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.
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 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 9,300 new cases of testicular cancer are diagnosed each year. The disease's five-year survival rate is more than 95%
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.
What are the symptoms of testicular cancer?
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.
How is testicular cancer diagnosed?
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.
What are the stages of testicular cancer?
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
What are the treatment options for testicular cancer
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.
Why come to MD Anderson for testicular cancer care?
At MD Anderson's Genitourinary Cancer Center, a team of experts targets each patient's testicular cancer, providing customized care to match your unique disease and circumstances. These highly focused physicians, as well as a specially trained support staff, personalize your care to ensure the most-advanced treatments with the least impact on your body.
As one of the nation's most active cancer centers, MD Anderson sees many more patients with testicular cancer than does the average oncologist. This translates to an extraordinary level of expertise, which can mean higher chances for successful treatment.
And at MD Anderson you're surrounded by the strength of one of the nation's largest and most experienced comprehensive cancer centers, which has all the support and wellness services needed to treat the whole person – not just the disease.
Knowledge and experience
Treatment for testicular cancer frequently requires surgery. Procedures, especially those to remove lymph glands, are delicate and require a high level of skill.
Our surgeons are among the most experienced in testicular cancer in the nation. They employ the latest techniques, which may mean less recovery time, fewer side effects, and faster healing for many patients. MD Anderson surgeons also have extensive experience in advanced nerve-sparing techniques.
If testicular cancer spreads, strong doses of chemotherapy may be needed. Our experienced oncologists take great care in selecting the best treatment for you. If a stem-cell transplant is necessary, MD Anderson offers one of the premier programs in the nation.
Pioneering research
As one of the world's largest cancer research centers, MD Anderson is leading investigations into new methods of testicular cancer diagnosis and treatment. You benefit from the most advanced research, and we're able to offer clinical trials (research studies) of new therapies for testicular cancer.
From the moment my brother received his diagnosis, I promised I would fight for him.
The Genitourinary Center is located in the Mays Clinic.
Before I was diagnosed with testicular cancer at age 21 last year, I only did self-checks in the shower when I remembered to. That translated to about once every two or three months. I knew that the disease usually occurred in younger men, but I also thought I’d felt a lump a few years earlier, and it turned out to be normal.
The lump I found on my right testicle in February 2017 seemed pretty big to me, so it must have formed fairly quickly. I went to my local urologist to get it checked out.
My doctor told me the testicle needed to be removed, whether the lump was cancerous or not. He’s a family friend and someone I trust, so I let him perform the surgery in Beaumont two days later. He referred me to MD Anderson afterwards for additional treatment.
At the time, I only lived about five miles away from the Texas Medical Center. And MD Anderson is the best cancer hospital in the world, so I knew that was where I wanted to be.
Why I chose to bank my sperm
At MD Anderson, I met with Dr. Amishi Shah. She confirmed that the lump had been cancerous and provided an official diagnosis: I’d had a non-seminomatous germ cell tumor. Those form in the cells that produce sperm and are pretty fast-growing, so she recommended one cycle of BEP (a combination of bleomycin, etoposide and cisplatin) chemotherapy.
Just one dose of that regimen can make a man infertile for up to two years, so before I started treatment, I visited a sperm bank. I’m not ready for children yet, but I do want my own someday, so banking my sperm seemed like a no-brainer decision. Better to be safe than sorry, right?
My only lingering chemotherapy side effect
My chemotherapy had to be administered through an IV, so I stayed at MD Anderson for a week. I also stayed at home for another week after that, due to my weakened immune system. I lost all my hair as a result of the chemo, but it’s since grown back. And I have a couple of chemo burns that look like bruises on my arms and upper legs. But other than that, my testicular cancer treatment didn’t really affect my day-to-day life.
I’ve shown no evidence of disease since March 2017, so the only lingering side effect I really have now is anxiety. I worry a little bit every day that the cancer might come back. And I check myself a lot more frequently now than I used to, at least once or twice a month. Because I realize how lucky I was to catch the cancer early, before it had spread.
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