosis of testicular cancer is especially important because the sooner cancer is found and treated, the better a man's chance for complete recovery.
How is testicular cancer diagnosed?
When a man's symptoms suggest that there might be cancer in a testicle, a personal and family medical history is taken a complete physical examination is conducted. In addition to checking general signs of health (temperature, pulse, blood pressure, and so on), the scrotum will be carefully examined. The patient will usually have a chest x-ray and blood and urine tests. If the physical exam and lab tests do not show an infection or another disorder, cancer is suspected because most tumors in the testicles are cancerous.
The only sure way to know whether cancer is present is for a pathologist to examine a sample of tissue under a microscope. To obtain the tissue, the affected testicle is removed through the groin. This operation is called inguinal orchiectomy. The surgeon does not cut through the scrotum and does not remove just a part of the testicle because, if the problem is cancer, cutting through the outer layer of the testicle might cause local spread of the disease.
The most common types of testicular cancer are seminoma and nonseminoma.
Seminomas make up about 40 percent of all cases. Nonseminomas are actually a group of cancers and comprise 60 percent of cases. They include choriocarcinoma, embryonal carcinoma, teratoma, and yolk sac tumors. Each of these two major types of testicular cancer grows and spreads differently, and they are treated differently.
How is testicular cancer treated?
Testicular cancer is almost always curable if it is found early. This disease responds well to treatment, even if it has spread to other parts of the body.
Staging
If a man has testicular cancer, it is important to find out the extent, or stage, of the disease (whether it has spread from the testicle to other parts of the body). Staging procedures include a thorough physical exam, blood tests, x-rays and scans, and, in some cases, additional surgery.
Most patients have computed tomography, also called CT or CAT scan, which is a series of x-rays of various sections of the body. Some have intravenous pyelography (IVP), x-rays used with a special dye to outline the urinary system. Some doctors recommend lymphangiography, x-rays taken with a special dye that outlines the lymph system in the abdomen. Ultrasonography, which creates a picture from the echoes of high-frequency sound waves bounced off internal organs, also may be useful.
Special lab tests can reveal certain substances in the blood. These substances are called tumor markers because they often are found in abnormal amounts in patients with some types of cancer. The levels of specific tumor markers in the blood can help the doctor determine what type of testicular cancer the patient has.
Surgery may be recommended to remove the lymph nodes deep in the abdomen. A pathologist then examines the nodes to determine whether they contain cancer cells. For patients with nonseminoma, removing the nodes helps stop the spread of their disease. Seminoma patients do not need this surgery because cancer cells in their lymph nodes can be destroyed with radiation therapy.
Methods of Treating Testicular Cancer
Testicular cancer can be treated with surgery, radiation therapy, and chemotherapy . One method or a combination of methods may used. Often, the patient is referred to medical centers that specialize in testicular cancer treatment.
Surgery
In most cases, surgery is performed to remove the testicle. Sometimes it also is necessary to remove lymph nodes in the abdomen. Additionally, tumors that have spread to other parts of the body may be partly or entirely removed by surgery.
Radiation Therapy
In radiation therapy (also called x-ray therapy, radiotherapy, cobalt treatment, or irradiation), high-energy rays are used to damage cancer cells and stop their growth. Like surgery, radiation therapy is a local treatment and affects only the cells in the treated area. The patient usually receives radiation therapy as an outpatient.
Seminomas are highly sensitive to radiation. Following surgery, men with seminomas generally have radiation therapy to their abdominal lymph nodes.
Nonseminomas are somewhat less sensitive to radiation. Patients with this type of cancer usually have other types of treatment.
Chemotherapy
The use of drugs to treat cancer is called chemotherapy. Anticancer drugs are recommended when there are signs that the cancer has spread. Chemotherapy is also sometimes used when the doctor suspects that undetected cancer cells remain in the body after surgery or irradiation. The use of anticancer drugs following surgery for early stage cancer is known as adjuvant therapy.
Chemotherapy may be given by mouth or injected into a muscle or a blood vessel. Chemotherapy is a systemic treatment, the drugs enter the bloodstream and reach cells all over the body. Depending on the specific drugs and the patient's general condition, chemotherapy may be taken as an outpatient at the hospital, at the doctor's office, or at home. However, some patients must be hospitalized for a time, so that effects of the treatment can be monitored.
