Testicular Cancer

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Testicular Cancer

Topic Overview

What is testicular cancer?

Testicular cancer occurs when cells that are not normal grow out of control in the testicles (testes). It is highly curable, especially when it is found early.

The testes are the two male sex organs that make and store sperm. They are located in a pouch below the penis called the scrotum. The testes also make the hormone testosterone.

Testicular cancer is not very common. It affects mostly young males between the ages of 15 and 35 who are white.1

This topic covers seminoma and nonseminoma cancer. It does not cover non-germ cell testicular cancers, such as Leydig cell tumors.

What causes testicular cancer?

Experts don't know what causes testicular cancer. But some problems may increase your chances of getting it. These include:

  • Having a testicle that has not dropped down into the scrotum from the belly. This is called an undescended testicle. Normally, a baby's testicles drop down into his scrotum before he is born or by the time he is 3 months old.
  • Klinefelter syndrome. This is a genetic problem that affects males. Normally, males have one X and one Y chromosome. Males with Klinefelter syndrome have at least two X chromosomes and, in rare cases, as many as three or four.
  • A personal or family history of testicular cancer.

Most men who get testicular cancer don't have any risk factors.

What are the symptoms?

The most common symptoms of testicular cancer include:

  • A change in the size or shape of one or both testes. You may or may not have pain.
  • A heavy feeling in the scrotum.
  • A dull pressure or pain in the lower back, belly, or groin, or in all three places.

How is testicular cancer diagnosed?

Most men find testicular cancer themselves during a self-examination. Or your doctor may find it during a routine physical exam.

Because other problems can cause symptoms like those of testicular cancer, your doctor may order tests to find out if you have another problem. These tests may include blood tests and imaging tests of the testicles such as an ultrasound or a CT or CAT scan. These tests can also help find out if cancer has spread to other parts of your body.

How is it treated?

Nearly all men with testicular cancer begin treatment with surgery to remove the testicle that has cancer. This surgery is called radical inguinal orchiectomy (say "IN-gwuh-nul or-kee-EK-tuh-mee"). Removing the testicle allows your doctor to find out the type of cancer cells you have. It also helps him or her plan any other treatment you may need.

Treatment after surgery may include:

  • Surveillance. You may be able to wait and watch to see what happens. During surveillance, you will have regular checkups with your doctor to make sure that the cancer is gone.
  • Chemotherapy. This is powerful medicine that destroys cancer cells that remain after surgery.
  • Radiation therapy. This is a high dose of X-rays used to destroy cancer cells. It is mostly used to treat a kind of cancer called seminoma. But it is sometimes used after surgery to kill leftover cancer cells. Radiation therapy can also be used to treat cancer that has spread beyond the testes.
  • Additional surgery to remove lymph nodes. This surgery is called retroperitoneal lymph node dissection (RPLND).

Chemotherapy is often used for cancer that has spread to other parts of the body. In some cases, surgery is used to remove that kind of cancer.

How will having testicular cancer affect you?

In most cases, removing a testicle does not cause long-term sexual problems or make you unable to father children. But if you had these problems before treatment, surgery may make them worse. Also, other treatments for cancer may cause you to become infertile. You may want to think about saving sperm in a sperm bank. Talk to your doctor if you have any questions or concerns about sexual problems or whether you can father children.

Some men choose to get an artificial, or prosthetic, testicle. A surgeon places the artificial testicle in the scrotum to keep the natural look of the genitals.

Unlike many other kinds of cancer, most testicular cancers grow slowly and respond well to treatments such as chemotherapy and radiation therapy. But these treatments can cause side effects. Most of the time, the side effects last only a little while, but there also are longer-term side effects from treatments.

Frequently Asked Questions

Learning about testicular cancer:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with testicular cancer:

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Cause

The exact causes of testicular cancer are unknown.

Most men who get testicular cancer don't have any risk factors. But there are some things that may increase your chances of getting testicular cancer. These risk factors include:

  • An undescended testicle (cryptorchidism). This is a testicle that has not descended from the abdomen into the scrotum. Normally, the testes descend into the scrotum before the baby is born or during the first 3 months of infancy. A man is at a higher risk even if the testicle is moved down surgically.
  • Klinefelter syndrome. This is a genetic disorder that affects males. Normally, males have one X and one Y chromosome. Males with Klinefelter syndrome have at least two X chromosomes and, in rare cases, as many as three or four.
  • A personal or family history of testicular cancer.

