Testicular Cancer
Testicular Cancer - A hopeful prognosis
Testicular cancer is one of the most curable forms of cancer. Among all men who have this disease, the five-year survival rate is over 90%. Doctors agree that this cure rate is one of the great success stories in the modern battle against cancer.
For most men, testicular cancer affects only one testicle. If only this cancerous testicle is removed, one healthy testicle is left to preserve a man's fertility. If both testicles are removed, a man will no longer be fertile. However, many plan ahead and store sperm at a sperm bank before surgery for testicular cancer. After treatment, most men are also able to resume normal sex lives.
Pronunciation
tes-TICK-ul-ar KAN-ser
Synonyms
- Testicular malignancy
- Testis carcinoma
- Testicular germ cell tumor
Detailed Description
Different types of cancer can grow in the testicles: seminoma, teratoma, embryonal carcinoma, yolk sac tumor, and choriocarcinoma, the last kind a rare but highly aggressive form.
It's important to distinguish the different types of testicular cancers because each form differs in prognosis and treatment. Seminomas, which account for 40% of all testicular cancers, develop from cells that produce sperm. Seminomas respond to radiation therapy and chemotherapy, and most men are disease-free five years after diagnosis and treatment. In contrast, nonseminomas tend to spread (metastasize) more quickly, but do respond well to chemotherapy. As many as 65% of men diagnosed with a nonseminoma tumor are already in a late stage of testicular cancer.
Scientists don't know what causes testicular cancer. But one major risk factor is having an undescended testicle. Boys born with an undescended testicle have a reported four times higher chance of developing testicular cancer later.
Testicular cancer is most easily cured when it is detected and treated in the early stages. Most men detect the cancer themselves. If done regularly, the testicular self-examination is a good screening process that you can do at home. After a warm shower, when your scrotum is relaxed, feel both testicles thoroughly with your thumb and forefingers. If you feel any lumps or changes on either testicle, see your doctor without delay.
Characteristics of Testicular Cancer
The main symptom of testicular cancer is a lump in the testicle. In the early stages, the cancer may remain confined to the testicle. In later stages, cancer cells may spread to the surrounding lymph nodes (retroperitoneal lymph nodes) and, in advanced cases, to other parts of the body.
How Common Is Testicular Cancer?
Cancer of the testes is the most common form of cancer in men ages 15 to 40. The number of cases peaks at three ages-- infancy, 25-40, and around age 60. The disease is four times more common among white men than African-American men.
The American Cancer Society estimates that the incidence of testicular cancer is steadily rising, with approximately 7,500 cases diagnosed each year. Although the cure rate is very high, roughly 300 to 400 men still die from this disease each year. Only males are affected by testicular cancer.
What You Can Expect
With early detection and treatment, the five-year survival rate for all early stages of testicular cancer is over 90%, and 70%-80% for advanced cases.
Established Causes
The cause of testicular cancer is not currently known.
Theoretical Causes
Though the cause is not known, researchers are studying how normal sex cells may change into germ cell tumors during cell division.
Drugs That Can Cause or Aggravate Testicular Cancer
Some drugs, such as bicalutamide and clomiphene, have been linked to cases of testicular cancer, although this is rare.
Risk Factors
Having certain risk factors increases a man's chances of developing testicular cancer:
- Undescended testicle (cryptorchidism)
- Family history of testicular cancer
- HIV infection (weak correlation)
- Previous cancer in other testicle
- Congenital and chromosomal abnormalities
- Being Caucasian
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.
Symptoms
Often, the first sign of testicular cancer is a hard lump on the testicle. As the cancer progresses, other symptoms may show up. If you have any of the warning signs below, see your doctor right away.
