Source: Cancer Resource Room

What is Testicular Cancer?
Testicular cancer is a disease in which malignant (cancer) cells form in the tissues of one or both testicles. The testicles are 2 egg-shaped glands located inside the scrotum (a sac of loose skin that lies directly below the penis). The testicles are held within the scrotum by the spermatic cord, which also contains the vas deferens and vessels and nerves of the testicles. View Male Overview and Male Pelvis.

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. 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.

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

Health history can affect the risk of developing testicular cancer
Anything that increases the chance of getting a disease is called a risk factor. Risk factors for testicular cancer include:

• Having had an undescended testicle.
• Having had abnormal development of the testicles.
• Having a personal or family history of testicular cancer.
• Having Klinefelter's syndrome.
• Being white
  

Symptoms of testicular cancer—What does the patient feel or notice?
Possible signs of testicular cancer include swelling or discomfort in the scrotum. These and other symptoms may be caused by testicular cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

• 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.

How is testicular cancer diagnosed?
Tests that examine the testicles and blood are used to detect (find) and diagnose testicular cancer. The following tests and procedures may be used:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. The testicles will be examined to check for lumps, swelling, or pain. A history of the patient's health habits and past illnesses and treatments will also be taken.
• Ultrasound test: 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: A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. The following 3 tumor markers are used to detect testicular cancer:
• Alpha-fetoprotein (AFP).
• Beta-human chorionic gonadotropin (ß-hCG).
• Lactate dehydrogenase (LDH).
  Tumor marker levels are measured before radical inguinal orchiectomy and biopsy, to help diagnose testicular cancer.
• Radical inguinal orchiectomy and biopsy: A procedure to remove the entire testicle through an incision in the groin. A tissue sample from the testicle is then viewed under a microscope to check for cancer cells. (The surgeon does not cut through the scrotum into the testicle to remove a sample of tissue for biopsy, because if cancer is present, this procedure could cause it to spread into the scrotum and lymph nodes.) If cancer is found, the cell type (seminoma or nonseminoma) is determined in order to help plan treatment.

Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:

• Stage of the cancer (whether it is in or near the testicle or has spread to other places in the body, and blood levels of AFP, ß-hCG, and LDH).
• Type of cancer.
• Size of the tumor.
• Number and size of retroperitoneal lymph nodes.

Testicular cancer is often curable.

Treatment for testicular cancer can cause infertility.
Certain treatments for testicular cancer can cause infertility that may be permanent. Patients who may wish to have children should consider sperm banking before having treatment. Sperm banking is the process of freezing sperm and storing it for later use.

After testicular cancer has been diagnosed, tests are done to find out if cancer cells have spread within the testicles or to other parts of the body.
The process used to find out if cancer has spread within the testicles or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help make the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Lymphangiography: A procedure used to x-ray the lymph system. A dye is injected into the lymph vessels in the feet. The dye travels upward through the lymph nodes and lymph vessels and x-rays are taken to see if there are any blockages. This test helps find out whether cancer has spread to the lymph nodes.
• Abdominal lymph node dissection: A procedure to examine lymph nodes in the abdomen. Lymph nodes are removed and a pathologist checks them for cancer cells. For patients with nonseminoma, removing the lymph nodes may help stop the spread of disease. Cancer cells in the lymph nodes of seminoma patients can be treated with radiation therapy.
• Radical inguinal orchiectomy and biopsy: A procedure to remove the entire testicle through an incision in the groin. A tissue sample from the testicle is then viewed under a microscope to check for cancer cells. (The surgeon does not cut through the scrotum into the testicle to remove a sample of tissue for biopsy, because if cancer is present, this procedure could cause it to spread into the scrotum and lymph nodes.)
• Serum tumor marker test: A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types or cancer when found in increased levels in the blood. These are called tumor markers. The following 3 tumor markers are used in staging testicular cancer:
  • Alpha-fetoprotein (AFP)
  • Beta-human chorionic gonadotropin (ß-hCG).
  • Lactate dehydrogenase (LDH).

Tumor marker levels are measured again, after radical inguinal orchiectomy and biopsy, in order to determine the stage of the cancer. This helps to show if all of the cancer has been removed or if more treatment is needed. Tumor marker levels are also measured during follow-up as a way of checking if the cancer has come back.

The following stages are used for testicular cancer:

• Stage 0
  In stage 0, abnormal cells are found only in the tiny tubules where the sperm cells begin to develop. The cells do not invade normal tissues. This is sometimes called a "precancerous condition." Stage 0 cancer is also called carcinoma in situ. All tumor marker levels are normal.
• Stage I
  Stage I is divided into stage IA, stage IB, and stage IS and is determined after a radical inguinal orchiectomy is done.
  • Stage IA: Cancer is in the testicle and epididymis and may have spread to the inner layer of the membrane surrounding the testicle. All tumor marker levels are normal.
  • Stage IB: The cancer
    • is in the testicle and the epididymis and has spread to the blood or lymph vessels in the testicle; or
    • has spread to the outer layer of the membrane surrounding the testicle; or
    • is in the spermatic cord or the scrotum and may be in the blood or lymph vessels of the testicle.

  All tumor marker levels are normal.

  • Stage IS: Cancer is found anywhere within the testicle, spermatic cord, or the scrotum and either:
    • all tumor marker levels are slightly above normal; or
    • one or more tumor marker levels are moderately above normal or high
• Stage II
  Stage II is divided into stage IIA, stage IIB, and stage IIC and is determined after a radical inguinal orchiectomy is done.
  • Stage IIA: The cancer
    • is anywhere within the testicle, spermatic cord, or scrotum; and
    • has spread to up to 5 lymph nodes in the abdomen, none larger than 2 centimeters.

  All tumor marker levels are normal or slightly above normal.

  • Stage IIB: The cancer is anywhere within the testicle, spermatic cord, or scrotum; and either:
    • has spread to up to 5 lymph nodes in the abdomen; at least one of the lymph nodes is larger than 2 centimeters, but none are larger than 5 centimeters; or
    • has spread to more than 5 lymph nodes; the lymph nodes are not larger than 5 centimeters.
      

All tumor markers levels are normal or slightly above normal.

• Stage IIC: The cancer
• is anywhere within the testicle, spermatic cord, or scrotum; and
• has spread to a lymph node in the abdomen that is larger than 5 centimeters.

All tumor marker levels are normal or slightly above normal.

• Stage III
  Stage III is divided into stage IIIA, stage IIIB, and stage IIIC and is determined after a radical inguinal orchiectomy is done.

  • Stage IIIA: The cancer
  • is anywhere within the testicle, spermatic cord, or scrotum; and
  • may have spread to one or more lymph nodes in the abdomen; and
  • has spread to distant lymph nodes or to the lungs.
    

  The level of one or more tumor markers may range from normal to slightly above normal.

  • Stage IIIB: The cancer
    • is anywhere within the testicle, spermatic cord, or scrotum; and
    • may have spread to one or more nearby or distant lymph nodes or to the lungs.

    The level of one or more tumor markers may range from normal to high.

  • Stage IIIC: The cancer
    • is anywhere within the testicle, spermatic cord, or scrotum; and
    • may have spread to one or more nearby or distant lymph nodes or to the lungs or anywhere else in the body.

    The level of one or more tumor markers may range from normal to very high.

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