Infertility from sperm problems has been linked to testicular cancer. Men with sperm problems have a higher rate of testicular cancer than men who do not. Experts don't yet know if the two problems share the same cause or if one causes the other.2

Symptoms

Common symptoms of testicular cancer include:

  • A swelling and/or lump in one or both of the testes. Pain in the testes or scrotum may or may not be present.
  • A feeling of heaviness in the scrotum.
  • A dull feeling of pain in the region of the lower abdominal area, groin, or lower back.

Sometimes these symptoms can be caused by other problems, such as a hydrocele or epididymitis.

Symptoms of advanced testicular cancer

Testicular cancer that has spread (metastasized) beyond the testicles and regional lymph nodes to other organs may cause other symptoms depending on the area of the body affected. Symptoms of late-stage testicular cancer may include:

  • Dull pain in the lower back and abdomen.
  • Lack of energy, sweating for no apparent reason, fever, or a general feeling of illness (malaise).
  • Shortness of breath, coughing, or chest pain.
  • Headache, confusion, or dementia.

What Happens

In most cases, the first sign of testicular cancer is a change in the size or shape of one or both testicles (testes). Often this change does not cause pain, though pain may be present. If unnoticed or untreated, testicular cancer may spread (metastasize) to other areas of the body.

After you are diagnosed with testicular cancer, you and your doctor will begin planning your treatment. Nearly all men with testicular cancer begin treatment with the surgical removal of the affected testicle(s), a procedure called a radical inguinal orchiectomy. Removing the affected testicle helps your doctor find out which type of cancer cells are present and whether your cancer has spread beyond the testes (stage).

After the removal of the affected testicle, your treatment plan may involve surveillance, radiation therapy, chemotherapy, or additional surgery. This depends on your choices, the type of cancer cells involved, and the stage of your cancer.

Testicular cancer is one of the most curable forms of cancer, especially during its early stages. If you have symptoms of testicular cancer, see a doctor as soon as possible.

What Increases Your Risk

Some things may increase your chances of getting testicular cancer. These risk factors include:

  • An undescended testicle (cryptorchidism). This is a testicle that has not moved down (descended) from the abdomen into the scrotum. Normally the testicles descend before or soon after birth. Surgery is usually done to move an undescended testicle into the scrotum. This makes it possible to check the testicle over time.
  • Klinefelter syndrome. This is a genetic disorder that affects males. Normally, males have one X and one Y chromosome. Males with Klinefelter syndrome have at least two X chromosomes and, in rare cases, as many as three or four.
  • A personal or family history of testicular cancer.

Most men who get testicular cancer don't have any known risk factors.

When To Call a Doctor

The most common symptom of testicular cancer is a noticeable change in the size or shape of one or both testicles.

Call your doctor as soon as possible if you have any symptoms of testicular cancer, including:

  • A swelling or lump in one or both of the testes. Pain in the testicles or scrotum may or may not be present.
  • A feeling of heaviness in the scrotum.
  • A dull feeling of pain in the abdomen, groin, or lower back.

Surveillance

Some early-stage testicular cancers are successfully managed with surveillance after surgery. This option involves frequent exams as well as blood tests and imaging tests to watch your condition. Surveillance may let men avoid the side effects associated with other follow-up treatments, such as chemotherapy and radiation therapy.

It is important to know that each treatment option, including surveillance, has its own risks. In choosing your course of treatment, your doctor should fully explain the potential risks and various outcomes so that you can be an informed, active participant at every stage of your treatment.

If you are concerned about your symptoms, talk to your doctor right away. Surveillance is not appropriate unless it is prescribed by a doctor.

Who To See

Health professionals who can evaluate your symptoms and your risk for testicular cancer include:

Health professionals who can manage your cancer treatment include:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Most abnormalities of the testes are found during a self-examination or routine physical exam by a doctor. If testicular cancer is suspected, your doctor may want to perform other tests, including:

  • Testicular ultrasound. This test may be used to rule out other possible causes of an enlarged or painful testicle before the testicle is removed. Ultrasound is a test that uses reflected sound waves to produce an image of organs and other structures in the body. Unlike many other imaging tests, an ultrasound does not use X-rays or other types of possibly harmful radiation.
  • Blood tests, which are often performed in order to measure the levels of tumor markers in your blood. Tumor markers are substances that appear in your bloodstream when cancer is present. Tumor marker levels are monitored at all stages of treatment for testicular cancer.
  • Imaging tests, such as chest X-ray and CT scan of the chest, abdomen, and pelvis.

