Embryonal Carcinoma

What is embryonal carcinoma?

Embryonal carcinoma is a rare, aggressive (fast-growing) germ cell tumor and form of testicular cancer. With this type of tumor, germ cells (cells that typically “germinate” into fully mature sperm cells) multiply rapidly. They form a malignant tumor inside your testicle.

Healthcare providers classify embryonal carcinomas as non-seminomatous germ cell tumors. Non-seminomas (like embryonal carcinoma) grow bigger and spread faster than tumors classified as seminomas.

How common is embryonal carcinoma?

Testicular cancer in all its forms, including germ cell tumors like embryonal carcinoma, is rare. Of all testicular cancer diagnoses, only 2% of germ cell tumors are pure embryonal carcinomas. But around 85% of all testicular mixed germ cell tumors contain embryonal carcinoma elements. Mixed germ cell tumors contain a mixture of non-seminoma tumor types.

In extremely rare cases, embryonal carcinoma can start in other organs, like your ovaries. Embryonal carcinoma that forms in the ovaries is a rare ovarian germ cell tumor. No matter where embryonal carcinoma starts, these tumors tend to grow and spread fast.

What are the symptoms of embryonal carcinoma?

Symptoms of embryonal carcinoma include:

• A swollen testicle.
• A (painful or painless) mass or lump in your testicle.
• Heaviness or discomfort in your scrotum.

Other symptoms may be signs that the cancer has spread beyond your testicle. These include:

• Low back pain.
• Flank pain.
• Shortness of breath (dyspnea).
• Cough or coughing up blood (hemoptysis).

What causes embryonal carcinoma?

Embryonal carcinomas form when germ cells multiply out of control. Eventually, the cells form a mass, or tumor. These tumors tend to grow fast and spread beyond your testicle.

Researchers don’t know why these cells start behaving abnormally in the first place. But they believe the abnormal germ cells form early, during embryonic development.

Risk factors

Risk factors for embryonal carcinoma include:

• Age: Most people diagnosed are between 25 and 35.
• Race: Testicular germ cell tumors are more common among non-Hispanic whites in the United States and Europe.
• Family history: Your risk may be greater if a close biological relative also has a germ cell tumor.
• Select medical conditions: Conditions that may increase your risk include undescended testicles (cryptorchidism) and Klinefelter syndrome.

How is embryonal carcinoma diagnosed?

Your healthcare provider will ask about your symptoms and medical history. They’ll perform a physical exam to check for lumps in your testicle and swelling in the lymph nodes in your abdomen. Swollen lymph nodes may be a sign of cancer spread.

Tests used to diagnose embryonal carcinoma include:

• Imaging tests: Usually, the first imaging test you’ll need is an ultrasound of both testicles. If an ultrasound reveals signs of a tumor, you may need additional imaging tests to check for cancer spread. Tests may include a CT scan (computed tomography scan), an X-ray or an MRI (magnetic resonance imaging).
• Serum tumor marker tests: Your provider will check your blood for signs of certain tumor markers linked to testicular cancer. These include alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). They’re sometimes present with embryonal carcinoma — but not always.
• Inguinal orchiectomy and biopsy: A provider will need to examine the tumor cells beneath a microscope to confirm that it’s embryonal carcinoma. Your provider will need to remove the entire affected testicle. With testicular cancer, removing just a sample of tissue (as is usually the case in a biopsy) puts you at risk of the cancer cells spreading.

Stages of embryonal carcinoma

As part of your diagnosis, your provider will determine your cancer stage, or how advanced it is. Cancer stage is the best predictor of your prognosis. Early-stage embryonal carcinoma is often curable. But it spreads so fast that up to 40% of cancers have already metastasized (spread to distant parts of your body) by the time providers diagnose them.

The stages of embryonal carcinoma are:

• Stage I: The cancer is in your testicle only.
• Stage II: The cancer has spread to lymph nodes in the back of your abdomen (retroperitoneum).
• Stage III: The cancer has spread beyond the lymph nodes in your retroperitoneum or to distant organs. Embryonal carcinoma usually spreads to the lungs, but it may also spread to your liver, brain or bones.

How is embryonal carcinoma treated?

The most common treatments for embryonal carcinoma include surgery to remove the cancer and chemotherapy. Your treatment plan depends on lots of factors. These include your cancer stage, overall health and treatment preferences. Specific treatments include:

• Radical inguinal orchiectomy: Your healthcare provider will remove the affected testicle. They’ll seal nearby blood vessels and lymph tissue to prevent the possibility of cancer spreading.
• Retroperitoneal lymph node dissection (RPLND): Your healthcare provider may remove the lymph nodes in the back of your abdomen if embryonal carcinoma has spread there (or if there’s a chance of spread).
• Chemotherapy: Embryonal carcinoma usually responds well to chemotherapy. Chemotherapy treatment uses drugs to kill cancer cells. You may need chemotherapy after surgery to kill any remaining cancer cells. Sometimes, with advanced-stage embryonal carcinoma, providers prescribe chemo before surgery.

Can embryonal carcinoma be prevented?

You can’t prevent embryonal carcinoma. But you can improve your outlook by seeing your healthcare provider at the first sign of a change in your testicles. Not all changes mean cancer, but you should always have a provider check to be sure.

What is the outlook for embryonal carcinoma?

The biggest indicator of your prognosis (outlook) is the tumor stage. According to a recent study tracking embryonal carcinoma survival rates, over 98% of people treated for Stage I cancer were alive five years later. Around 80% with Stage III embryonal carcinoma were alive five years later.

Even if you respond well to treatment, your healthcare provider will continue to monitor you in case the cancer returns. With embryonal carcinoma, there’s a 20% chance of recurrence if the cancer’s only in your testicle. The likelihood of recurrence increases to over 50% if the cancer is in your scrotum or lymph nodes.

How do I take care of myself?

Share any concerns you may have about your treatment with your healthcare provider. For example, many people who learn they’ll need to have a testicle removed wonder what this will mean for their sexuality and fertility. But the remaining testicle will produce enough testosterone so you can get erect and ejaculate. You should still be able to have biological children.

If you’re concerned about your appearance, getting a prosthetic testicle may be an option. Sperm banking is also a possibility if you’re concerned about preserving your fertility.

What questions should I ask my healthcare provider?

Questions to ask include:

• What stage is my cancer?
• What are my treatment options?
• What outcomes should I expect after treatment?
• How likely is it that treatment will get rid of the cancer for good?
• Should I bank my sperm before treatment?