Questions and Answers About Testicular Cancer

The testicles (also called testes or gonads) are a pair of male sex glands. They produce and store sperm, and are also the body’s main source of male. These hormones control the development of the reproductive organs and male characteristics. The testicles are located under the penis in a sac-like pouch called the scrotum.

Testicular cancer can be broadly classified into two types: seminoma and nonseminoma. Seminomas make up about 30 percent of all testicular cancers. Nonseminomas are a group of cancers that include choriocarcinoma, embryonal, teratoma, and yolk sac tumors. A testicular cancer may have a combination of both types.

An estimated 7,400 men in the United States will be diagnosed with testicular cancer in 1999. Although testicular cancer accounts for only 1 percent of all cancers in men, it is the most common form of cancer in young men between the ages of 15 and 35. Any man can get testicular cancer, but it is more common in white men than in black men.

• Undescended testicle (cryptorchidism): Normally, the testicles descend into the scrotum before birth. Men who have had a testicle that did not move down into the scrotum are at greater risk for developing the disease. This is true even if surgery is performed to place the testicle in the scrotum.
• Abnormal testicular development: Men whose testicles did not develop normally are also at increased risk.
• Klinefelter’s syndrome: Men with Klinefelter’s syndrome (a sex chromosome disorder that may be characterized by low levels of male hormones, sterility, breast enlargement, and small testes) are at greater risk of developing testicular cancer.
• History of testicular cancer: Men who have previously had testicular cancer are at increased risk of developing cancer in the other testicle.

Men should see a doctor if they notice any of the following symptoms:

• A painless lump or swelling in either testicle;
• Any enlargement of a testicle or change in the way it feels;
• A feeling of heaviness in the scrotum;
• A dull ache in the lower abdomen or the groin (the area where the thigh meets the abdomen);
• A sudden collection of fluid in the scrotum;
• Pain or discomfort in a testicle or in the scrotum.

These symptoms can be caused by cancer or by other conditions. It is important to see a doctor to determine the cause of any symptoms.

• Blood tests measure the levels of tumor markers. Tumor markers are substances often found in higher-than-normal amounts when cancer is present. Tumor markers such as alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactase dehydrogenase (LDH) may detect a tumor that is too small to be detected during physical exams or imaging tests.
• Ultrasound is a diagnostic test in which high-frequency sound waves are bounced off tissues and internal organs. Their echoes produce a picture called a sonogram. Ultrasound of the scrotum can show the presence and size of a mass in the testicle. It is also helpful in ruling out other conditions, such as swelling due to infection.
• Biopsy. Microscopic examination of testicular tissue by a pathologist is the only sure way to know whether cancer is present. In nearly all cases of suspected cancer, the entire affected testicle is removed through an incision in the groin. This procedure is called inguinal orchiectomy. In rare cases (for example, when a man has only one testicle), the surgeon performs an inguinal biopsy, removing a sample of tissue from the testicle through an incision in the groin and proceeding with orchiectomy only if the pathologist finds cancer cells. (The surgeon does not cut through the scrotum to remove tissue, because if the problem is cancer, this procedure could cause the disease to spread.)

If testicular cancer is found, more tests are needed to find out if the cancer has spread from the testicle to other parts of the body. Determining the stage (extent) of the disease helps the doctor to plan appropriate treatment.

Seminomas and nonseminomas grow and spread differently, and each type may need different treatment. Treatment also depends on the stage of the cancer, the patient’s age and general health, and other factors. Men are often treated by a team of specialists, which may include a surgeon, a medical oncologist, and a radiation oncologist.

• Surgery to remove the testicle through an incision in the groin is called a radical inguinal orchiectomy. Men may be concerned that losing a testicle will affect their ability to have sexual intercourse or make them sterile (unable to produce children). However, a man with one remaining healthy testicle can still have a normal erection and produce sperm. Therefore, an operation to remove one testicle does not make a man impotent (unable to have an erection) and seldom interferes with fertility (the ability to produce children). Men can also have an artificial testicle, called a prosthesis, placed in the scrotum. The implant has the weight and feel of a normal testicle.Some of the lymph nodes located deep in the abdomen may also be removed (lymph node dissection). This type of surgery does not change a man’s ability to have an erection or an orgasm, but it can cause sterility because it interferes with ejaculation. Patients may wish to talk with the doctor about the possibility of removing the lymph nodes using a special nerve-sparing surgical technique that may protect the ability to ejaculate normally.
• Radiation therapy, also called radiotherapy, uses high-energy rays to kill cancer cells and shrink tumors. Radiation therapy is a local therapy; it affects cancer cells only in the treated areas. Radiation therapy for testicular cancer comes from a machine outside the body (external beam radiation) and is usually aimed at lymph nodes in the abdomen. Seminomas are highly sensitive to radiation. Nonseminomas are less sensitive to radiation, so men with this type of cancer usually do not undergo radiation.Radiation therapy affects normal as well as cancerous cells. The side effects of radiation therapy depend mainly on the treatment dose. Common side effects include fatigue, skin changes at the site where the treatment is given, loss of appetite, nausea, and diarrhea. Radiation therapy interferes with sperm production, but most patients regain their fertility within a matter of months.
• Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Chemotherapy is given to destroy cancerous cells that may remain in the body after surgery. The use of anticancer drugs following surgery is known as adjuvant therapy. Chemotherapy may also be the initial treatment if the cancer is advanced; that is, if it has spread outside the testicle. Most anticancer drugs are given by injection into a vein (IV).Chemotherapy is a systemic therapy, meaning that drugs travel through the blood stream and affect normal as well as cancerous cells all over the body. The side effects depend largely on the specific drugs and the dose. Common side effects may include nausea, loss of hair, fatigue, diarrhea, vomiting, fever, chills, coughing/shortness of breath, mouth sores, or skin rash. Other common side effects are dizziness, numbness, loss of reflexes, or difficulty hearing. Some anticancer drugs interfere with sperm production. Although the reduction in sperm count is permanent for some patients, many others recover their fertility.

Men with testicular cancer should discuss their concerns about sexual function and fertility with the doctor. If a man is to have treatment that might lead to infertility, he may want to ask the doctor about sperm banking (freezing sperm before treatment for use in the future). This procedure can allow some men to produce children after loss of fertility.