If the testicular ultrasound and blood tests suggest testicular cancer, a doctor will surgically remove your affected testicle. This procedure, called a radical inguinal orchiectomy, is done to confirm a diagnosis of testicular cancer. Following orchiectomy, a pathologist will examine tissue from the testicle under a microscope (biopsy). If cancer is found, you may have other imaging tests to see whether your cancer has spread beyond the testes. The tests may be X-rays, CT scans, or MRIs of the abdomen, chest, and head.

Ongoing exams and tests

During your treatment for testicular cancer, your doctor will schedule a thorough follow-up program to monitor your recovery, especially if you participate in a surveillance program after your initial treatment. These exams and tests may continue for several years following your treatment. In addition to physical exams, your specific follow-up program may include:

  • Periodic imaging tests such as chest X-rays or CT scans.
  • Blood tests to check the levels of tumor markers in your blood. Tumor marker levels that are stable or that increase after you've had treatment may be a sign of more cancer.

Early detection

A genital exam is an important part of a routine physical exam for every adolescent boy and man.

Testicular self-examination (TSE) may also detect testicular cancer at an early stage. Many testicular cancers are first discovered as a painless lump or an enlarged testicle during self-examination.

Some doctors recommend that men ages 15 to 40 perform monthly testicular self-examination. But this is controversial. Many doctors do not believe monthly TSE is needed for men who are at average risk for testicular cancer. Monthly TSE may be recommended for men who are at high risk for testicular cancer. This includes men with a history of an undescended testicle or a family or personal history of testicular cancer.

Treatment Overview

If you are diagnosed with testicular cancer, your doctor will explain what type of cancer you have, whether it has spread beyond the testicle (metastasized), and the potential for curing it. You and your doctor will discuss your treatment options and possible outcomes of those treatments. Testicular cancer is considered a highly curable disease, especially when diagnosed at an early stage.

Initial treatment

Treatment for testicular cancer begins with a radical inguinal orchiectomy, which is surgery to remove the affected testicle(s). After surgery, depending on which type of cancer cells are present and whether your cancer has spread to other areas of your body (stage), you may need only surveillance. Or you may need further treatment with chemotherapy, radiation therapy, or surgery to remove lymph nodes (RPLND).

If your cancer was found early, you may have a choice regarding further treatment. Talk with your doctor about the risks and possible side effects of each treatment option. For more information, see:

Click here to view a Decision Point. Testicular Cancer: Which Treatment Should I Have for Stage I Seminoma Testicular Cancer After My Surgery?
Click here to view a Decision Point. Testicular Cancer: Which Treatment Should I Have for Stage I Nonseminoma Testicular Cancer After My Surgery?

If testicular cancer is not found and treated during its early stages, it may spread (metastasize) to the lymph nodes and to the lungs, liver, brain, and bones. But often testicular cancer that has spread can still be treated successfully.

Ongoing treatment

Regardless of the therapy you choose to treat your testicular cancer, it is important to receive follow-up care, which may lead to early identification and management of recurrent cancer (cancer that comes back). Your regular follow-up program may include:

  • Physical exams.
  • Imaging tests, including X-rays, CT scans, and MRIs.
  • Blood tests, to check tumor marker levels. Stable or increasing tumor marker levels after treatment may mean that your cancer is still present or has returned and that further treatment is needed.

A diagnosis of testicular cancer means that you will be seeing your doctor regularly for years to come, so it's a good idea to develop a relationship based on trust and the sharing of information. Your doctor may give you some advice on changes to make in your life to help treatment be successful.

Treatment if the condition gets worse

Testicular cancer that has come back (recurred) may be discovered during a physical exam, through an imaging test, or as a result of increasing tumor marker levels. In some cases, treatment for recurrent testicular cancer may be successful, especially if the cancer has spread only to the lymph nodes in the pelvis, abdomen, or lower back and pelvis (retroperitoneum).

Recurrent testicular cancer may be treated with chemotherapy, surgery to remove lymph nodes, or radiation. Sometimes high doses of chemotherapy are needed. If these treatments don't work, then high-dose chemotherapy with autologous stem cell transplant may be tried.

In many cases of recurrent testicular cancer, chemotherapy treatment is followed by surgery to remove any remaining cancer as well as tissue damaged as a result of the chemotherapy.

What to think about

When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It is normal to have a wide range of feelings and for those feelings to change quickly. Some people find that it helps to talk about their feelings with their family and friends.

If your emotional reaction to cancer interferes with your ability to make decisions about your health, it is important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. You can also contact your local chapter of the American Cancer Society to help you find a support group.

