Testicular Cancer

Testicular cancer occurs most often in younger men. It is the most-often diagnosed cancer in men between ages 20 and 34. However, it accounts for only 1% of all cancers that occur in men. When testicular cancer is detected early, there is a nearly 99% chance for successful treatment. Approximately 8,500 new cases of testicular cancer are diagnosed each year, and about 350 men, or less than 5%, die of the disease.

The testicles (also called testes) are a pair of male sex glands that are in a sac-like pouch (the scrotum) under the penis. They produce and store sperm and also are the body’s main source of male hormones. These hormones control the development of the reproductive organs and male characteristics.

Testicular cancer occurs when cells in the testicles grow and multiply uncontrollably, damaging surrounding tissue and interfering with the normal function of the testicle. If the disease spreads, it is still called testicular cancer.

Testicular Cancer Types

There are two basic types of testicular cancer, each with subtypes:

Germ cell tumors occur in the cells that produce sperm. Tumor types include:

Seminomas, the type found most often, are responsible for half of testicular cancer cases. They are generally slow growing and responsive to treatment.

Nonseminomas tend to grow and spread faster than seminomas. Tumor types include:

• Embryonal carcinoma (about 20% of testicular cancers)
• Yolk sac carcinoma (most often occurs in infants and young boys)
• Choriocarcinoma, a rare and extremely aggressive cancer
• Teratomas

Stromal tumors occur in the testicular tissue where hormones are produced. Stromal tumor types include:

• Leydig cell tumors, which occur in cells that produce male sex hormones
• Sertoli cell tumors, which occur in cells that nourish germ cells

Testicular Cancer Risk Factors

Anything that increases your chance of getting testicular cancer is a risk factor. These include:

• Age: Most cases occur between the ages of 15 and 40, and testicular cancer is the type of cancer found most often in men ages 20 to 34.
• Race: White men are five to 10 times more likely to develop testicular cancer than men of other races.
• Family or personal history of testicular cancer
• Undescended testicle (cryptorchidism): Men with testicles that did not move down into the scrotum before birth are at increased risk. Men who had surgery to correct this condition are still at high risk of testicular cancer.
• Abnormal testicular development
• Klinefelter's syndrome: A sex chromosome disorder characterized by low levels of male hormones, sterility, breast enlargement, and small testes
• Human immunodeficiency virus (HIV) or AIDS
• Previous treatment for testicular cancer

Not everyone with risk factors gets testicular cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.

Research shows that many cancers can be prevented.

In rare cases, testicular cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.

Symptoms of testicular cancer vary from man to man. Signs you may have testicular cancer include:

• Small, hard lump that is often painless
• Change in consistency of the testicles
• Feeling of heaviness in the scrotum
• Dull ache in the lower abdomen or the groin
• Sudden collection of fluid in the scrotum
• Pain or discomfort in a testicle or in the scrotum
• Breast growth or loss of sexual desire
• In boys, growth of facial and body hair at an abnormally young age
• Lower back pain if cancer spreads

These symptoms do not always mean you have testicular cancer. However, it is important to discuss any symptoms with your doctor, since they may signal other health problems.

In rare cases, testicular cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.

If you have testicular cancer, it is important to get an accurate diagnosis to help increase your chances for successful treatment. At MD Anderson, our specialized experts use the most modern and accurate technology to diagnose testicular cancer and pinpoint the extent (stage) of the disease.

When an ultrasound shows a mass in your testicle, it is likely your doctor will perform a surgical removal of the testicle (orchiectomy). An incision is made in the groin rather than the scrotum, to avoid possibly spreading cancer cells. A tissue sample from the testicle is examined under a microscope to determine the presence of testicular cancer cells and the stage of the disease.

Other Testicular Cancer Diagnostic Tests

If you have symptoms that may signal testicular cancer, your doctor will perform a physical exam and ask you questions about your health, lifestyle, and family history.

