Testicular Cancer: Questions and Answers
- What is testicular cancer?
Testicular cancer is a disease in which cells
(cancerous) in one or both testicles.
The testicles (also called testes or gonads)
are a pair of male sex glands.
They produce and store sperm
and are the main source of testosterone
in men. These hormones control the development of the reproductive organs
and other male physical characteristics. The testicles are located under the
in a sac-like pouch called the scrotum.
Based on the characteristics of the cells in the tumor,
testicular cancers are classified as seminomas or nonseminomas. Other types
of cancer that arise in the testicles are rare and are not described here.
Seminomas may be one of three types: classic, anaplastic, or spermatocytic.
Types of nonseminomas include choriocarcinoma, embryonal carcinoma,
and yolk sac tumors. Testicular tumors may contain both seminoma and nonseminoma
Testicular cancer accounts for only 1 percent of all cancers in men in the
United States. About 8,000 men are diagnosed with testicular cancer, and about
390 men die of this disease each year (1). Testicular cancer occurs most often
in men between the ages of 20 and 39, and is the most common form of cancer
in men between the ages of 15 and 34. It is most common in white men, especially
those of Scandinavian descent. The testicular cancer rate has more than doubled
among white men in the past 40 years, but has only recently begun to increase
among black men. The reason for the racial differences in incidence
is not known.
- What are the risk factors for testicular cancer?
The exact causes of testicular cancer are not known. However, studies have
shown that several factors increase a man's chance of developing this disease.
- Undescended testicle (cryptorchidism):
Normally, the testicles descend from inside the abdomen into the
scrotum before birth. The risk of testicular cancer is increased in males
with a testicle that does not move down into the scrotum. This risk does
not change even after surgery
to move the testicle into the scrotum. The increased risk applies to both
- Congenital abnormalities: Men born with abnormalities
of the testicles, penis, or kidneys,
as well as those with inguinal hernia (hernia in the groin area, where the
thigh meets the abdomen), may be at increased risk.
- History of testicular cancer: Men who have had testicular
cancer are at increased risk of developing cancer in the other testicle.
- Family history of testicular cancer: The risk for testicular
cancer is greater in men whose brother or father has had the disease.
How is testicular cancer detected? What are symptoms
of testicular cancer?
Most testicular cancers are found by men themselves. Also, doctors generally
examine the testicles during routine physical exams. Between regular checkups,
if a man notices anything unusual about his testicles, he should talk with
his doctor. Men should see a doctor if they notice any of the following symptoms:
- a painless lump or swelling in a testicle
- pain or discomfort in a testicle or in the scrotum
- 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, back, or groin
- a sudden collection of fluid
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 of these symptoms.
How is testicular cancer diagnosed?
To help find the cause of symptoms, the doctor evaluates a man's general
health. The doctor also performs a physical exam and may order laboratory
and diagnostic tests. These tests include:
- Blood tests that 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
chorionic gonadotropin (ßHCG), and lactate
may suggest the presence of a testicular tumor, even if it is too small
to be detected by physical exams or imaging
- Ultrasound, a test in which high-frequency sound waves
are bounced off internal organs and tissues.
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
or a collection of fluid unrelated to cancer.
- Biopsy (microscopic
examination of testicular tissue by a pathologist)
to determine 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 radical inguinal
orchiectomy. In rare cases (for example, when a man has only one testicle),
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. 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.
How is testicular cancer treated? What are the side effects
Although the incidence of testicular cancer has risen in recent years, more
than 95 percent of cases can be cured. Treatment is more likely to be successful
when testicular cancer is found early. In addition, treatment can often be
less aggressive and may cause fewer side
Most men with testicular cancer can be cured with surgery, radiation
therapy, and/or chemotherapy.
The side effects depend on the type of treatment and may be different for
Seminomas and nonseminomas grow and spread differently and are treated differently.
Nonseminomas tend to grow and spread more quickly; seminomas are more sensitive
If the tumor contains both seminoma and nonseminoma cells, it is treated as
a nonseminoma. Treatment also depends on the stage of the cancer, the patient's
age and general health, and other factors. Treatment is often provided by
a team of specialists, which may include a surgeon, a medical
oncologist, and a radiation
The three types of standard treatment are described below.
- 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 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). For cosmetic purposes, men can have a
(an artificial testicle) placed in the scrotum at the time of their orchiectomy
or at any time afterward.
Some of the lymph
nodes located deep in the abdomen may also be removed (lymph
node dissection). This type of surgery does not usually change a man's
ability to have an erection or an orgasm, but it can cause problems with
fertility if it interferes with ejaculation.