Infertility. Some cancer treatments raise your risk of infertility. Unless you are sure you won't want to father a child in the future, talk to your doctor about sperm banking before any treatment for testicular cancer.

Palliative care

Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Your quality of life may be improved by having palliative care to manage your symptoms.

Testicular cancer has a very good cure rate, especially if it is found early. For some people who have advanced-stage cancer, a time comes when more treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice care.

It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care. For more information, see the topics:

Palliative Care.
Hospice Care.
Care at the End of Life.

For more information about testicular cancer, see the following topics:

Prevention

There are no proven ways to prevent testicular cancer. But the following steps may increase the possibility of finding early-stage testicular cancer when it is most likely to be curable.

  • Perform regular testicular self-exams. Most cases of testicular cancer are discovered during a self-exam or during a routine physical done by a doctor.
  • Be aware of any pain or discomfort in your scrotum, pelvis, or lower back. If you have any discomfort in these areas, see your doctor as soon as possible.

Home Treatment

Home treatment can help you manage the side effects that may occur from your treatment. Some treatments for testicular cancer, such as chemotherapy or radiation, can have serious side effects. Be sure to follow any instructions and take medicines given to you by your doctor. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms.

  • Home treatment for nausea or vomiting includes watching for and treating early signs of dehydration, such as having a dry mouth or feeling lightheaded when you stand up. Eating smaller meals may help. So can a little bit of ginger candy or ginger tea.
  • Home treatment for diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your doctor before using any nonprescription medicines for your diarrhea.
  • Home treatment for constipation includes gentle exercise along with adequate intake of fluids and a diet that is high in fruits, vegetables, and fiber. Check with your doctor before using a laxative for your constipation.
  • Home treatment for fatigue includes making sure you get extra rest while you are receiving chemotherapy or radiation therapy. Let your symptoms be your guide. You may be able to stick to your usual routine and just get some extra sleep. Fatigue is often worse at the end of treatment or just after treatment is completed.

Other issues may include:

  • Hair loss. This can be emotionally distressing. Not all chemotherapy medicines cause hair loss, and some people have only mild thinning that is noticeable only to them. Talk to your doctor about whether hair loss is an expected side effect with the medicines you will receive.
  • Poor appetite. Healthy habits such as eating a balanced diet and getting enough sleep and exercise can help control your symptoms. To prevent weight loss and to conserve your strength, eat well during treatment for testicular cancer.
  • Sleep problems. If you find you have trouble sleeping, be sure to have a regular bedtime, get some exercise during the day, avoid caffeine late in the day, and follow other tips to help you sleep more easily.

Testicular cancer and its treatments do not always cause pain. If you have pain, there are many options to relieve it. If your doctor gives you instructions or medicines to treat pain, be sure to follow them. Home treatment for pain, such as a nonsteroidal anti-inflammatory medication (NSAID) or an alternative therapy, such as biofeedback, may improve your physical and mental well-being. Be sure to discuss with your doctor any home treatment you use for pain. For more information, see the topic Cancer Pain.

The diagnosis of testicular cancer and the need for treatment can be very stressful. You may be able to reduce your stress by expressing your feelings to others. Learning relaxation techniques, such as meditation or yoga, may also help you reduce stress.

Your feelings about your body may change following a diagnosis of testicular cancer and the need for treatment. Adapting to your body image changes may involve talking openly about your concerns with your partner and discussing your feelings with your doctor. Your doctor may also be able to refer you to groups that can offer support and information.

Medications

Chemotherapy treatment for testicular cancer uses powerful medicines to kill the cancer cells in your body. But because of the risk of serious side effects linked to chemotherapy, it is important to discuss the risks and benefits of these medicines with your doctor before starting treatment.

Chemotherapy can cause nausea and vomiting. Your doctor may prescribe medicines to control nausea and vomiting to take before, during, or after your treatments.

Medication choices

Some common medicines used to treat testicular cancer include:

What to think about

You may be given a choice between receiving chemotherapy or another treatment. When making your decision, it is important to talk to your doctor about the risks and possible side effects of chemotherapy.

Surgery

Nearly all men with testicular cancer begin treatment with surgery to remove the cancerous testicle. This procedure is called a radical inguinal orchiectomy. With nonseminoma cancer, surgery may be done to remove lymph nodes in the pelvis and lower back. This surgery is called retroperitoneal lymph node dissection (RPLND).

