What is testicular cancer?

Testicular cancer warning signs include a testicular lump, back pain, swelling, and infection.
Testicular cancer warning signs include a testicular lump, back pain, swelling, and infection.

Testicular cancer arises from the testes (a part of the male reproductive system). The testicles are responsible for the production of male sex hormones and sperm for reproduction. They are located within the scrotum, a loose bag of skin below the penis. Testicular cancer is the most common type of cancer occurring in males in the US between the ages of 15 and 35.

Testicular cancer can be aggressive and grow and spread rapidly. However, this cancer is highly treatable even after it spreads. Hence, the prognosis for men with testicular cancer is good. Studies have shown that the risk of dying from testicular cancer is about 1 in 5,000.

How is testicular cancer treated?

The treatment may involve one or a combination of multiple treatment modalities, which depends on the extent of the disease.

The treatment options include

  • Surgery
    • Orchiectomy: Removal of the testicle. A prosthetic can be placed in the sac.
    • Testes-sparing surgery: The tumor is carefully removed and the healthy part of the testis is left behind. This is ideal for patients with small tumors or benign/noncancerous tumors. 
    • Retroperitoneal lymph node dissection: Surgical removal of the lymph nodes to which cancer commonly spreads. 
  • Radiation therapyThis targets and kills cancer cells and shrinks tumors using radiation
  • Chemotherapy: The tumor cells are killed with cancer medication. 
  • Targeted therapy: This treatment uses medications that target tumor-specific proteins that the cancer cells display. This is the most specific therapy for cancer and known for minimal side effects.
  • Stem cell therapy may be a treatment option in some cases. However, stem cell therapy is still in the experimental stages in most countries.

What causes testicular cancer?

The exact cause of testicular cancer is unknown. Some factors increase the risk of testicular cancer, including 

  • Undescended testes (cryptorchidism) are a risk factor for the development of testicular cancer. Surgical correction of undescended testes before puberty reduces the risk of testicular cancer. 
  • Age: Testicular cancer usually occurs in males between the agesof 20 to 35.
  • Race: Testicular cancer is more common in Caucasian men than in those of other races.
  • Genetic conditions like Klinefelter syndrome cause abnormal development of the testes.
  • Family history of cancer.
  • Human immunodeficiency virus (HIV) infection.

What are the warning signs of testicular cancer?

The initial signs and symptoms of testicular cancer include

  • A painless lump in the testicle.
  • Dull aching in the scrotum or the groin.
  • Varicocele (swollen blood vessels) appearing as enlarged, dark blue veins.
  • Hydrocele (fluid around the testicle) causing swelling.
  • Twisting of the testicle (torsion) may be the presenting symptom. On further investigation, the mass may be discovered.
  • The affected testicle feels firmer and harder than the other. 
  • Formation of blood clots in blood vessels which can reach the lungs causing chest pain and breathlessness.
  • Back pain
  • Infection of the testicle can occur causing pain.

What are the types of testicular cancer?

Most testicular cancers are germ cell (cells that produce sperm) tumors. There are two main types of testicular cancer, seminomas and nonseminomas.

  • Seminomas grow and spread slowly. There are two subtypes
    • Classical seminoma: This is the most common type and it usually occurs in men between the ages of 25 to 45.
    • Spermatocytic seminoma: This commonly occurs in older men and it usually does not spread.
  • Nonseminomas grow and spread more quickly. They usually consist of multiple types of cancer cells, including
  • Embryonal carcinoma: This cancer contains cells that look like embryonic cells under a microscope.
  • Yolk sac carcinoma: This cancer contains cells that look like the sac that surrounds an embryo. This cancer usually occurs in children.
  • Choriocarcinoma: This cancer is usually rare and spreads to the rest of the body quickly.
  • Teratoma: This is a rare tumor that contains other tissues and organs, including teeth and hair.

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How is testicular cancer diagnosed?

  • Self-examination can help in early diagnosis and treatment. The affected testis is enlarged, firm and usually painless. 
  • The physician orders testicular sonography and Doppler ultrasound to reveal the tumor. The physician performs a complete physical assessment.
  • A testicular biopsy confirms the diagnosis. It is a minimally invasive procedure that involves obtaining a small sample of the testicle.
  • Testicular magnetic resonance imaging (MRI) may reveal the extent of the tumor.
  • Lymphangiography may be performed to assess the local spread of the tumor to the lymph nodes of the groin.

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Medically Reviewed on 8/13/2020
References
Medscape Medical Reference

Medscape


American Cancer Society


Medline


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