- A firm lump on the testicle (the lump usually isn't painful, but in some cases, it may be)
- Enlarged or swollen testicle (it may be normal for one testicle to be slightly larger than the other; try to become familiar with your testicles through regular self-exams and then look out for changes in size)
- Pain or discomfort in the testicle or scrotum
- A feeling of heaviness in scrotum
- Dull ache in groin or lower abdomen
- Breast tenderness or growth from high levels of the hormone HCG, or human chorionic gonadotropin (uncommon)
- Lower back pain (later stages)
Conditions That May Be Mistaken for Testicular Cancer
Other problems may be confused with testicular cancer, including:
- Scrotal masses (noncancerous tumors, cysts, and inflammations):
- Hydrocele (a collection of watery fluid in the membrane that covers the testicle)
- Hematoma (a collection of blood in the scrotum, usually after an injury)
- Spermatocele (a collection of fluid containing sperm)
- Varicocele (swelling in scrotum caused by enlarged or varicose veins)
- Epididymitis (an inflamed epididymis, which is the spermatic cord behind the testicle)
- Orchitis (inflamed testicle)
- Inguinal hernia (a portion of the intestine drops into the scrotum and causes a bulge)
- Syphilitic gumma (a lump caused by syphilis, a sexually transmitted disease)
How Testicular Cancer Is Diagnosed
To diagnose testicular cancer, your doctor may do the following:
Manual exam
Your doctor will do a manual exam of your testicles to feel for lumps and other abnormal areas.
Transscrotal ultrasonography
An ultrasound scan is a painless, noninvasive way for your doctor to check for a tumor inside your testicle. A probe is placed against your scrotum and an ultrasound machine bounces high-frequency sound waves off the testicles to create images on a video monitor. Your doctor checks these pictures to distinguish a solid tumor from other problems that can cause a lump in the scrotum.
Surgery
A solid mass in the testicle is almost always cancerous. If your doctor strongly suspects cancer, a surgeon will perform an operation called inguinal orchiectomy, in which the whole affected testicle is taken out through an incision in your groin. Surgeons don't cut through the scrotum or remove only part of the testicle because cutting the outer layer of the testicle can cause the cancer to spread. If cancer remains confined to the testicle, then inguinal orchiectomy may remove the tumor completely.
Depending on the type and extent of your cancer, the surgeon may also remove the retroperitoneal lymph nodes, into which the testicles drain. The nodes are checked under a microscope for cancer cells, too. Also, removing the lymph nodes may help stop the spread of cancer.
Staging Testicular Cancer
If your doctor diagnoses testicular cancer, you'll be tested further to find out whether the cancer remains confined to the testicle or has spread to other parts of your body, such as the lymph nodes, lungs, liver, bones, or brain.
This process, called "staging" the cancer, helps your doctor to assess your chances of a cure and to plan your treatment. These are the stages of testicular cancer:
- Stage I: the cancer is confined to the testicle
- Stage II: the cancer has spread to the surrounding lymph nodes
- Stage III: the cancer has spread beyond the testicle and surrounding lymph nodes to other parts of the body
Doctors use several tests to stage testicular cancer. For instance, you may have an x-ray of the lymph glands or a CT or MRI scan of your abdomen to check for cancer in the lymph nodes, as well as a chest X-ray to detect cancer in the lungs.
You will also have special laboratory blood tests to check for alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (bHCG), two hormones that appear in men with testicular cancer. These hormones, called "tumor markers," can help your doctor to figure out what type of testicular cancer you have.
Goals of Treatment
Fortunately, testicular cancer is one of the most curable forms of cancer. The most common form, seminoma, can be cured in nearly all cases if caught and treated early. When all types of testicular cancer are included, about 90% of men are still be alive five years after treatment.
Effective treatment for testicular cancer includes surgery, radiation therapy and chemotherapy. Doctors classify testicular cancers into two types: seminomas and nonseminomas. Your choice of treatment will depend on the type and extent of your cancer. Seminomas, for instance, are very sensitive to radiation, while nonseminomas respond better to chemotherapy.
In general, your doctors will aim to remove the tumor and destroy any cancer cells that have spread to the lymph nodes or to other sites in your body. After surgery, you may receive radiation therapy or chemotherapy to kill cancer cells that have spread and to prevent cancer from coming back. After you've been treated, your doctor will monitor you for several years to make sure the cancer has not returned.
Treatment Overview
Surgery
Inguinal orchiectomy, in which the cancerous testicle is removed through an incision in the groin, is the main treatment for testicular cancer. You may also have surgery to remove lymph nodes in the abdomen, a procedure called retroperitoneal lymph node dissection (RPLND). Surgery may be followed up with radiation, chemotherapy, or both.