Patients may wish to talk with their doctor about the possibility of removing
the lymph nodes using a special nerve-sparing
surgical technique that may preserve the ability to ejaculate normally.
- Radiation therapy
(also called radiotherapy)
uses high-energy rays to kill cancer cells and shrink tumors. It is a local
therapy, meaning that it affects cancer cells only in the treated areas.
radiation (from a machine outside the body), aimed at the lymph nodes
in the abdomen, is used to treat seminomas. It is usually given after surgery.
Because nonseminomas are less sensitive to radiation, men with this type
of cancer usually do not undergo radiation therapy.
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,
Radiation therapy interferes with sperm production, but many patients regain
their fertility over a period of 1 to 2 years.
- Chemotherapy is the use of anticancer drugs
to kill cancer cells. When chemotherapy is given to testicular cancer patients,
it is usually given as adjuvant
therapy (after surgery) to destroy cancerous cells that may remain in
the body. Chemotherapy may also be the initial treatment if the cancer is
advanced; that is, if it has spread outside the testicle at the time of
the diagnosis. Most anticancer drugs are given by injection
into a vein.
Chemotherapy is a systemic
therapy, meaning drugs travel through the bloodstream and affect normal
as well as cancerous cells throughout the body. The side effects depend
largely on the specific drugs and the doses. Common side effects include
nausea, hair loss, fatigue, diarrhea, vomiting, fever, chills, coughing/shortness
of breath, mouth sores, or skin rash. Other side effects include dizziness,
numbness, loss of reflexes, or difficulty hearing. Some anticancer drugs
also interfere with sperm production. Although the reduction in sperm count
is permanent for some patients, many others recover their fertility.
Some men with advanced or recurrent testicular cancer may undergo treatment
with very high doses of chemotherapy. These high doses of chemotherapy kill
cancer cells, but they also destroy the bone
marrow, which makes and stores blood cells. Such treatment can be given
only if patients undergo a bone marrow transplant. In a transplant, bone
cells are removed from the patient before chemotherapy is administered.
These cells are frozen temporarily and then thawed and returned to the patient
through a needle (like a blood
transfusion) after the high-dose
chemotherapy has been administered.
Men with testicular cancer should discuss their concerns about sexual function
and fertility with their doctor. It is important to know that men with testicular
cancer often have fertility problems even before their cancer is treated.
If a man has pre-existing fertility problems, or if he 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 allows some men to have children even if the treatment causes loss
Is follow-up treatment necessary? What does it involve?
Regular follow-up exams are extremely important for men who have been treated
for testicular cancer. Like all cancers, testicular cancer can recur
(come back). Men who have had testicular cancer should see their doctor regularly
and should report any unusual symptoms right away. Follow-up varies for different
types and stages of testicular cancer. Generally, patients are checked frequently
by their doctor and have regular blood tests to measure tumor marker levels.
They also have regular x-rays
tomography, also called CT
scans or CAT
scans (detailed pictures of areas inside the body created by a computer
linked to an x-ray machine). Men who have had testicular cancer have an increased
likelihood of developing cancer in the remaining testicle. Patients treated
with chemotherapy may have an increased risk of certain types of leukemia,
as well as other types of cancer. Regular follow-up care ensures that changes
in health are discussed and that problems are treated as soon as possible.
Are clinical trials (research studies) available for men with testicular
Yes. Participation in clinical
trials is an important treatment option for many men with testicular cancer.
To develop new treatments, and better ways to use current treatments, the
National Cancer Institute (NCI) is sponsoring clinical trials (research studies
with people) in many hospitals and cancer centers around the country. Clinical
trials are a critical step in the development of new methods of treatment.
Before any new treatment can be recommended for general use, doctors conduct
clinical trials to find out whether the treatment is safe for patients and
effective against the disease.
People interested in taking part in a clinical trial should talk with their
doctor. Information about clinical trials is available from the NCI's Cancer
Information Service (CIS) (see below) at 1–800–4–CANCER
and in the NCI booklet Taking Part in Cancer Treatment Research Studies,
which can be found at http://www.cancer.gov/publications
on the Internet. This booklet describes how research studies are carried out
and explains their possible benefits and risks. Further information about
clinical trials is available at http://www.cancer.gov/clinicaltrials
on the NCI's Web site. The Web site offers detailed information about specific
ongoing studies by linking to PDQ®,
the NCI's comprehensive cancer information database. The CIS also provides
information from PDQ.
- American Cancer Society, Inc. Cancer Facts and Figures 2005. Atlanta: American Cancer Society, Inc., 2005. Also available at http://www.cancer.org/downloads/STT/CAFF2005f4PWSecured.pdf on the Internet.
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(toll-free): 18004CANCER (18004226237)
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