The testicles or testes are two male glands located inside the scrotum (a loose bag of skin beneath the penis). They are part of the male reproductive system and the endocrine system, producing sperm and male hormones. Testicular cancer begins in the testes’ cells. Testicular cancer usually develops in one testis, but between 2 and 3 percent of testicular cancer cases develop in both testes either at the same time or successively. Not long ago, testicular cancer was considered a difficult and dangerous type of cancer, but nowadays more effective diagnostic and treatment options have greatly increased the survival rate of men with testicular cancer.
Dr. Navneet Sharda provides this information as an educational source. It is not intended as a substitute for a consultation with a qualified healthcare provider.
The most common symptoms testicular cancer include:
These symptoms can vary between patients and can be similar with other medical conditions. Always consult with your physician. A correct and early diagnosis can substantially increase the survival rate for testicular cancer patients.
Testicular Cancer Types
The testicles contain several types of cells, and each type of cell can develop into different types of cancer. The most common type of testicular cancer (that represents more than 95 percent of all testicle cancers cases) is germ cell tumor or germinal tumor.
There are two main types of germ cell tumors:
Seminomas, represents about 40 percent of all germinal tumors, and it develops in men between the age of 30 and 40. In most cases, the cancer is confined to the testes, but in 25 percent of the patients the cancer spreads to the lymph nodes. One of the main characteristics of this type of tumor is that the germ cells become malignant in an early stage of development. Seminomas are more responsive to treatment than the non-seminomas.
Non-seminomas, represents about 60 percent of the all germinal tumors, and it develops in men who are in their mid-30s. This type of cancer tends to develop early, grows fast, and spreads quickly. There are four types of non-seminomas:
Embryonal carcinomas – This type of tumor represents 25 percent of the non-seminomas, and it develops in men between the age of 20 and 30. Embryonla carcinomas are highly malignant and aggressive tumors, which grow rapidly and tend to spread to the lungs and liver.
Teratoma carcinomas – This type of tumors represents 20 to 30 percent of all non-seminomas tumors and it affects young boys more then adult men.
Yolk-sac tumors is a rare type of testicular cancer that can affect adult men but more commonly occurs in young boys.
Choriocarcinomas is a rare type of testicular cancer.
There is another type of testicular cancer, called stromal cell tumor, which represents only 3 to 4 percent of all testicular cancers and 20 percent of childhood testicular tumors. This type pf cancer develops within the testicles supportive tissues (called stroma).
An important prognostic predictor for any type of cancer is the clinicopathologic stage. A clinicopathologic stage describes the cancer developmental phase, and is established according to several criteria: (1) the tumor size, (2) the cancer location (if the cancer is present in one or both testes), (3) the cancer extent (if the cancer has spread to other structures of organs within the body).
There are four stages of testicular cancer:
Stage 0 (Tumor in situ): In this stage, the cancer is confined to the testis, and it did not spread beyond the testicle tissue.
Stage I (Local): There are two subtypes:
Stage IA: In this stage, the cancer may have spread to the membrane that surrounds the testis.
Stage IB: In this stage, the cancer has spread to the lymph or blood system, to the testis membrane, or the scrotum.
Stage II (Regional): This stage is divided in two subtypes:
Nonbulky Stage II: In this stage, the cancer is present in the testis, spermatic cord, or scrotum, and has also spread to five abdominal lymph nodes within the abdominal cavity, but the tumors are no larger than 2 centimeters.
Bulky Stage II: In this stage, the cancer is present in the testis, spermatic cord, or scrotum, and has spread to five lymph nodes within the abdominal cavity, where one of the tumors is larger than 2 centimeters.
Stage III (Distant): This stage is divided into two subtypes:
Nonbulky Stage III: In this stage, the cancer has spread to the lymph nodes within the abdominal cavity and to the lungs, but the tumor is less then 2 centimeters.
