Testicular cancer is a disease in which malignant (cancer) cells form in the tissues of one or both testicles.

 

The testicles are the male sex glands and produce testosterone and sperm. Germ cells within the testicles produce immature sperm that travel through a network of tubules (tiny tubes) and larger tubes into the epididymis (a long coiled tube next to the testicles) where the sperm mature and are stored. Almost all testicular cancers start in the germ cells.

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The two main types of testicular germ cell tumors are seminomas and nonseminomas. These 2 types grow and spread differently and are treated differently. Nonseminomas tend to grow and spread more quickly than seminomas. Seminomas are more sensitive to radiation. A testicular tumor that contains both seminoma and nonseminoma cells is treated as a nonseminoma.

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Testicular cancer is the most common cancer in men 20 to 35 years old.

Risk factors for testicular cancer include:

• Having had an undescended testicle.

• Having had abnormal development of the testicles.

• Having a personal history of testicular cancer.

• Having a family history of testicular cancer (especially in a father or brother).

• Being White.​

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Signs and symptoms of testicular cancer include swelling or discomfort in the scrotum. Make an appointment if you have any of the following symptoms:

• A painless lump or swelling in either testicle.

• A change in how the testicle feels.

• A dull ache in the lower abdomen or the groin.

• A sudden build-up of fluid in the scrotum.

• Pain or discomfort in a testicle or in the scrotum.

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During your visit, you may have the following:

• Physical exam of the testes: check for lumps, swelling, or pain in the testicles.

• Ultrasound exam of the testes: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

• Serum tumor marker test: 

  • Alpha-fetoprotein (AFP).

  • Beta-human chorionic gonadotropin (beta-hCG).

  Tumor marker levels are measured before inguinal orchiectomy and biopsy, to help diagnose testicular cancer.

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Surgery is the main treatment for testicular cancer. Based on the diagnosis, other choices may be offered. Changes in fertility should be discussed before surgery.

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Orchiectomy

Orchiectomy is used to diagnose and treat early-stage or later-stage cancer. This surgery removes the entire testicle and mass through a small cut in the groin. The spermatic cord is also removed. A pathologist will stage the cell type after surgery. Routine surveillance is done after surgery to make sure the cancer doesn’t return. If one testicle is removed and the other is normal, testosterone levels should be fine. The remaining testicle should make enough testosterone. Also, if a man is worried about the way he looks, a testicular prosthesis (fake testicle) is an option.

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Testis Sparing Surgery

Testis-sparing surgery (TSS) is sometimes recommended for some men. This surgery removes just the tumor tissue, not the entire testis. For TSS, the mass must be very small and tumor markers must be negative. TSS is best for men who have benign tumors rather than cancer. If the tumor is cancerous and the patient has a normal testicle on the other side, TSS is not recommended. Surveillance after surgery is important to check for cancer.

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Retroperitoneal Lymph Node Dissection

Retroperitoneal lymph node dissection (RPLND) is a complex surgery, helpful for some men. It is typically used for men with non-seminomatous germ cell tumors that may return. It can be used rather than chemotherapy for stage IIA or IIB non-seminoma tumors. After RPLND surgery, either chemotherapy or surveillance is offered based on the cancer location, type and the risk that it can return.

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Radiation

Radiation is used to kill cancer cells in the testis or in nearby lymph nodes. It is only used in seminoma because some forms of non-seminoma are resistant to radiotherapy. It may be an option if testicular cancer (either type) has spread to far organs like the brain. There are a few radiation therapy types used.

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Chemotherapy

Chemotherapy is used for cancers that spread beyond the testicles, or if tumor markers rise after surgery. Serum tumor markers and imaging tests help guide how much chemotherapy to use, and if it can help. One, two or three chemotherapies may be combined for testicular cancer treatment. These drugs are given in three or four three-week cycles. Sometimes more surgery will be done to remove tumors after chemotherapy is complete.

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Further Treatment

Beyond basic surgery, care depends on the type of cell and follow-up tests. Even if cancer was found early and treated, follow-up tests are recommended. If, after time, cancer returns, then more treatment will be needed