What are the side effects of treatment for testicular cancer?
The treatments used against cancer must be very powerful. That is why patients may have some unpleasant side effects.
Many men worry that losing one testicle will affect their ability to have sexual intercourse or make them sterile. But a man with one healthy testicle can still have a normal erection and produce sperm. Therefore, an operation to remove just one testicle does not make a patient impotent and seldom interferes with fertility. 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.
Surgery to remove the lymph nodes does not change a man's ability to have an erection or an orgasm, but the operation can cause sterility because it interferes with ejaculation. Some men recover the ability to ejaculate without treatment; others may be helped by medication. Patients should talk with the doctor about the possibility of removing the lymph nodes using a special surgical technique that may protect the ability to ejaculate. This may not be possible in any given case.
Radiation therapy affects both normal and cancerous cells, but normal cells are able to recover. Having treatments 5 days a week for several weeks spreads out the total dose of radiation and gives the patient weekend rest breaks. Nevertheless, the body must work very hard during radiation therapy to repair the tissues injured by the treatment. Patients may feel unusually tired, and they should try to rest as much as possible. Radiation therapy does not change the ability to have sex. Radiation therapy does, however, interfere with sperm production. Usually the effect is temporary, and most patients regain their fertility within a matter of months.
Other unpleasant effects of radiation therapy include diarrhea , nausea, and vomiting. These problems can usually be controlled with medication. Also, there may be skin reactions in the area being treated, and it is important to treat the skin gently. Lotions and creams should not be used on these areas without the doctor's advice.
Chemotherapy causes side effects because it damages not only cancer cells, but other rapidly growing cells as well. Often anticancer drugs are given in cycles; treatment periods alternate with rest periods. The side effects of chemotherapy depend on the specific drugs that are given and the response of the individual patient. These drugs commonly affect hair cells, blood-forming cells, and cells that line the digestive tract. As a result, they may cause various problems, including hair loss , lowered resistance to infection, loss of appetite, nausea and vomiting, and mouth sores. Most men who receive chemotherapy for testicular cancer can continue to function sexually, although some anticancer drugs interfere with sperm production. Although this effect is permanent for some patients, many recover their fertility later on.
Loss of appetite can be a serious problem for patients receiving radiation therapy or chemotherapy. Researchers are learning that patients who eat well are better able to withstand the side effects of their treatment. Therefore, good nutrition is important. Eating well means getting enough calories to prevent weight loss and having enough protein to build and repair skin, hair, muscles, and organs. Many patients find that having several small meals and snacks throughout the day is easier than trying to eat three large meals.
The side effects of cancer therapy vary from person to person and may even be different from one treatment to the next in the same patient. Patients may find that they are less interested in sexual activity if they are tired or feel ill. Attempts are made to plan treatment to minimize problems. Fortunately, most side effects are temporary. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and suggest ways to deal with them.
What happens after patients are treated for testicular cancer?
Regular follow-up exams are very important for anyone treated for testicular cancer. A patient who has had testicular cancer should be closely monitored for several years to be sure the cancer is completely gone. If the cancer does recur, early detection is very important so that additional treatment can be started.
Follow-up care varies for the different types and stages of testicular cancer. Generally, patients are checked and have blood tests to measure tumor marker levels every month for the first 2 years after treatment. They also have regular x-rays and scans. After that, checkups may be needed just once or twice a year. Testicular cancer seldom recurs after a patient has been free of the disease for 3 years.
Patients who have been treated for cancer in one testicle have about a 1 percent chance of developing cancer in the remaining one. If cancer does arise in the second testicle, it is nearly always a new disease rather than a metastasis from the first tumor. Patients should be checked regularly by their doctor and should continue to perform testicular self-examination every month. Any unusual symptoms should be reported to the doctor without delay. As with the patient's first cancer, the earlier a new tumor is detected and treated, the greater the chance of cure.
How can patients and their families cope with testicular cancer?
