What is Testicular Cancer?
Your testicles are the male reproductive glands in your scrotum., the sac behind your penis. Each adult testicle is about the size of a walnut. Testicular cancer happens when malignant cells develop in your testicle.
Testicular cancer is relatively rare, with about 9,560 men in the US diagnosed each year. It’s usually diagnosed in men, with an average age of 33. About 95% of men are cured from testicular cancer, regardless of stage.
Types of Testicular Cancer
Germ Cell Tumors
Germ cell tumors account for nearly all testicular cancers. These tumors happen in the cells responsible for making sperm. Germ cells give rise to two main kinds of cancer.
- Seminomas are the most common germ cell type of testicular cancer. They occur most often in men 20 to 45 years old. Seminomas are usually treated with surgery, sometimes with radiation, too. Seminomas that have spread throughout the body are treated with chemotherapy.
- Nonseminomas may be more aggressive. They are treated somewhat differently from seminomas. These tumors also occur in men in their 20s and 30s. Types include embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and teratoma.
Infrequently, germ cell tumors develop in the back of your abdomen or in your chest.. These tumors are diagnosed by biopsy and treated with chemotherapy. They do not show up on testicular ultrasound.
Stromal Cell Tumors
Stromal cell tumors develop in the stromal cells. These are the testicles’ supportive tissues that produce the male hormone testosterone. These tumors are less common and are generally noncancerous. Fewer than one in 20 adult testicular tumors are stromal tumors. However, they make up about 20% of tumors in boys. Leydig cell tumors and Steroli cell tumors are main types of stromal cell tumors.
Secondary tumors result when you have cancer elsewhere in your body that spreads to the testicle. Lymphoma is the most common cancer that spreads to the testicles. Boys with acute leukemia may develop testicular tumors. Cancer is named for the point of origin, so these occurrences are not called testicular cancer.
Diagnosis, Symptoms, and Risk Factors
Diagnosis of testicular cancer starts with a physical examination of your testicles. If your doctor suspects you have cancer, they may order these tests:
- Ultrasound. Your radiology team uses sound waves to take images of your testicles, then a radiologist reads the images to look for signs of cancer. This painless test doesn’t expose you to radiation.
- Biopsy. A biopsy involves taking a tissue sample. Then a pathologist examines the sample for signs of cancer. If you have a solid mass in one testicle, the only sure way to confirm testicular cancer is to remove your testicle in an operation, followed by pathology examination. You’ll have no loss of sexual function from this operation.
Once your doctors confirm you have testicular cancer, they will order other tests to find out if the cancer cells have spread within your testicles or to other parts of your body. These tests may include:
- Chest X-ray, an imaging test to see if the cancer has spread to your lungs.
- CT scan, a test that takes multiple X-rays to create a 3D image of your body, which can show if testicular cancer has spread to other organs.
- MRI, a test that uses radio waves and strong magnets to take pictures of your body. An MRI maps the location, size, and sometimes even the type of tissue contained in a tumor that’s spread to another part of your body.
- Serum tumor markers test, which helps determine your cancer stage, track your response to treatment, and find out if cancer has recurred. Your care team will take a blood sample to look for markers that indicate cancer is present. These include:
- Alpha-fetoprotein (AFP)
- Beta-human chorionic gonadropic (ß-hCG)
- Lactate dehydrogenase (LDH)
Your doctor will stage your cancer to figure out the most effective therapy for you. Staging takes into account the size of your tumor, the level of your serum tumor markers, and whether the cancer has spread to lymph nodes or other organs.
- Stage I cancer is confined to your testicle
- Stage II cancer has spread to lymph nodes in your abdomen but not other parts of your body or distant organs
- Stage III cancer has spread to any side beyond your abdominal lymph nodes
The most common sign of a testicular cancer is a painless lump in the testicle. If you have this symptom or any of the symptoms below, it’s important to talk to your doctor:
- Swelling of the scrotum or the testicle
- Pain or discomfort in the scrotum or the testicle
- A lump (pain-free) in either testicle
- Any change in how the testicle feels, such as a new heaviness
- The buildup of fluid in the scrotum
- An ache in the groin or lower abdomen
- Tenderness in the breast area, a sign of an elevated hormone called human chorionic gonadotropin (HCG)
- New back or abdominal pain (more advanced testicular cancer)
Testicular Cancer Risks
Many testicular cancer risks are out of your control. Here are known risk factors for developing testicular cancer:
- Race: White American men are five times more likely to get testicular cancer than African American men.
- An undescended testicle: The testicles normally descend from your abdomen into your scrotum before you’re born. This happens in about 3% of boys, when the testicles stay in the abdomen or groin. About 14% of testicular cancers happen in men with an undescended testicle.
- Abnormal development of the testicles
- Previous cancer in one testicle: Increases your risk of developing cancer in the other testicle by less than 1%.
- Family history: Rarely, men who have testicular cancer also have a close relative who have had the disease.
- HIV/AIDS: Men with HIV seem to have a higher risk of testicular cancer. The risk may be even greater for men who have AIDS.