A disease in which cells become malignant in one or both testicles. About 7,400 men in the United States are diagnosed with testicular cancer each year. 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. Although any man can have testicular cancer, it is more common in Caucasians than in African Americans.

More than 95 percent of men who have stage I or stage II testicular cancer are successfully treated. Stage III testicular cancer has about a 75 percent recovery rate.

Types of Testicular Cancer

About 95 percent of all testicular tumors are germ cell tumors. Germ cell tumors in men are classified as either seminomas or nonseminomas. The types grow and spread differently; treatment and prognosis also vary according to type.

About half of all testicular cancers are seminomas. Almost all men recover from this type of cancer if it is treated early.

Nonseminomas are a group of cancers that include choriocarcinoma, embryonal cell carcinoma, teratoma, and yolk sac tumors. These cancers often develop earlier in life than seminomas and usually affect men in their 20s.

A testicular cancer may have a combination of both types.

Secondary Testicular Cancer

Secondary testicular tumors begin in another organ and then spread to the testicle. Lymphoma is the most common secondary testicular cancer. Among men older than 50 years of age, testicular lymphoma is more common than primary testicular tumors. The disease prognosis depends on the type and stage of lymphoma. The usual treatment is surgical removal, followed by radiation therapy and/or chemotherapy.

Secondary testicular tumors also can affect children who have acute leukemia; in these cases, the leukemia cells can sometimes form a tumor in the testicle.

Cancers of the prostate, lung, skin (melanoma), kidney, and other organs also can spread to the testicles. The prognosis for these cancers is usually poor because these cancers generally spread quickly to other organs as well. Treatment depends on the specific type of cancer.

Risk Factors

Although the causes of testicular cancer are not known, studies show that several factors increase a man’s risk of development of testicular cancer.

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 the disease, even if surgery is performed to place the testicle into the scrotum. (However, most men who have testicular cancer do not have a history of undescended testicles.)

Abnormal testicular development

Men whose testicles did not develop normally are at increased risk.

Klinefelter syndrome

The sex chromosome disorder klinefelter syndrome is characterized by low levels of male hormones, sterility, breast enlargement, and small testes. It has been linked to a greater risk of development of testicular cancer.

Personal history

Men who have previously had testicular cancer are at increased risk of having cancer in the other testicle.

Age

Testicular cancer affects younger men, particularly those between ages 15 and 35; it is uncommon in children and in men older than age 40.

Symptoms

The following symptoms can be caused by cancer or by other conditions:

  • • Painless lump or swelling in either testicle
  • • Enlargement of a testicle or change in the way it feels
  • • Heavy feeling in the scrotum
  • • Dull ache in the lower abdomen, lower back, or groin
  • • Sudden appearance of fluid buildup in the scrotum
  • • Pain or discomfort in a testicle or scrotum

Occasionally, men who have germ cell cancer notice breast tenderness or enlarged breasts, because certain types of germ cell tumors secrete high levels of a hormone called human chorionic gonadotropin (hCG), which stimulates breast development. Because blood tests can measure hCG levels, these tests are important in diagnosis, staging, and follow-up of some testicular cancers.

Some men who have testicular cancer have no symptoms; instead, their cancer is found during medical testing for other conditions. Sometimes, imaging tests or biopsies to find the cause of infertility can uncover a small testicular cancer.

Self-Exams

Because the earlier testicular cancer is found the better the chance for cure, experts recommend that men of all ages, starting in the midteenage years, examine their testicles regularly. The best time to do this is during or after a bath or shower, when the skin of the scrotum is relaxed. To perform a testicular self-exam:

  1. 1. Stand in front of a mirror, looking for any swelling on the skin of the scrotum.
  2. 2. Hold the penis out of the way and examine each testicle separately.
  3. 3. Place the index and middle fingers under the testicle while placing the thumbs on the top and roll the testicle gently between the fingers.
  4. 4. Look and feel for any hard lumps or smooth round masses, or any change in the size, shape, or consistency of the testes. Each normal testis has an epididymis, which feels like a small bump on the upper or middle outer side of the testis. Normal testicles also contain blood vessels, supporting tissues, and tubes that conduct sperm.
  5. 5. It is normal for one testicle to be a little larger than the other. Sometimes, a testicle can be enlarged because fluid has collected around it. This is called a hydrocele. Veins in the testicle can dilate and cause enlargement and lumpi-ness around the testicle; this is called a varicocele. A doctor may need to examine these conditions to make sure cancer is not present.

Testicular Cancer: Diagnosis

Staging

If testicular cancer is found, more tests are needed to classify the cancer according to its stage (whether or not it has spread from the testicle to other parts of the body). A chest X-ray can determine whether cancer has spread to the lungs or lymph nodes. Computed tomography (CT) scans are helpful in staging the cancer to determine whether it has spread into the liver or other organs. CT scans can show the lymph nodes and distant organs where the cancer may have spread. magnetic resonance imaging (MRI) scans are particularly helpful in examining the brain and spinal cord. Positron emission tomography (PET) scans are very useful for detecting cancer that has spread beyond the testes and for checking enlarged lymph nodes to reveal whether they contain scar tissue or active tumor.

The following are the stages of testicular cancer:

Stage I: Testicular cancer is only found in the testicle.

Stage II: Testicular cancer has spread to the lymph nodes in the abdomen.

Stage III: Testicular cancer has spread beyond the lymph nodes to other areas, such as the lungs or liver.

Testicular Cancer: Treatment

Follow-up Care

Men who have had testicular cancer have a higher risk of developing cancer in the remaining testicle, as well as of certain types of leukemia and other cancers. For this reason, regular follow-up is extremely important; it usually involves frequent exams and regular blood tests to measure tumor marker levels. X-rays and CT scans are usually performed at regular intervals.

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