When people have cancer, life can change for them and for the people who care about them. These changes in daily life can be difficult to handle. When a man learns that he has testicular cancer, it is natural to have many different and sometimes confusing emotions.
At times, patients and family members may be frightened, angry, or depressed. Their feelings may vary from hope to despair or from courage to fear. Patients are usually better able to handle these feelings if they talk about their illness and share their feelings with family members and friends.
Concerns about the future, as well as about medical tests and treatments, hospital stays, medical bills, and sexuality, are common. Talking with doctors, nurses, or other members of the health care team may help ease fear and confusion. Patients should ask questions about their disease and its treatment and take an active part in decisions about their medical care. Patients and family members often find it helpful to write down questions as they think of them to prepare for the next visit to the doctor. Taking notes during talks with the doctor can be a useful aid to memory. Patients should ask the doctor to repeat or explain anything that is not clear.
Most people want to know what kind of cancer they have, how it can be treated, and how successful the treatment is likely to be. The patient's doctor is the best person to answer questions and give advice about working or other activities. If it is difficult to talk with the doctor about feelings and other very personal matters, patients may find it helpful to talk with others facing similar problems. This kind of help is available through support groups, such as those described in the next section. If the patient or his family finds that emotional problems become too hard to handle, a mental health counselor may be able to help.
Adapting to the changes that are brought about by having cancer is easier for patients and those who care about them when they have helpful information and support services. Often, the social service office at the hospital or clinic can suggest local and national agencies that will help with emotional support, financial aid, transportation, home care, or rehabilitation.
What does the future hold for testicular cancer?
More than 8 million Americans living today have had some type of cancer. The outlook for men with testicular cancer is excellent. Because researchers have found better ways to diagnose and treat this disease, the chance of recovering has improved dramatically. Today, a large majority of testicular cancer patients are cured by their initial treatment, and many of those who have a recurrence can be cured too.
Scientists at hospitals and medical centers throughout the United States are studying testicular cancer. They are working toward a better understanding of its causes, prevention, diagnosis, and treatment. Researchers are looking for additional tumor markers that may be present in abnormal amounts in the blood or urine of a person with very early testicular cancer. If such markers are found, it might be possible to detect testicular cancer even before any symptoms are noticed. Several such markers have been studied, and research is continuing. Researchers are also looking for treatment methods that are more effective and easier for patients to tolerate. They are studying new drugs and drug combinations, varied doses, and different treatment schedules. - Testicular cancer is one of the most common cancers in young men between the ages of 15 and 34 years.
- Most testicular cancers are found by the men themselves as a lump in the testicle.
- The cancer risk for men born with undescended testicles is increased if the problem is not corrected in early childhood.
- When a growth in the testicle is detected, cancer is confirmed after surgical removal of the affected testicle (orchiectomy) and examination of the tissue under a microscope.
- Testicular cancer is almost always curable if it is found early.
- Testicular cancer can be treated with surgery, radiation therapy, and chemotherapy, or a combination of these treatments.
Resources
General information about cancer is widely available. Some helpful resources and publications are listed below. Others may be available at a local library or from support groups in the community.
CANCER INFORMATION SERVICE (CIS)
1-800-4-CANCER
The Cancer Information Service, a program of the National Cancer Institute, provides a nationwide telephone service for cancer patients and their families and friends, the public, and health care professionals. The staff can answer questions and can send booklets about cancer. They also know about local resources and services. One toll-free number, 1-800-4-CANCER (1-800- 422-6237), connects callers with the office that services their area. Spanish- speaking staff members are available.
AMERICAN CANCER SOCIETY (ACS)
1599 Clifton Road, N.E.
Atlanta, GA 30329
1-800-ACS-2345
The American Cancer Society is a voluntary organization with a national office (at the above address) and local units all over the country. It supports research, conducts educational programs, and offers many services to patients and their families. It also provides free booklets on testicular cancer and on sexuality. To request booklets or to learn about services and activities in local areas, call the Society's toll-free number, 1-800-ACS-2345 (1-800-227-2345), or the number listed under American Cancer Society in the white pages of the telephone book.
This information been modified from that furnished by the National Cancer Institute, a part of the National Institutes of Health (NIH).
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