Testicular cancer develops in the testicles (or testes) but can spread to nearby tissues and other parts of the body via the lymph system and blood. The testes, which are home to a variety of cell types, are responsible for producing male sex hormones and sperm for production. When healthy cells in the testicles develop abnormalities, they can start to grow and divide rapidly, causing the accumulated cells to form a cancerous mass in one or both of the testes. Age, family history, lifestyle choices, congenital defects, and certain diseases can all increase a man's risk.
Types of Testicular Cancer
Knowing a cancer's classification can help the oncologist and consulting urologist determine how to best treat the disease. Around 90 percent of all testicular cancers start in the germ cells that produce immature sperm, and there are two main types of cancer that grow from these cells: seminomas and nonseminomas.
- Seminoma: A slow-growing form of testicular cancer that may spread to the lymph nodes but is often just in the testicles. Seminomas--found mostly in men in their 30s and 40s--are very responsive to radiation therapy.
- Nonseminoma: This type of testicular cancer grows rather quickly and frequently consists of more than one cell type. Nonseminomas are further characterized by these different cell types, which include yolk sac tumor, teratoma, embryonal carcinoma, and choriocarcinoma. The fastest-growing type is the choriocarcinoma and it is more likely to spread to the lungs, bone, and brain.
Another, less common type of testicular cancer is carcinoma in situ (CIS). This noninvasive cancer starts as a flat lesion but can amass into a tumor. It typically develops in the epidermis and does not penetrate the deeper dermis or spread to other areas of the body. CIS tends to grow slowly and may not be detected for years.
Symptoms Associated with Testicular Cancer
Some men who have testicular cancer experience no genital symptoms at all. Those who do may encounter:
- Abdominal or groin pain
- Heaviness in the scrotal area
- A lump or enlargement in the testicle(s)
- Tenderness of the breasts
- Pain in the testicle or scrotum
- Swelling in the testicle or groin
- A sudden build up of fluid in the scrotum
Risk Factors for Testicular Cancer
There are a number of risk factors that increase a man's chance of developing testicular cancer. They include:
- Family history of testicular cancer
- Prior history of abnormal testicle development, such as Klinefelter syndrome
- Prior history of an undescended testicle, even if the testicle was surgically corrected
- Race: Caucasian men are more likely to experience testicular cancer than African-American and Asian-American men
- Lifestyle choices, such as smoking
Diagnosing Testicular Cancer
Some men are able to detect testicular cancer through a self-exam. The best time to do so is after a shower or bath, when the scrotum is relaxed and lumps are easier to find. If testicular cancer is suspected, a physician will also perform a physical examination of the testicles and scrotum.
Other tests to help confirm diagnosis include:
- Ultrasound: Uses high-frequency sound waves to image the testicles and determine if the lumps are solid or fluid filled, as well as whether they are inside or outside of the testicle.
- Biopsy: A small piece of tissue is removed for examination under a microscope.
- Radical inguinal orchiectomy: In instances where testicular cancer is suspected, the entire testicle may removed then analyzed in a lag by a pathologist, who can determine if cancer is present (and, if so, what type).
- CT scan: If cancer has spread, this exam uses a series of X-ray images to look for signs of testicular cancer in the abdominal lymph nodes.
Stages of Testicular Cancer
Following tests, the testicular cancer is given a stage:
- Stage I: The testicular cancer is solely in the testicle(s).
- Stage II: The cancer has traveled to the abdominal lymph nodes.
- Stage III: Cancer has spread to other parts of the body, such as the lungs, liver, bones, and brain.
Testicular Cancer Treatment
Testicular cancer is very treatable, even if it has spread to other parts of the body. Treatment options depend on the type and stage of cancer, but include chemotherapy, surgery, and radiation therapy.
Albala D, Morey A, Gomella L, & Stein J. (2011). Testicular cancer. Oxford American Handbook of Urology. P294-309