One or more of the following tests may be used to find out if you have testicular cancer and if it has spread. These tests also may be used to find out if treatment is working.

Blood tests: Special blood tests that detect certain protein "markers" are used to diagnose and find out the extent of testicular cancer before and after orchiectomy. These tests include:

• Alpha-fetoprotein (AFP): Elevated levels of this protein, which normally is produced by a fetus in the womb, may indicate the presence of a germ cell tumor in men.
• Beta human chorionic gonadotropin (b-HCG): Increased levels of this protein, normally found in pregnant women, can indicate the presence of several types of cancer, including testicular cancer.
• Lactate dehydrogenase (LDH): This enzyme is related to increased energy production by the body's cells and tissues, which sometimes can indicate cancer.

In rare cases, testicular cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.

Testicular Cancer Staging

If you are diagnosed with testicular cancer, your doctor will determine the stage (or extent) of the disease. Staging is a way to determine how much disease is in the body and where it has spread when it is diagnosed.

This information is important because it helps your doctor determine the best type of treatment for you.

Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

Testicular Cancer Stages

(source: National Cancer Institute)

Stage 0 (carcinoma in situ): Abnormal cells are found in the tiny tubules where sperm cells begin to develop. These abnormal cells may become cancer and spread into nearby normal tissue. All tumor marker levels are normal. Stage 0 is also called carcinoma in situ.

Stage 1A: Cancer is in the testicle and epididymis (tube connecting ducts in rear of testicle to vas deferens) and may have spread to the inner layer of the membrane surrounding the testicle. All tumor marker levels are normal.

Stage 1B: Cancer is one of the following:

• In the testicle and epididymis and has spread to the blood or lymph vessels in the testicle
• Spread to the outer layer of the membrane surrounding the testicle
• 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 1S: Cancer is found anywhere within the testicle, spermatic cord or the scrotum and either:

• All tumor marker levels are slightly above normal
• One or more tumor marker levels are moderately above normal or high

Stage 2A: Cancer is one of the following:

• Anywhere within the testicle, spermatic cord or scrotum
• In up to five lymph nodes in the abdomen, none larger than 2 centimeters
• All tumor marker levels are normal or slightly above normal

Stage 2B: Cancer is anywhere within the testicle, spermatic cord or scrotum and has spread to either:

• Up to five lymph nodes in the abdomen; at least one of the lymph nodes is larger than 2 centimeters, but none is larger than 5 centimeters
• More than five lymph nodes that are not larger than 5 centimeters
• All tumor marker levels are normal or slightly above normal

Stage 2C: Cancer:

• Is anywhere within the testicle, spermatic cord or scrotum and
• Has spread to a lymph node in the abdomen and the tumor is larger than 5 centimeters
• All tumor marker levels are normal or slightly above normal

Stage 3A: Cancer is all of the following:

• Anywhere within the testicle, spermatic cord or scrotum
• Spread to one or more lymph nodes in the abdomen
• 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 3B: Cancer:

• Is anywhere within the testicle, spermatic cord or scrotum
• 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 3C: Cancer:

• Is anywhere within the testicle, spermatic cord or scrotum
• 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

Our Treatment Approach

Treatment for testicular cancer at MD Anderson focuses on the most modern techniques in surgery, chemotherapy and other therapies. We customize your treatment to include the most advanced procedures with the least impact on your body.

Our renowned team of experts considers all the options, and then choose the best course of action specifically for you. Your personalized testicular cancer treatment may include:

• Surgery by a dedicated team of urologists, vascular surgeons, and anesthesiologists with expertise in this complex cancer
• Special nerve-sparing surgical procedures to retain as much function as possible
• The most modern restoration and prosthetic techniques
• Dose-dense chemotherapy, which allows a higher level of drugs to be given and may help prevent stem cell transplant in some patients
• Stem cell transplants at one of the premier programs in the country

Experience Matters

Because MD Anderson is one of the nation’s largest cancer centers, we see a much greater number of patients with testicular cancer than do most oncologists. This is particularly important in surgery for testicular cancer, which is delicate, challenging and requires a great deal of expertise.

