An Overview of Testicular Cancer

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More than 9,000 American men are faced with a diagnosis of testicular cancer each year. The disease is characterized by the development of a malignant tumor in the testicles (testes) where sperm and male hormones are produced. Testicular cancer is usually identified by a painless lump on the testes and may be accompanied by such symptoms as fatigue, lower back pain, swollen lymph nodes, and a heaviness in the scrotum.

Diagnosis involves both an ultrasound and a series of blood tests. Based on those results, the affected testicle may be removed. The analysis of the tumor and other imaging tests can usually provide the doctor the information needed to stage the disease and design a treatment plan, which may involve surgery, chemotherapy, or radiation.

While a testicular cancer diagnosis can be alarming, treatment today has advanced to a point where most men achieve complete disease remission—including those whose cancer has spread.

Symptoms

Most testicular cancers are discovered accidentally while taking a shower, having sex, or undergoing an unrelated medical exam (such as a fertility test or a routine physical). The tumor itself will usually only involve a single testicle and appear as a hard, painless lump, ranging in size from a grain of barley to a marble.

Other initial signs and symptoms may include:

  • Scrotal swelling
  • Heaviness in the scrotum
  • Localized pain or discomfort
  • Lower abdominal or back pain (if the tumor has spread to local lymph nodes)

If the cancer spreads (metastasizes), it could lead to other more serious symptoms depending on which organ is affected.

Secondary tumors in the lungs may result in shortness of breath and the coughing up of blood. Cancer that has spread to the brain may cause confusion, dizziness, and other neurological symptoms. The cancer can also affect how your blood cells act, triggering the formation of clots and the development of deep vein thrombosis (DVT).

Certain types of testicular cancer can also affect your hormones and trigger the abnormal enlargement of breast tissues, known as gynecomastia. As the disease progresses, chronic fatigue and unexplained weight loss may also occur.

While the appearance of a lump may be distressing, it's important to remember that testicular cancer is a relatively uncommon malignancy. More often than not, that lump will be the result of an infection or injury that only a doctor can diagnose.

Recognizing Symptoms of Testicular Cancer

Causes

What makes testicular cancer so unnerving is that it tends to affect men between the ages of 15 and 35, a time in life where serious medical problems are not usually expected.

What triggers the development of cancer remains a medical mystery. What we do know is that there are a number of genetic, physiological, and lifestyle factors that may contribute to your risk.

In recent years, scientists have found no less than 19 genetic mutations directly linked to the testicular cancers. While family history was once dismissed as a major risk factor, current evidence suggests that having a father with testicular cancer raises your risk of the disease by 200 percent, while having a brother increases it to 400 percent.

In addition to age and genetics, other common risk factors include:

  • Race, wherein white and Hispanic men are as much as four times more likely to get the disease than men of other races
  • An undescended testicle, known as cryptorchidism, which increases your risk by 800 percent
  • Carcinoma in situ (CIS), a precancerous condition, which places you at a 50 percent risk of getting testicular cancer over five years

In contrast to other types of cancer, lifestyle appears to play a less significant role in the development of the disease. Research regarding cigarette smoking and obesity has often failed to demonstrate any measurable impact and, in some cases, has concluded that the relative risk is smaller rather than larger.

The one exception may be marijuana. According to researchers in New Zealand, the weekly use of cannabis is not only associated with a 250 percent increased the risk of testicular cancer but more severe forms of the disease.

On the other hand, certain conditions commonly presumed to cause testicular cancer—including injury, vasectomy, horseback riding, and cycling—are in no way linked to the disease.

Testicular Cancer Causes and Risk Factors

Diagnosis

There are a number of standard tools used in the diagnosis of testicular cancer. They not only help confirm or exclude cancer as the cause, they are able to distinguish between different types of cancer, some of which are more aggressive or less responsive to therapy. 

The vast majority of testicular cancers are referred to as germ cell tumors, which arise from cells that produce the precursors of mature sperm (called spermatozoa). These are further broken down into two key subtypes: slower advancing tumors, known as seminomas, and more aggressive types, known as non-seminomas

To begin the investigation, the doctor will typically use an ultrasound to visualize the growth and a series of blood tests to detect tumor markers consistent with cancer. The ultrasound (which uses sound waves to view internal organs) is especially important as it can help differentiate between a benign and malignant tumor of the testicle. In general, on ultrasound, seminomas look more homogenous than non-seminomas, but the test cannot reliably differentiate between the two tumor types.