Bulky Stage III: In this stage, the cancer has spread to multiple location within the body, and the lymph nodes tumors are larger than 2 centimeters.
Testicular Cancer Medical Tests and Diagnosis
Anamnesis:One of the first steps in establishing a testicular cancer diagnosis is a detailed and complex medical review of a patient’s past health problems and general health state, family medical history, testicular cancer risk factors, and symptoms.
Physical Examination: During the physical examination, the doctor checks the general signs of health and signs of the cancer such as testes lumps, swollen testes, changes in the breast appearance, abdominal lumps possibly caused by swollen lymph nodes (a sign that the cancer has spread).
Blood Tests: The blood test performed in patients that might suffer from testicular cancer is a serum tumor marker test. This test measures the amount of certain substances, called tumor markers, which are released into the blood by organs, tissues, or tumor cells. There are three tumor markers used to detect testicular cancer:
Alpha-fetoprotein (AFP) is a protein produced normally by the fetus, but it cannot be detected in healthy adult women (unless pregnant) and men. A high amount of AFP in the blood might suggest the present of germ cell tumor (testicular tumor). Non-seminomas can cause the level of AFP to increase.
Beta-human chorionic gonadotropin (ß-hCG) is a hormone normally found in the blood and urine of pregnant women. This hormone is also produced by several tumor cells (such as testis, uterus, ovary, liver, stomach, pancreas, or lungs). Non-seminomas and occasionally the seminimas cause the level of the hormone to increase.
Lactate dehydrogenase (LDH) is an enzyme found in many body tissues, which is released in the blood when the tissues suffer damage. Sometimes a high level of LDH can indicate that the cancer has spread.
Scrotal Ultrasound: Ultrasound imaging is a medical technique that uses high-frequency sound waves to create an interior image of the body on a special computer screen.
Chest X-ray: An x-ray test uses high energy electromagnetic radiation to penetrate the body and create the inside image on a film. The chest x-ray is performed in order to establish whether or not the cancer has spread in the upper part of the abdominal cavity (such as the liver and abdominal lymph nodes).
Computed tomography (CT): This imaging test is similar with an x-ray test, and creates a detailed cross-sectional image of the body.
Magnetic resonance imaging (MRI):MRI is an advanced technique that uses radio waves, strong magnets and a contrast substance to outline the image of a certain part of the body. The cancer cells absorb a high amount of the contrast substance and reveal the shape and pattern of the abnormal tissue mass.
Positron Emission Tomography (PET): This technique uses radioactive glucose to locate the cancer. Cancer cells absorb a higher amount of this radioactive glucose than normal tissues.
Radical inguinal orchiectomy: This is a medical procedure where the entire testis together with the spermatic cord is removed through an incision in the groin.
Biopsy: This is another medical procedure used to removed a sample of tumor tissue, performed when the cancer diagnosis is uncertain.This tissue is then examined by a pathologist, who can establish the cancer type and stage.
Testicular Cancer Treatment
Testicular cancer treatment varies from patient to patient, according to several factors: (1) the tumor type, (2) the cancer stage, and (3) the cancer extant.
The treatment options for testicular cancer are: surgery, chemotherapy, and radiation therapy.
Surgery: The surgical removal of the testicle is called orchiectomy. In most cases, the surgical removal of the testicle together with the surrounding lymph nodes is the first treatment approach for seminomas and non-seminomas patients.
Chemotherapy: Chemotherapy is a systemic treatment (affects cells throughout the entire body) that uses drugs either to stop the abnormal growth and dividing process of the cancerous cells, or to kill them. The most common drugs used to treat testicular cancer are: cisplatin, bleomycin, and etoposide.
Radiation therapy or Radiotherapy: This is a cancer treatment which uses high-energy rays or particles to destroy cancerous cells. This treatment is commonly used in patients that suffer from seminomas, and is administrated after surgery to prevent the cancer relapse, or to treat the remaining cancerous cells that spread to the lymph glands. It is a highly effective in treating seminomas.