Advanced Urology Associates Testicular Cancer Center of Excellence

• 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.

• 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.

• 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

• 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.

• 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).

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 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.