Testicular Cancer

Advanced Urology Associates specializes in testicular cancer treatment for men, we offer the most state-of-the-art treatments and cancer care available.

The testicles (testes) are located inside the scrotum, a loose bag of skin underneath the penis. The testicles produce the male sex hormone, testosterone, and sperm for reproduction.

What is Testicular Cancer?

Our body is composed of billions of cells that function for a while and then die, being replaced in an organized manner. Sometimes there can be an uncontrolled replacement of the cells, leaving them unorganized. This abnormal growth of cells and disorder is cancer. The cancer cells can grow without the normal control and limits. Testicular cancer means cancer cells form in the tissues of the testicles. It starts when cells in the testicles grow out of control and crowd out normal cells. Cancer can spread locally into surrounding tissues or break away from the tumor and enter body fluids, such as blood and lymph and spread to other parts of the body, called metastasis. The most common place for metastasis from testicular cancer is in the lungs and liver.

These are the two most common types of testicular cancer:

  • Seminomas: Occur in all age groups and tend to grow and spread slower than most other testicular cancers.
  • Non-seminomas: Often found in younger men in their late teens and early 30’s and tend to grow and spread rapidly. Several types of non-seminoma tumors exist.

Compared with other types of cancer, testicular cancer is rare. But testicular cancer is the most common cancer in American males between the ages of 15 and 35. This type of cancer is highly treatable, even when cancer has spread beyond the testicle.

What is Testicular Cancer Caused By?

It is not clear what causes testicular cancer in most cases. Nearly all testicular cancers begin in the germ cells, the cells in the testicles that produce immature sperm. But it is not known what causes these cells to become abnormal and develop into cancer.

What Are the Risk Factors for Developing Testicular Cancer?

Factors that may increase your risk of testicular cancer include:

  • An undescended testicle (cryptorchidism): the testes form in the abdominal area during fetal development and usually descend into the scrotum before birth. Men who have a testicle that never descended are at greater risk of testicular cancer than are men whose testicles descended normally. The risk remains elevated even if the testicle has been surgically relocated to the scrotum.
  • Abnormal testicle development: caused by some conditions, such as Klinefelter syndrome, may increase the risk of developing testicular cancer.
  • Family history.
  • Age: Testicular cancer affects teens and younger men, particularly those between ages 15 and 35. However, it can occur at any age.
  • Race: Testicular cancer is most common in Caucasian men.

How Can I Prevent Testicular Cancer?

There is no way to prevent testicular cancer. It is recommended to perform monthly self-examinations to identify any abnormal signs or symptoms early.

How to do a Testicular Self-Exam

Boys can start doing monthly testicular self-exams during their teen years. The best time to examine your testicles is right after a hot bath or shower. The scrotal skin is most relaxed at this time and testicles can be felt more easily. The exam should be done while standing and only takes a few minutes.

  • Look for swelling in the scrotum.
  • Gently feel the scrotal sac to find a testicle.
  • Examine the testicles one at a time. Firmly and gently roll each testicle between the thumb and fingers of both hands to feel the whole surface.
  • Note that it is normal for one testicle to be slightly larger than the other. It is also normal to fell a cord-like structure (the epididymis) on the top and back of each testicle.
  • If you find a lump, swelling, or other change, get it checked right away. Changes are not always cancer. If it is cancer and you catch it early, you have the best chance for a cure.

What Are the Signs and Symptoms of Testicular Cancer?

Testicular cancer usually affects only one testicle. Symptoms of testicular cancer may include:

  • A lump or enlargement in either testicle, the most common symptom
  • A feeling of heaviness in the scrotum
  • A dull ache in the abdomen or groin
  • A sudden collection of fluid in the scrotum
  • Pain or discomfort in a testicle or the scrotum
  • Enlargement or tenderness of the breasts
  • Back pain

How is Testicular Cancer Diagnosed?