Radiation Therapy
In radiation therapy, high-dose X-ray beams are delivered from a machine to destroy cancer cells or to slow their rate of growth. After surgery, radiation is sometimes beamed to lymph nodes in the abdomen, chest and neck if cancer has spread to those common sites. Seminomas respond well to radiation, as well as chemotherapy; in contrast, nonseminomas respond better to chemotherapy.
Chemotherapy
Chemotherapy drugs can be taken by mouth or by shot to kill cancer cells that have spread outside the testicle. Injection is particularly effective because the drug enters the bloodstream, where it can circulate to other areas of the body. Chemotherapy drugs vary in their method of action. For example, some drugs act directly to destroy the cancerous cells. Others act to make the cancerous cell more vulnerable to radiation. For the most part, combinations of drugs are more effective than medications taken alone. Research is currently being conducted to develop new drugs, as well as to find out which combinations are the most effective. Drugs of choice include:
- Actinomycin
- Adriamycin (doxorubicin)
- Blenoxane (bleomycin sulfate)
- Cytoxan (cyclophosphamide)
- Etoposide (vepesid)
- IFEX (ifosamide)
- Paraplatin (carboplatin)
- Platinol (cisplatin)
- Velban (vinblastine sulfate)
Bone marrow transplant
Men with very aggressive or recurring tumors may need high-dose chemotherapy. This therapy kills cancer cells, but it also destroys bone marrow. In order to "rescue" patients after such intense treatment, bone marrow is removed before chemotherapy, treated to kill any cancer cells, then frozen. After the high-dose chemotherapy, the frozen marrow is thawed and transplanted back into the man to allow the bone marrow to grow anew.
Considerations When Selecting Treatment
Testicular cancer tends to strike younger men. Many worry about how treatment will affect their fertility or sexual function. If you have one testicle removed, you should still be able to have sex, and your remaining testicle can produce enough sperm and hormones to enable you to father children.
If retroperitoneal lymph nodes are removed, sexual function (erection and orgasm) isn't affected in most cases. However, lymph node surgery can cause infertility by destroying the nerves that control ejaculation. Today, nerve-sparing surgery methods can help you to remain fertile. If you hope to have children, talk to your surgeon about the best way to remove the cancer while preserving fertility. Your sperm count may drop after lymph node surgery, chemotherapy, and radiation therapy, but often rise to normal levels after treatment ends. You may need to use contraception for up to two years, as some treatments may cause temporary genetic damage to the sperm in your remaining testicle.
If both your testicles are removed, you'll no longer be able to produce sperm. If you're intent on having children, you may want to consider donating sperm to a sperm bank before the surgery. Without testicles, you may also need regular injections of male hormones about every three weeks to retain normal sexual function.
Appropriate Healthcare Setting
The appropriate healthcare is outpatient, unless surgery is required.
Healthcare Professionals Who May Be Involved
- Internists
- Family Physicians
- Urologists
- Medical oncologists
- Surgical oncologists
- Radiation oncologists
- Pathologists
Activity & Diet Recommendations
There is no special diet for men who have testicular cancer. It's wise, though, to follow a healthy diet and to eat enough calories to keep your strength up during cancer treatment.
You're free to resume your daily activities as soon as possible after surgery or other cancer treatments. Therapy can cause fatigue, so don't push yourself to do too much too soon.
It's fine to resume sexual relations when you are able, but sometimes cancer treatment can cause temporary genetic damage to the sperm in your remaining testicle. Use birth control for as long as your doctor directs (usually one to two years) until your sperm returns to normal.
Monitoring Testicular Cancer
If you've had testicular cancer, you'll need to stay in touch with your doctor for several years to monitor your health and to check for any recurrence of cancer. If you've had one testicle removed, you'll have a roughly two to five percent chance of developing cancer in the other testicle. Usually, this is a new cancer, rather than a metastasis from the original cancer, because there is no direct lymphatic connection between the two testicles.
