Douglas A. Nelson, MD, is double board-certified in medical oncology and hematology. He was a physician in the US Air Force and now practices at MD Anderson Cancer Center, where he is an associate professor.
Testicular cancer is rare, typically affecting men ages 15 to 45. It can cause a painless testicular lump, swelling, or heaviness, and may result in infertility. Risk factors include cryptorchidism (undescended testicle) or family history of this cancer. These tumors are caused by abnormal overgrowth in the testicles (also called testes), originating from germ cells (cells that normally form sperm cells) or abnormal testicular tissue.
Testicular cancer is diagnosed with a physical exam, ultrasound, and removal of the affected testicle. Cancer staging and grading is based on imaging, microscopic exam of the removed testicle, and lymph node biopsy. Treatment options include surveillance, surgery, chemotherapy, and/or radiation. The prognosis is very good with treatment.
Testicular cancer can cause a testicular lump or swelling, which can be detected during a medical exam. Or a man may notice a change in the shape or size of the testicle. Men who are at risk for testicular cancer should check their testicles on a monthly basis (such as in the shower) for any changes. If a change is detected, an ultrasound can help determine if it's caused by testicular cancer.
Testicular cancer is linked to congenital and hereditary causes, not lifestyle or environmental factors. Cryptorchidism increases the risk, as does a family history of testicular cancer. This type of cancer is linked to a number of genetic mutations, which are believed to be inherited. Abnormal growth of cells in the testicle leads to testicular cancer.
Pain is not a common symptom of testicular cancer. Usually, testicular cancer causes a painless lump in the affected testicle. It can also cause swelling, heaviness in the scrotum, discomfort, or pain. Metastases can cause severe pain or aching, such as in the back, pelvis, or elsewhere in the body.
Testicular cancer generally grows slowly, but once it metastasizes, it can cause serious harm to the body quickly. Metastatic testicular cancer can involve the lungs, bone, brain, or other organs. Non-seminomas are a type of testicular cancer that tend to spread more often and faster than seminomas (which are the more common type).
With treatment, testicular cancer has a 95% five year survival rate. The prognosis is better for testicular cancer if it is localized or has only regional spread than for testicular cancer that has metastasized to distant areas of the body. Treatment is based on the stage of the cancer and can include surveillance, surgery, chemotherapy, and/or radiation therapy.
Cryptorchidism is a condition in which one or both testicles remain undescended by the time an infant is four months old. The testes normally develop in the abdomen of a baby boy prior to birth, and they descend into the scrotum shortly before or after birth. Cryptorchidism should be surgically corrected with orchiopexy between six and 12 months of age.
Lymph nodes, which are distributed throughout the body, are part of the immune system. Immune cells travel throughout the lymphatic vessels, and are stored in the lymph nodes. Certain cancers, such as testicular cancer, can spread to nearby lymph nodes. Often, surgical removal of lymph nodes that have been invaded by cancer is part of cancer treatment.
Radiation therapy is one of the treatments used for cancer and some other diseases that are associated with tissue overgrowth. Radiation therapy applies high dose radiation to the area of abnormality. Often, radiation therapy can shrink a testicular tumor and prolong survival from cancer, but it is also associated with side effects.
Testicular cancer diagnosis includes a radical inguinal orchiectomy, which is surgical removal of the testicle, the spermatic cord, and associated blood and lymph vessels. The resected tissue is examined for identification and staging of cancer. The whole testicle is removed because a limited biopsy procedure can disrupt testicular cancer cells, promoting their spread.
There are several subtypes of testicular cancer, and seminoma is the most common. Seminoma develops due to abnormal growth of cells in the testes that are precursors to sperm cells. It grows slowly and may spread to the nearby lymph nodes, and it usually doesn’t metastasize. If treated, seminoma has a good prognosis.
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