In most cases, men discover testicular cancer by themselves, either unintentionally or while doing a self-examination to check for lumps. To determine whether a lump is cancerous, your doctor may recommend:

  • A testicular ultrasound uses sound waves to create an image of the scrotum and testicles. During an ultrasound, you lie on your back with your legs spread. Gel is than applied to the scrotum and a hand-held probe is moved over the scrotum to take the ultrasound images. The lump can be identified in the ultrasound, and the nature of the lump, whether the lump is solid or fluid-filled will be identified. If it is solid, it is more likely to be cancer. An ultrasound also will determine if the lump is inside or outside of the testicle.
  • Lab work can determine the levels of tumor markers in your blood. Tumor markers are normally in your blood, but the levels may be elevated in certain situations. A high level of a tumor marker may help in determining the diagnosis. If numbers are elevated after the testicle has been removed or other treatment, it may be a sign that cancer still remains in the body.
  • Computerized Tomography (CT) scan takes a series of x-ray images of your chest, abdomen, and pelvis to look for signs if cancer has spread.
  • Positron Emission Tomography/Computed Tomography (PET/CT) scan is a nuclear medicine imaging study that uses a radioactive material, or “sugar” that will highlight as increased uptake in an area of cancer. This scan looks for spread of the cancer.
  • Biopsy of the tumor in the testicle involves taking a small piece of tissue to check it for cancer cells. A biopsy is the only way to tell for sure that the tumor is cancerous. For many kinds of cancer, a biopsy is done before surgery. But for testicular cancer, this could spread the cancer, so the biopsy is done during surgery to take out the cancer. The tissue taken during the biopsy is then evaluated by a pathologist to determine the type of cancer.

What is Testicular Cancer Grading?

The cancer cells collected from the biopsy are graded. This helps predict how fast the cancer is likely to grow and spread. Cancer cells are graded based on how much they look like normal cells. Grades 1, 2, and 3 are used. Cells that look very different from the normal cells are given a higher grade (Grade 3) and tend to grow faster.

What is Staging of Testicular Cancer?

Once testicular cancer is diagnosed, the stage, or extent of the cancer is determined. Tests, including grading, images and labs, described above help stage your testicular cancer and determine what treatment is best for you.

  • Stage 1-the cancer is limited to the testicle.
  • Stage II-the cancer has spread to the lymph nodes in the abdomen.
  • Stage III-the cancer has spread to other parts of the body; most commonly the lungs and liver (metastasis).

How is Testicular Cancer Treated?

Treatment options depend on a number of factors, including the type and stage of cancer, your overall health, and your own preferences for treatment.

Surgery is the main treatment for testicular cancer:

  • Surgery to remove your testicle (radical inguinal orchiectomy) is the primary treatment for nearly all stages and types of testicular cancer. An incision is made in the groin and the surgeon removes the entire testicle through the opening. A prosthetic, saline filled testicle can be inserted if you choose. This may be the only treatment needed in early-stage testicular cancer.
  • Surgery to remove nearby lymph nodes (retroperitoneal lymph node dissection) is performed through an incision in your abdomen. Care is taken to avoid damaging nerves surrounding the lymph nodes.
  • Surgery should not cause erectile problems. Although infertility is not common, it is recommended that you preserve your sperm for future child-bearing if desired.

If surgery is the only treatment, you will typically be seen every few months for the first few years, then less frequently after that. You will have blood tests, CT scans, and physical exam to be sure the cancer has not returned.

Radiation Therapy Treatment

Radiation therapy is an option for certain types of testicular cancer, usually used in conjunction with chemotherapy or may be used after surgery based on pathology findings.

  • Uses high powered energy beams to kill cancer cells. You are positioned on a table and a large machine moves around you, aiming the energy beams at precise points on your body.
  • Radiation therapy is sometimes used in men who have the seminoma type of testicular cancer. It may also be recommended after surgery to remove your testicle, especially with spread of the cancer to the lymph nodes.
  • Side effects may include nausea, diarrhea, and fatigue, as well as redness and irritation to the skin in your abdominal and groin areas. It is also likely to reduce sperm counts temporarily and may impact fertility. There are options for preserving your sperm before beginning treatment.

Chemotherapy Treatment

  • Uses drugs to kill cancer cells. Chemotherapy travels throughout your body to kill cancer cells that may have metastasized from the original tumor.
  • It may be used as the only treatment or may be recommended before or after lymph node removal surgery.
  • Side effects depend on the drugs used. Common side effects include fatigue, nausea, hair loss, and increased risk of infection. It may lead to infertility. There are options for preserving your sperm before beginning treatment.

Questions About Testicular Cancer or Treatments?

If you have recently been diagnosed with testicular cancer and have questions about treatments at Advanced Urology Associates, please call 815.409.4930 or request an appointment today.