Your doctor will outline follow-up procedures, which will include blood tests to check for the tumor markers AFP and HCG. These blood tests, which are used as tumor markers when cancer is diagnosed or suspected, can also be used to monitor your condition after cancer treatment. If the hormone levels rise after treatment, the cancer may have come back.
You'll also need chest X-rays, CT scans, and other imaging techniques to check for recurrence or metastasis. If you stick to your follow-up schedule, you'll stand the best chance of detecting any new cancer in its early stages.
Possible Complications
Cancer treatment can cause complications and side effects, among them:
- Surgery
- Infertility/inability to ejaculate (after retroperitoneal lymph node dissection, which can damage nerves that control ejaculation)
- Radiation therapy
- Fatigue
- Infertility, usually temporary
- Inflamed kidneys (nephritis)
- Inflamed intestine (enteritis)
- Chemotherapy
- Increased risk of infection
- Nausea or vomiting
- Hair loss
- Infertility (some men recover fertility two to three years after treatment ends)
Quality of Life
Men with testicular cancer can take comfort in knowing that this type of cancer has a very high cure rate. Still, it's frightening to be diagnosed with cancer. Finding emotional support through a trusted friend, counselor, or support group can help you and your loved ones to cope with treatment and to become educated about this disease. If you're inclined, ask your doctor or hospital for suggestions on how to locate support groups.
If you're informed about the disease, you can become a full partner with your doctor in weighing decisions about treatment. Each type of treatment has adverse affects that may last for several months, or even your entire life. Discuss with your doctor all the pros and cons of a taking certain route before treatment begins. Don't be afraid to ask questions, and keep your doctors informed about any side effects or changes you notice during treatment.
You may also worry about your sex life and fertility. In most cases, men will be able to resume a normal sex life after testicular cancer treatment. Fortunately, with today's surgical methods to spare nerves that control ejaculation, testicular cancer surgery doesn't mean that you'll become infertile. If you have one testicle remaining, you may still be able to have children. If both testicles are removed, you can still become a father if you store sperm at a sperm bank before your operation.
Realize, too, that it's normal to want to put the whole ordeal behind you once cancer treatment ends. However, successful surgery, chemotherapy, and radiation does not mean you are home free. You will be monitored periodically for a few years to make sure you stay healthy and cancer-free. If you have any new symptoms after cancer treatment, be sure to tell your doctor right away. As with any cancer, you have the best chances of being cured when the cancer is diagnosed and treated early.
Currently, there is no alternative therapy that can effectively treat testicular cancer. Alternative care can be provided to help you cope with cancer, though. Pain can be controlled with different techniques like meditation, visualization, or hypnosis. Furthermore, these techniques may also foster a sense of hope and well-being.
A special screening test for men that is akin to the breast self-exam for women is the testicular self-exam. The test can be done in three minutes, preferably each month. The best time to check your testicles is when the scrotal skin is relaxed, usually after a shower or bath. Roll each testicle with your thumb and forefinger, feeling for hard lumps or nodules (smooth, rounded masses). If you feel anything that concerns you, contact your doctor right away.
Websites & Organizations
American Cancer Society
625 North Court
Palatine, IL 60067
Phone: 800-ACS-2345 (800-227-2345)
Cancer AnswerLine:
800-865-1125
Comprehensive Cancer Center University of Michigan
1500 E. Medical Center Dr.
Ann Arbor, MI 48109
Cancer Information Line: 800-865-1125
Email: wwwcancer@umich.edu
The Lance Armstrong Foundation
P.O. Box 27483
Austin, TX 78755-2483
Phone: 800-496-4402
National Cancer Institute
1275 York Avenue, Box 166
New York, NY 10021
Phone: 800-4-CANCER (800422-6237)
National Coalition for Cancer Survivorship
1010 Wayne Avenue, 5th Floor
Silver Springs, MD 20910
Phone: 888-837-6227 or 301-650-8868
Office of Cancer Communications
National Cancer Institute (NCI)
Bldg. 31, room 101-18
9000 Rockville Pike
Bethesda, MD 20205
Phone: 800-638-6694 or 800-4-CANCER (800-422-6237)
The Orchid Cancer Appeal
The Testicular Cancer Resource Center
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