Testicular Cancer

Testicular cancer is a disease in which cells become malignant (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 (male hormones) in men. These hormones control the development of the reproductive organs and other male physical characteristics. The testicles are located under the penis 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, teratoma, and yolk sac tumors. Testicular tumors may contain both seminoma and nonseminoma cells.

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 testicles.
  • 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.

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.

Treatment

Radical Orchiectomy:

Orchiectomy is the removal of one or both testicles (testes). The testicles are the male sex organs that produce sperm and the male hormone, testosterone. An orchiectomy is a common treatment for testicular cancer. It may also be done to treat other conditions such as prostate cancer or in the event of severe trauma to one or both testes. During the procedure, a small incision is made in the lower abdomen just below the belt line. The testicle is then pushed up from the scrotum through the incision and removed. The procedure is usually finished in less than an hour.

Laparoscopic Retroperitoneal Lymph Node Dissection:

Retroperitoneal lymph node dissection (RPLND) is a procedure to remove abdominal lymph nodes to treat testicular cancer, as well as help establish its exact stage and type. It is usually performed using an incision that extends from the sternum to several inches below the navel. While laparoscopic methods may be used, they have been considered less effective by some surgeons.

Testicular cancer spreads in a well-known pattern, and the lymph nodes in the retroperitoneum are a primary landing site during spread of the disease. Examining the removed lymphatic tissue will determine the extent of spread of any malignant disease and if no malignant tissue is found, the cancer may be more accurately considered as a stage I cancer, limited to the testis. The procedure is becoming standard treatment for clinical stage I and II non-seminomatous germ cell tumors (NSGCTT) because of the low mortality and relapse rate with this procedure, as compared with the alternative, which is observation. Also, NSGCTT is considered more aggressive than seminomas, the “other” kind of testicular cancer. Seminomas are also much more sensitive to radiation than NSGCTTs, so the noninvasive radiation treatment is often preferred over RPLND.