What are the testicles?
The testicles are male sex glands that produce sperm and the hormone testosterone. The testicles are two egg-shaped glands inside the scrotum, or sac of skin that lies below the penis.
What is testicular cancer?
Testicular cancer is a disease that occurs when cancerous (malignant) cells develop in the tissues of a testicle. The development of cancerous cells in both testicles can occur, but is very rare. Testicular cancer is the most common cancer in men aged 20 to 35. The disease usually is curable.
What are the risk factors for developing testicular cancer?
Risk factors for developing testicular cancer include:
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Klinefelter’s syndrome—This is a disorder in which males have an extra X chromosome. Other genetic syndromes are also associated with higher risk
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Race—White men are more likely to develop this cancer than are men of other races.
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Undescended testicle(s) — This is when one or both testicles do not move down into the scrotum before birth.
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History —This involves a personal or family history of testicular cancer.
What are the symptoms of testicular cancer?
The following symptoms might be signs of testicular cancer or of another condition. Consult a doctor if you have any of these symptoms:
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Swelling or discomfort in the scrotum
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Painless lump or swelling in either testicle
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Sudden build-up of fluid on the scrotum
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Dull ache in the groin or lower abdomen
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Pain or discomfort in the scrotum or a testicle
How is testicular cancer diagnosed?
Testicular cancer is diagnosed with the help of tests that examine the testicles and the blood. Ultimately, a biopsy must be performed to obtain a tissue sample for laboratory analysis for cancer cells. Tests to help diagnose testicular cancer can include:
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Ultrasound—This is a procedure that uses high-energy sound waves to form pictures of body tissues.
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A physical exam and history —A physical exam and medical history can help the doctor look for problems that might be related to testicular cancer.
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Aserum tumor marker test—This procedure examines a blood sample to measure the amounts of certain substances linked to specific types of cancers. These substances are called tumor markers and are classified in the groups alpha-fetoprotein (AFP), beta-human chorionic gonadotrophin (B-hCG) and lactate dehydrongenase (LDH).
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Inguinal orchiectomyandbiopsy—This procedure involves the removal of the entire testicle through an incision in the groin. A tissue sample from the testicle is then checked for cancer cells.
What are the stages of testicular cancer?
Stage 0
—Abnormal cells have not entered normal tissues but are found only in tubules where sperm cells start to develop.
Stage I
—This stage consists of the stages IA, IB, and IS.
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In Stage IA, the cancer is confined to the testicle and the epididymis, and all tumor marker levels are normal. The cancer might not have spread through the membrane that surrounds the testicle.
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In Stage IB, one of the following applies: The cancer is in the testicle and the epidydmis but invades into the blood vessels or lymphatics within the testicle; the cancer has spread to the outer layer of the membrane around the testicle; or the cancer is in the spermatic cord or the scrotum, and can be found in the blood or lymph vessels of the testicle. In stage IB, all tumor marker levels are normal.
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In Stage IS, the cancer is anywhere within the spermatic cord, testicle, or scrotum. In addition, some or all of the tumor markers are elevated.
Stage II
—This stage consists of Stage IIA, Stage IIB, and Stage IIC. This stage is diagnosed after an inguinal orchiectomy (removal of a testicle through an incision in the groin) is performed.
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In Stage IIA, the cancer is anywhere in the testicle, spermatic cord, or scrotum, and the cancer has spread to a maximum of five lymph nodes in the abdomen. None of the lymph nodes is larger than 2 centimeters in size. Tumor markers might be normal or abnormal.
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In stage IIB, the cancer is anywhere in the testicle, spermatic cord, or scrotum. The cancer either has spread to a maximum of five lymph nodes in the abdomen (at least one of the lymph nodes is larger than 2 centimeters but none is larger than 5 centimeters) or the cancer has spread to more than five lymph nodes, with the lymph nodes not being larger than 5 centimeters. Tumor markers might be normal or abnormal.
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In Stage IIC, the cancer is anywhere within the testicle, spermatic cord, or scrotum, and the cancer has spread to a lymph node in the abdomen. The lymph node is larger than 5 centimeters. Tumor markers might be normal or abnormal.