Surgery choices

Testicular cancer may be treated with the following surgeries:

  • Surgery to remove a testicle (radical inguinal orchiectomy)
  • Surgery to remove lymph nodes in the pelvis and lower back (retroperitoneal lymph node dissection, or RPLND)
  • Surgery to remove other areas of cancer if it has spread in the body

What to think about

Try to find an experienced surgeon and a medical center where many surgeries are done for your kind of cancer. Experience can make a big difference. You will likely have fewer side effects, and you'll recover more quickly.

Other Treatment

Radiation therapy

Radiation therapy for testicular cancer uses high-dose X-rays or other types of radiation to kill testicular cancer cells. Radiation therapy may be used after surgery to keep testicular cancer from coming back. Sometimes radiation therapy is used to treat testicular cancer that has come back.

Radiation therapy may be used to treat seminoma cancer. Because the lymph nodes in the pelvis and lower back (retroperitoneum) are the most common areas of metastasis for testicular cancer, radiation is commonly focused on that area.

What to think about

You may have a choice between radiation therapy or another treatment. When making your decision, it is important to talk to your doctor about the risks and possible side effects of radiation therapy.

Complementary therapies

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:

Mind-body treatments like the ones listed above may help you feel better. They can make it easier to cope with cancer treatments. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.

Before you try a complementary therapy, talk to your doctor about its potential value and side effects. Let your doctor know if you are already using any such therapies. Complementary therapies are not meant to take the place of standard medical treatment. But they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.

Other Places To Get Help

Organizations

American Cancer Society (ACS)
Phone: 1-800-ACS-2345 (1-800-227-2345)
TDD: 1-866-228-4327 toll-free
Web Address: www.cancer.org
 

The American Cancer Society (ACS) conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free numbers have information about services and activities in local areas and can provide referrals to local ACS divisions.


National Cancer Institute (NCI)
6116 Executive Boulevard
Suite 300
Bethesda, MD  20892-8322
Phone: 1-800-4-CANCER (1-800-422-6237)
Web Address: www.cancer.gov (or https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help online)
 

The National Cancer Institute (NCI) is a U.S. government agency that provides up-to-date information about the prevention, detection, and treatment of cancer. NCI also offers supportive care to people who have cancer and to their families. NCI information is also available to doctors, nurses, and other health professionals. NCI provides the latest information about clinical trials. The Cancer Information Service, a service of NCI, has trained staff members available to answer questions and send free publications. Spanish-speaking staff members are also available.


UrologyHealth.org, American Urological Association
1000 Corporate Boulevard
Linthicum, MD  21090
Phone: 1-866-RING AUA (1-866-746-4282) toll-free
Phone: (410) 689-3700
Fax: (410) 689-3800
Email: auafoundation@auafoundation.org
Email: patienteducation@auafoundation.org
Web Address: www.urologyhealth.org
 

UrologyHealth.org is a website written by urologists for patients. Visitors can find specific topics by using the "search" option.

The website provides information about adult and pediatric urologic topics, including kidney, bladder, and prostate conditions. You can find a urologist, sign up for a free quarterly newsletter, or click on the Urology Resource Center to find materials about urologic problems.


References

Citations

  1. Bosl GJ, et al. (2008). Cancer of the testis. In VT DeVita et al., eds., DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology, 8th ed., vol. 1, pp. 1463–1485. Philadelphia: Lippincott Williams and Wilkins.
  2. Raman JD, et al. (2005). Increased incidence of testicular cancer in men presenting with infertility and abnormal semen analysis. Journal of Urology, 174: 1819–1822.

Other Works Consulted

  • American Joint Committee on Cancer (2010). Testis. In AJCC Cancer Staging Manual, 7th ed., pp. 469–478. New York: Springer.
  • Cornett PA, Dea TO (2010). Primary tumors of the testis section of Cancer. In SJ McPhee, MA Papadakis, eds., Current Medical Diagnosis and Treatment, 49th ed., pp. 1492–1494. New York: McGraw-Hill.
  • Kollmannsberger C, et al. (2010). Evolution in management of testicular seminoma: Population-based outcomes with selective utilization of active therapies. Annals of Oncology. Published online October 6, 2010 (doi:10.1093/annonc/mdq466).
  • National Cancer Institute (2010). Testicular Cancer PDQ: Screening—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/screening/testicular/patient.
  • Neal R, et al. (2008). Testicular cancer: seminoma, search date April 2006. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  • van As NJ, et al. (2008). Evidence-based pragmatic guidelines for the follow-up of testicular cancer: Optimising the detection of relapse. British Journal of Cancer, 98(12):1894–1902.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Christopher G. Wood, MD, FACS - Urology, Oncology
Last Revised January 13, 2011

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