Testicular Cancer

The testicles are egg-shaped glands in the scrotum that produce sperm and testosterone. Within the testis are tiny, coiled tubes called the seminiferous tubules. These structures have a cell lining which produce sperm cells from puberty until old age. From the seminiferous tubules, the sperm travel through several structures within the testicle before entering the epididymis. Located at the top outside edge of the testicle, the epididymis is a tubular structure in which sperm mature. In the spaces between the seminiferous tubules, are Leydig cells which produce testosterone and other hormones.

Although it is rare, testicular cancer is the most common form of cancer in men aged 15 to 35. Fortunately, it is highly responsive to treatments. The earlier the cancer is detected and treated, the better the outcome. Approximately 97% of all testis cancers are cured by surgery with or without radiation treatment or chemotherapy.

Most tumors occur in late adolescence or early adulthood, but testicular cancer can occur in men over 60 as well as in infants. Caucasian men have a much higher incidence of testicular cancer than African or Asian men. In about 97% of cases, only one testicle is affected by cancer. However, men with testicular cancer in one testicle have an increased risk of getting cancer in the other testicle as well.

There are two major types of testicular cancer – seminoma and nonseminoma. Occasionally both types of cancer exist in a single tumor. When this happens, the disease is treated as if it were nonseminoma cancer. Seminoma occurs in all age groups. It generally is slow growing and responsive to radiation therapy. Nonseminoma develops in younger men and grows and spreads more quickly.

Risk Factors

The cause of testicular cancer is unknown. There are, however, several risk factors which are:

1. An undescended testicle or abnormal development of a testicle
2. A close family member with testicular cancer
   
3. Having Klinefelter syndrome, a genetic mutation
   
4. Being Caucasian

Symptoms

Pain and/or a lump in the testicle or scrotum are indications that a urologist should be consulted. Any enlargement of a testicle, or change in the way it feels warrants a visit to the physician as well. Sudden collections of fluid in the scrotum, a feeling of heaviness in the scrotum or swelling of the testicle are additional symptoms. Many conditions other than cancer can cause these symptoms, but it is important that an evaluation be conducted to rule out cancer.

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Evaluation

Diagnosis

A thorough physical exam and additional tests are necessary to diagnose testicular cancer. The physician will feel for swelling, tenderness and/or lumps in the testis. In order to gain more detailed information, a scrotal ultrasound may be performed. Sound waves are analyzed by computer and an image of the testis and scrotum is displayed on a monitor. If the ultrasound indicates that the mass is solid (rather than fluid), further tests may be necessary.

Blood tests are used to diagnose different types of testicular tumors based on the proteins that many testicular cancers produce. These proteins are called tumor markers and are significant because when they are present in increased concentration in the blood, it suggests that a tumor is in the testicle. The final diagnosis of testicular cancer is made when a pathologist studies cells from the mass after it has been surgically removed.

Staging

Staging is the process of determining the extent of the cancer. Stage I is when the cancer has not spread beyond the testis. Stage II disease involves the lymph nodes within the abdomen, and Stage III is cancer which has spread to other parts of the body. Most commonly, testicular cancer migrates to the lungs, liver, bones and brain.

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Treatment

Surgery

When testicular cancer is diagnosed, surgery to remove the testicle is the preferred treatment for most types and stages of the disease. The testicle is removed through an incision in the groin. In cases where the cancer is discovered in its early stage, surgery may be the only treatment required. In other cases, additional surgery to remove lymph nodes my be necessary.

Radiation Therapy

Radiation therapy following surgery may be prescribed for the seminoma type of testicular cancer. Beams of high energy are focused precisely to kill cancer cells which may have spread to abdominal lymph nodes.

Chemotherapy

Chemotherapy treatment utilizes specialized drugs to kill cancer cells which may have traveled from the original tumor site to other areas of the body. Chemotherapy is most often used in treating the nonseminoma type of testicular cancer.

Summary

Testicular cancer is highly responsive to treatments. The earlier the cancer is detected and treated, the better the outcome. Approximately 97% of all testis cancers are cured by surgery with or without radiation treatment or chemotherapy.

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The University of Cincinnati Urology Division is one of the leading urology programs, not just in Cincinnati, but in the U.S. UC Urology provides quality health care using the most advanced technology and state-of-the-art diagnostic treatments. Many of our urologists are recognized in multiple national and local "Best Doctors" and "Top Doctors" listings. We provide minimally invasive surgical treatments which include laparoscopic, robot-assisted laparoscopic and endourologic procedures as well as comprehensive care for all urologic conditions.