Stage III
—This stage is divided into Stage IIIA, Stage IIIB, and Stage IIIC and is determined after an inguinal orchiectomy (removal of a testicle through an incision in the groin) is performed.
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In Stage IIIA, the cancer is anywhere within the testicle, spermatic cord, or scrotum, and the cancer might have spread to one or more lymph nodes in the abdomen. In addition, the cancer has spread to distant lymph nodes or to the lungs. Tumor markers might be normal or abnormal.
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In stage IIIB, the cancer is anywhere within the testicle, spermatic cord, or scrotum, and the cancer might have spread to one or more nearby or distant lymph nodes or to the lungs. Tumor markers might be normal or abnormal.
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In stage IIIC, the cancer is anywhere within the testicle, spermatic cord, or scrotum, and the cancer might have spread to one or more nearby or distant lymph nodes, or to the lungs or anywhere else in the body. Tumor markers might be normal or abnormal.
How is testicular cancer treated at each stage?
Nearly all testicular cancers start in the germ cells (those that become sperm or eggs). The main types of testicular germ cell tumors are seminomas and non-seminomas. Non-seminomas tend to grow and spread faster than do seminomas. Seminomas are more sensitive to radiation, and both kinds are very sensitive to chemotherapy. If a testicular tumor has both seminoma and non-seminoma cells, it is treated as a non-seminoma.
The three main kinds of treatment for testicular cancer are:
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Surgical treatment
—This treatment can include removing the testicle (orchiectomy) and removing associated lymph nodes (lymphadenectomy). Usually, surgery is performed for both seminoma and non-seminoma testicular cancers. This is misleading — orchiectomy is performed for both seminomas and non-seminomas, but lymph node removal is used only for non-seminomas.
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Radiation therapy
—This treatment uses high-dose X-rays or other high-energy rays. Radiation might be used after surgery for patients with seminomas to prevent the tumor from returning. Usually, radiation is limited to the treatment of seminomas.
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Chemotherapy
—This treatment uses drugs such as cisplatin, bleomycin, and etoposide to kill cancer cells. Chemotherapy has improved the survival rate for people with both seminomas and non-seminomas.
Treatment by stage for testicular cancer
In Stage I, the treatment is usually surgery to remove the testicle. For stage I seminomas, observation or radiation to the lymph nodes in the abdomen are commonly employed. For non-seminomas, observation, surgery to remove lymph nodes in the abdomen, and sometimes chemotherapy are used.
In Stage II, seminoma tumors are divided into bulky and non-bulky disease. Bulky disease is generally defined as tumors greater than 5 centimeters. The treatment of stage II seminomas includes surgery to remove the testicle followed by radiation to the lymph nodes in the case of non-bulky disease. In cases of bulky disease, the treatment involves chemotherapy followed by surgery. The treatment of Stage II non-seminomas is usually surgery to remove the testicle and lymph nodes in the abdomen, possibly followed by chemotherapy.
In Stage III, the treatment is surgery to remove the testicle and multi-drug chemotherapy. In stage III non-seminomas, the treatment usually is chemotherapy and surgical removal of the testicle. Treatment is the same for Stage III seminomas and non-seminomas — orchiectomy followed by chemotherapy and then surgical removal of any residual masses.
If the cancer is a recurrence of a previous testicular cancer, the treatment usually consists of chemotherapy using combinations of different medicines, such as ifosfamide, cisplatin, etoposide, or vinblastine. This treatment sometimes is followed by an autologous bone marrow or peripheral stem-cell transplant. Recurrences occurring more than two years after initial treatment are usually treated surgically.
What is the prognosis (chance of recovery) for men with testicular cancer?
The prognosis is good from men with testicular cancer. This form of cancer is treated successfully in more than 95 percent of cases.
Can testicular cancer be prevented?
There is no way to prevent testicular cancer, but early detection is important. Men should perform testicular self-examination (TSE) on a monthly basis. If you are a male over 15 years old who has not been informed about how to perform TSE, call your doctor.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 2/21/2005
