Testicular Cancer

What is testicular cancer?

Testicular cancer is one of the most curable forms of cancer. It is diagnosed and treated by the Urology Division of Premier Medical Group. An early diagnosis followed by an appropriate treatment program can greatly increase your chance for a cure. Testicular cancer is most common in men between the ages of 20 and 34.

The testicles are the male sex glands and produce testosterone and sperm. Testicles contain what is called “germ cells”. These germ cells produce immature sperm, which eventually mature and are stored in a coil near the testicles.

Almost all testicular cancers start in the germ cells, and the two main types of testicular germ cell tumors are seminomas and non-seminomas. These grow and spread at different rates and therefore need to be treated differently.

What are the symptoms of testicular cancer?

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The most common symptoms of testicular cancer include:

  • A painless change in the size or shape of one or both testes
  • A feeling of heaviness in the scrotum
  • A dull pain in the lower back, abdomen, or groin
  • Swelling or lump in one or both testes
  • Pain in the testes

You should contact your doctor if you experience any of the above symptoms.

Other conditions that have symptoms similar to testicular cancer include:

  • Hydrocele: A painless buildup of fluid around one or both testicles. This causes the scrotum or groin area to swell.
  • Varicocele: An enlarged, twisted varicose vein in the scrotum. This can feel like a “bag of worms” and may sometimes cause discomfort.
  • Spermatocele: A sperm-filled cyst in the epididymis, which feels like a smooth, firm lump in the scrotum.
  • Orchitis: An inflammation or infection of the testicle caused by a virus, bacteria, trauma or exertion.
  • Epididymitis: An inflammation and infection of the epididymis, most often caused by a bacterial infection, UTI (in older men), or STDs

Symptoms of advanced testicular cancer

  • Dull pain in the lower back and abdomen
  • Lack of energy and generalized weakness
  • Shortness of breath, coughing, or chest pain
  • Headache, confusion, or dementia.

What are the risk factors for testicular cancer?

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  • Undescended testicle (occurs in infancy when the testicle has not descended to its proper location within the scrotum)
  • Abnormal development of the testicles.
  • HIV
  • Caucasian race

How is testicular cancer diagnosed?

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Your doctor will begin with a complete physical exam and history. The testicles will be examined for lumps, swelling, or pain.

The diagnosis of testicular cancer is confirmed with scrotal sonography. Tumor markers help to confirm and stage testicular cancer. Alpha-fetoprotein (AFP), Beta-human chorionic gonadotropin (β-hCG), and Lactate dehydrogenase (LDH) are specific tumor markers for testicular cancer. These levels are measured before surgery to remove the testicle.

How is testicular cancer treated?

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Testicular cancer is considered a highly curable disease. Your treatment will depend on what type of testicular cancer you have been diagnosed with and whether the cancer has spread (metastasized) beyond the testicle. Between 65%-85% of seminomas present as localized cancers, whereas 60-70% of nonseminomas present with recognized metastatic disease. In addition to tumor markers, CT scans of the chest, abdomen and pelvis help to determine the extent of disease and guide treatment.

Surgery

Treatment for testicular cancer begins with a radical inguinal orchiectomy, which is surgery to remove the affected testicle(s). If tumor is present in both testicles or if a patient only has one testicle, removal of the tumor with preservation of the testicle can be performed.

Removal of lymph nodes in the abdomen and lower back may be required (Retroperitoneal Lymph Node Dissection, or RPLND). This is especially common for nonseminomas.

Radiation

Radiation to lymph nodes in the abdomen is used for seminomas, as these tumors are very radiosensitive.

Chemotherapy

Used when there is bulky tumor in the lymph nodes or spread to other organs such as the lungs or liver. The most common chemotherapy is cisplatin combination therapy, which uses more than one medicine together. The dose ranges in intensity depending on how far the cancer has advanced.

Observation

With serial drawing of tumor markers, CT’s of chest, abdomen, and pelvis, can be offered to patients who have no signs of metastatic disease and whose cancers are deemed low risk. This approach requires patients to be diligent and compliant with their blood work, X-rays and appointments.

What is the prognosis for testicular cancer?

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The patient’s prognosis depends on several factors, such as the stage of the cancer, whether it has metastasized, the type of cancer, size of tumor and number and size of the surrounding lymph nodes affected. In general, testicular cancer (either seminoma or nonseminoma) has cure rates above 90%.