Studies have shown that the effectiveness of surgical treatment for testicular cancer depends a great deal on the number of procedures the surgeon has performed. MD Anderson’s skilled surgeons are among the most experienced in the country. This translates to optimal chances for your successful recovery.

And because we are a major cancer research center, we are able to offer clinical trials of new treatments for some types of testicular cancer.

Our Testicular Cancer Treatments

If you are diagnosed with testicular cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health.

One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Surgery

Orchiectomy: Surgery to remove the testicle. In most cases, orchiectomy is performed during testicular cancer diagnosis. The testicle is removed through an incision in the groin, and tissue samples are examined to determine the stage of the testicular cancer.

Retroperitoneal lymph node dissection (RPLND): For some patients, especially those with nonseminoma testicular cancer, surgery may also involve removal of lymph nodes in the abdominal area. This is done at the same time as the orchiectomy or in a second surgical procedure.

Nerve-sparing techniques: To preserve normal ejaculation, the surgeons at MD Anderson are skilled in surgical techniques that may avoid damage to the nerves surrounding retroperitoneal lymph nodes in some men.

Reconstructive surgery: Men who are uncomfortable with their appearance after orchiectomy can have a prosthesis implanted in the scrotum that provides the look and feel of a real testicle.

Possible side effects of testicular cancer surgery

If one testicle is removed to treat testicular cancer, most men can get erections and have sex if they are getting enough testosterone. If both testicles are removed, a man cannot father a child or make enough testosterone to have sex. In this case, testosterone needs to be taken in the form of a gel, patch or shot.

Because both surgical procedures may affect fertility, you may want to talk to your doctor about sperm banking if you want to start a family at some point. Sperm cells can be collected before cancer treatment and frozen for future use.

Radiation Therapy

Seminomas, which are the form of testicular cancer found most often, are very sensitive to radiation treatment. In fact, the treatment dosage is only about one-third of that required for prostate cancer, and the treatment cycle is only two weeks.

Radiation is performed after surgery to remove the testicle (orchiectomy). If the tumor was a seminoma, the oncologist may choose "watchful waiting" to see if the testicular cancer returns or use radiation to treat the lymph nodes along the spine, where the majority of recurrences are located.

Even if testicular cancer comes back, it is still treatable with radiation or chemotherapy. Radiation treatment has an average recurrence rate of about 5%. Radiation also can be used after chemotherapy if any cancer remains.

Other types of testicular cancer (nonseminoma) are more resistant to radiation. They are treated with orchiectomy, chemotherapy, and surgery to remove affected lymph nodes.

Chemotherapy

Chemotherapy is sometimes used in conjunction with surgical removal of the testicle to make sure all the cancer cells have been destroyed. For men with advanced tumors that have spread beyond the testicle or metastasized (spread) to distant areas of the body, chemotherapy is usually given for nine weeks or longer.

The most frequently used chemotherapy combinations for testicular cancer are:

• BEP: Blenoxane® (bleomycin), Etopophos® or Vepesid® (etoposide), and Platinol® (cisplatin)
• EP: Etopophos® or Vepesid® (etoposide) and Platinol® (cisplatin)

For men with poor-risk testicular cancer, MD Anderson uses an approach called dose-dense chemotherapy. A higher number of chemotherapy drugs are given at more-frequent intervals; this allows the cancer cells less time to recover between each treatment.

Stem Cell Transplantation

A stem cell transplant is used most often for testicular cancers that have returned after successful treatment. MD Anderson has one of the most-advanced stem cell transplant centers in the nation.

Our Testicular Cancer Clinical Trials

Since MD Anderson is one of the nation’s leading research centers, we’re able to offer a number of clinical trials (research studies) of new treatments for testicular cancer.