Based on the evidence, the doctors may proceed with the next stage of the diagnosis called a radical inguinal orchiectomy. This is a surgical procedure in which the testicle and tumor are permanently removed. While this may seem excessive—removing a testicle to diagnose a disease—it is only done because the disruption of cells, even with a needle biopsy, may cause the cancer to spread.

An orchiectomy is only performed if all diagnostic signs, including a visual examination of the tumor, are strongly positive. The tissues can then be analyzed by a pathologist, the results of which can be used for the next stage of diagnosis known as the cancer staging.

Cancer staging determines the extent of the metastasis and will involve imaging tests, such as a CT scan or MRI, to check for signs of cancer in the lungs, brain, and other organs. Based on the accumulated evidence, the pathologist will broadly stage the disease, as follows:

  • Stage 1 means that the cancer is confined to the testicles.
  • Stage 2 means that the cancer has spread to the lymph nodes.
  • Stage 3 means that the cancer has metastasized at distance.
What Tests Are Used to Diagnose Testicular Cancer?

Treatment

If you have been positively diagnosed with testicular cancer, treatment may involve surgery, chemotherapy, or radiation. While the choice is largely determined by the staging and classification of the tumor, clinical expertise is also needed to weight the benefits of consequences of the various treatment approaches. 

Surgery

For a stage 1 or stage 2 non-seminomas, a surgery called a retroperitoneal lymph node dissection (RPLND) may be performed once you have healed from the orchiectomy. RPLND is done in order to better find the stage of the testicular cancer. Also, because non-seminomas are more likely to metastasize, an RPLND is used as a safeguard to prevent further spread of the disease. An RPLND may also be used after chemotherapy to remove any cancerous remnants.

Chemotherapy

Chemotherapy involves the use of toxic drugs that target fast-replicating cells like cancer. The drugs are typically used in combination to treat stage 2 and stage 3 seminomas, as well as stage 1, stage 2, and stage 3 non-seminomas.  

Chemotherapy is delivered intravenously (into a blood vein) in several cycles administered every three to four weeks. The duration and choice of drugs will be based on the severity of the disease and type of tumor you have. 

The three most common drug therapies are referred to by the following acronyms:

  • BEP: bleomycin + etoposide + Platinol (cisplatin)
  • EP: etoposide + Platinol (cisplatin)
  • VIP: VP-16 (etoposide) or vinblastine + ifosfamide + Platinol (cisplatin)

In men unable to tolerate high-dose chemotherapy, a stem cell transplant may be explored to help "boost" blood cell production. The procedure is only used under specific conditions and involves the harvesting of stems cell from your own bloodstream.

Radiation Therapy

Radiation is primarily used to treat stage 2 seminomas and is less commonly used in adjuvant (preventive) therapy to treat stage 1 seminomas. Radiation is not effective in treating non-seminomas at any stage, even in adjuvant therapy.

In cases where the affected lymph nodes are either too large or too widespread, chemotherapy may be recommended as an alternative.

Treatment Options for Testicular Cancer

A Word From Verywell

As scary as the disease may seem, testicular cancer is one of the most treatable of all cancers. Thanks to advances in chemotherapeutic drugs, we are now achieving five-year survival rates approaching 99 percent in stage 1 testicular cancer patients. Moreover, the five-year survival rate for stage 3 testicular cancer is approximately 73 percent.

This should not suggest, however, that you have any leeway in the diagnosis or treatment of the disease. Early diagnosis not only translates to higher cure rates but far fewer treatment-related complications or side effects.

To this end, many doctors will recommend a monthly testicular self-exam (TSE) to check for any suspicious lumps or growths during a shower or bath. While the practice has not been shown to reduce the incidence of the disease, from an individual standpoint, it can make a big difference in whether you get diagnosed early or late.

Recognizing Symptoms of Testicular Cancer
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