Testicular cancer
Testicular cancer is a type of cancer that develops in the testicles, which are the male sex glands responsible for producing sperm and hormones. It primarily originates in germ cells and is classified into two main types: seminomas, which are typically slower-growing and respond well to radiation and chemotherapy, and nonseminomas, which are more aggressive but also respond effectively to chemotherapy. Risk factors for developing testicular cancer include a history of undescended testicles (cryptorchidism), family history of the disease, male infertility, and prenatal exposure to certain synthetic hormones like diethylstilbestrol (DES).
The condition is most commonly diagnosed in young men aged 15 to 44, with white males exhibiting a higher incidence than other racial groups. Symptoms generally include a painless lump in the testicle, swelling, and sometimes discomfort or heaviness in the scrotum. Early detection through self-examination and prompt medical evaluation is crucial, as diagnosis usually requires the removal of the affected testicle for confirmation.
Despite the serious nature of the disease, testicular cancer has a high survival rate, with approximately 95% of patients living at least five years after diagnosis, especially when caught early. Treatment typically involves surgery, and many patients retain normal reproductive function afterward. Given its low recurrence rate and effective treatment options, awareness and understanding of testicular cancer are vital for early detection and successful management.
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Subject Terms
Testicular cancer
ALSO KNOWN AS: Germ-cell tumors, testicular tumors
RELATED CONDITIONS: Testicular tumors, germ-cell tumors, cryptorchidism, male infertility
DEFINITION: Testicular cancer is the development of tumors in the testicles or male sex glands.
Risk factors: A significant risk factor associated with testicular cancer is a history of an undescended testicle (cryptorchidism). Research has shown that men who have any type of abnormal development of the testicles are at an increased risk of developing testicular cancer. A history of testicular cancer in an individual or their family is another strong risk factor. Male factor infertility is associated with a higher rate of testicular cancer. Some studies suggest that exposure to the synthetic hormone diethylstilbestrol (DES) during fetal development can lead to an increased risk of testicular cancer.
Etiology and the disease process: Testicular tumors originate in the germ cells, or embryonic cells that develop into sperm cells, in more than 90 percent of cases. These tumors can be divided into seminomas or nonseminomas. Seminomas are slow to grow and usually remain in the testicle. These types of tumors are very responsive to radiation therapy and chemotherapy. Nonseminomas are cancers that occur in combination with other types of cancers and arise from more mature germ cells. These cancers are more aggressive in growth and respond well to chemotherapy. Rarely tumors leading to testicular cancer include Leydig and Sertoli cell tumors, leiomyosarcoma, rhabdomyosarcoma, and mesothelioma.
Incidence: Approximately one out of every 250 men will develop testicular cancer at some point in their lives. Men between fifteen and forty-four are most commonly diagnosed, with an average age of thirty-three at diagnosis. White males are more likely to be diagnosed than Hispanic or Black males. Infants and men over sixty are also infrequently diagnosed. Deaths from testicular cancer are rare at about one in 5,000 individuals.
Symptoms: Symptoms of testicular cancer most often include a painless lump in one testicle or enlarged testicles, with painful swelling reported in some cases. Other symptoms include increased fluid in the scrotum, a feeling of heaviness in the scrotum, a dull ache in the groin or lower abdomen, or enlargement or tenderness of the breasts (gynecomastia).
Screening and diagnosis: The most effective screening mechanism for testicular cancer is the testicular self-examination (TSE). It involves a manual exam of the testicles to assess for any suspicious lumps, and it can be performed at home.
If testicular cancer is suspected, the physician conducts a medical history and physical exam. In addition to carefully examining the scrotum, the physician will order an ultrasound, chest X-ray, and blood and urine tests.
A serum marker test may measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the blood. Certain substances, called tumor markers, are linked to specific types of cancer when found in increased levels in the blood. Three tumor markers are used in staging testicular cancer—alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-HCG), and lactate dehydrogenase (LDH) if ultrasound reveals a solid mass in the testicle.
Testicular tumors are easily misdiagnosed as epididymitis, so if a lump or mass on the testicle is found, it is essential to rule out testicular cancer early on. This may involve obtaining a second opinion if the patient is not offered an ultrasound at the first discovery of a lump in the testicle.
A lymphangiography procedure may also be used to X-ray the lymph system. In this procedure, a dye is injected into the lymph vessels in the feet to observe any possible blockages. This test helps determine whether cancer has spread to the lymph nodes.
The only way to confirm the diagnosis of testicular cancer is by removal of the testis (orchiectomy). Biopsy of the tumor is not an option because of the risk of malignancy of any remaining cancerous cells in the testis.
After removal of the suspicious testicle, the tumor is staged by a pathologist. The size of the tumor is irrelevant to the stage of the cancer.
- Stage I: Cancer is only in the testis.
- Stage II: Cancer is in the testis and lymph nodes.
- Stage III: Cancer in the testis has spread to remote sites in the body (for example, the lungs, brain, liver, or bones).
Treatment and therapy: Almost all treatment involves surgically removing the testicle (orchiectomy). This is necessary because any remaining cancer cells could become malignant and spread to other parts of the body. The risk of surgery is very low, and most men can maintain a normal reproductive life with one testicle. Sometimes, if the cancer has spread, surgery includes removing the lymph nodes in the abdomen.
Radiation therapy uses high-energy rays to kill localized cancer cells. Seminomas are highly sensitive to radiation, and most men will receive this therapy for their lymph nodes following surgery. Radiation is ineffective with nonseminomas.
Chemotherapy involves injecting drugs into the bloodstream (via a vein or orally) to treat the entire body. It is used if the physician suspects cancer cells have spread or if the cells are suspected to remain after surgery or radiation therapy.
Tumor-marker levels are measured again after radical inguinal orchiectomy and biopsy to determine the stage of the cancer. This helps to show whether all the cancer has been removed or if more treatment is needed. Tumor-marker levels are also measured during follow-up to check if the cancer has come back.
Prognosis, prevention, and outcomes: Although testicular cancer is the most common malignancy in men between fifteen and forty-four, it has a relatively high survival rate. It is almost always curable if discovered early on. It responds well to treatment even when it has spread to other body parts.
Men diagnosed with testicular cancer have a five-year survival rate of 95.2 percent. Individuals with cancer that has spread to nearby organs or lymph nodes have a survival rate of 96 percent. Those with cancer that has spread to organs or lymph nodes away from the tumor have a five-year survival rate of about 73 percent.
Generally, after the removal of one testis, a man can lead a life of normal fertility because the remaining testis increases the production of testosterone and sperm cells. In the case of men with decreased fertility before surgery, it may be prudent to consider sperm banking (freezing sperm for later use) if they want to have children.
Testicular cancer has a low recurrence rate, with most instances occurring within two years. If cancer is rarely found in the other testicle, but if so, it is treated similarly. The patient will then need to take hormone supplements such as testosterone (produced in the testes) and will be infertile but otherwise will lead a normal life.
Bibliography
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