Testicular cancer is the uncontrolled growth of abnormal cells in one or both testicles (testes). The testicles are the male sex glands. They are located in the scrotum, behind the penis. They produce testosterone and other male hormones. They also produce and store sperm, the male reproductive cells.

Once testicular cancer develops, it can remain within the testicle, or it can spread to lymph nodes in the abdomen. If it is not detected, testicular cancer eventually can spread to the lungs, brain, liver and elsewhere.

In 2008, about 8,100 men will be diagnosed with testicular cancer in the United States. Most will be between the ages of 20 and 40. Though testicular cancer makes up only 1% of all cancer cases in men, it is the most common cancer in younger men.

Testicular cancer is more common in whites than blacks. Men with a history of undescended testicle (cryptorchidism) have an increased risk for testicular cancer. About 10% of all testicular cancers are found in this group of men. Also, men who have developed cancer in one testicle have a 2% to 3% lifetime risk of developing cancer in the other testicle.

Other men also are at increased risk for testicular cancer:

• Men with a family history of testicular cancer
• Men with an undeveloped testis
• HIV positive men
• Men with certain genetic conditions, such as Down syndrome or Klinefelter syndrome

There is speculation about whether these conditions also increase risk:

• Mumps infection of the testicle
• Maternal exposure to diethylstilbestrol
• Exposure to Agent Orange

Sometimes, testicular cancer is found when a man is being evaluated for infertility.

There are two main types of testicular tumors:

• Germ cell tumors — Most testicular cancers — about 95% — start in germ cells. These are the cells that form sperm. There are two types of germ cell tumors:
  • Seminomas (40% of all testicular cancers) tend to grow slowly. They usually stay within the testicles for a long time without spreading.
  • Non-seminomas (55% of all testicular cancers) form in more mature germ cells. They are more likely to spread, especially to lymph nodes. Lymph nodes are bean-shaped structures throughout the body that produce and store infection-fighting cells.



• Tumors of supportive tissues — About 5% of testicular cancers begin in the testicles' supporting tissues. These cancers are called Sertoli cell tumors and Leydig cell tumors.

Most often, men notice a painless swelling or hardening of a testicle. It may be hard on one side, but not the other. Sometimes, men notice a painful, growing lump on the scrotum. Men also may notice breast enlargement. Rarely, a milky substance may come out of the nipple. These two symptoms occur when the tumor is affecting the secretion of male hormones.

Less common symptoms include:

• A lump in the neck
• Back pain that doesn't go away
• Shortness of breath
• Coughing up blood

These less common symptoms tend to appear after the cancer has spread to other parts of the body.

Your doctor will ask when you first noticed the problem and whether your symptoms have worsened over time. He or she will examine the testicle and feel for swollen lymph nodes. Be sure to tell the doctor if either of your testicles was not descended at birth. Your doctor may suspect that you have testicular cancer based on your symptoms or findings during your physical exam, such as a hard lump or area of tenderness. To determine whether a soft lump is solid or fluid filled, your doctor may use a small flashlight to see if light can be transmitted through the lump.

The physical examination may be followed by:

• Ultrasound — In this procedure, high-frequency sound waves are used to check for a mass inside the testicle and for abnormal accumulations of fluid.



• Magnetic resonance imaging (MRI) or computed tomography (CT) scans — These painless techniques use magnetic fields or X-rays to create images of the abdomen to check for abnormal masses and enlarged lymph nodes.



• Chest X-ray — This will check whether the cancer has spread to the lungs.

The best way to confirm the diagnosis of testicular cancer is to remove the testicle in a procedure called an orchiectomy (see below). After surgery, the testicle will be examined in the laboratory to determine if cancer is present, and if so, the specific type. Blood tests also will be done to measure levels of tumor-markers, which include:

• Alpha-fetoprotein (AFP)
• Beta-human chorionic gonadotropin (beta-hCG)
• Lactic dehydrogenase

In many people, testicular cancer develops slowly and may remain undetected for years. Like all cancers, testicular cancer will continue to grow and possibly spread until it is treated. More often, testicular cancer can be a very rapidly growing cancer where urgent treatment is required.

There is no way to prevent most cases of testicular cancer. Men who had an undescended testicle at birth should be monitored regularly for early signs of cancer. Most pediatricians recommend placing an undescended testis back into the scrotal sac at a very early age. If the testis did not even begin its descent into the scrotum, some pediatricians recommend that the testicle should be surgically removed. These "abdominal testes" are more likely to become cancerous over time.

Treatment of testicular cancer depends on the cancer's stage, which indicates how far the cancer has spread. The stages of testicular cancer are:

• Stage I — Cancer is found only in the testicles.



• Stage II — Cancer has spread to nearby lymph nodes in the abdomen or pelvis.



• Stage III — Cancer has spread beyond the local lymph nodes to the lungs, brain, liver or other parts of the body. Or, cancer has spread to nearby lymph nodes and levels of tumor-marker proteins in the blood are quite elevated.



• Recurrent — Cancer has returned after prior treatment.

The treatment for most stages of testicular cancer is to remove the testicle. In this procedure, the surgeon removes the testicle through an incision in the groin. Before the surgery and three weeks after surgery, blood tests will be done to measure levels of tumor markers. Some men will need additional surgery (called retroperitoneal lymph node dissection) to check whether the cancer has spread to lymph nodes in the groin and lower back.

After surgery, the treatment of testicular cancer varies according to the cancer's stage. Most men will require additional treatment, such as radiation or chemotherapy. A few men may require only close observation.

After treatment, regular follow-up exams are critical to make certain that the cancer is gone. For the first two years, a man is examined every one to two months, and blood tests, X-rays and CT scans are done. Then, check-ups that include periodic X-ray examinations are done only once or twice a year, but a physical examination and periodic blood tests are done more frequently.

Contact your doctor if you discover any lumps on the testicles or in the scrotum, or if you develop persistent pain and swelling of either testicle.

Testicular cancer usually can be cured if it is detected and treated early. However, this type of cancer can spread silently and quickly, meaning that some men will not be diagnosed until the disease is in an advanced stage.

Testicular cancer was once incurable if the cancer had spread beyond the testicles. Now, this cancer is one of the most curable.

Most men with testicular cancer have an excellent prognosis. Men with Stage I disease are very likely to be cured with surgery and radiation therapy. Men with Stage II testicular cancer have a very good prognosis following surgery and radiation or chemotherapy. Even men with the most advanced cases still have a five-year survival rate of greater than 50%. That means that more than half of these men will be alive five years after diagnosis.

People who have been cured of testicular cancer involving one testicle have a 2% to 3% risk that they will develop cancer in the other testicle at some point in their lives.

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