Definition

Testicular cancer is a disease in which cancer cells grow in one or both testicles. The testicles are a pair of male sex glands that make and store sperm. The testicles also make male hormones. They are located under the penis in a sac-like pouch called the scrotum.

There are 3 main types of testicular cancer:

• Seminomas
• Non-seminomas (yolk sac, embryonal cell carcinoma, teratomas, and choriocarcinoma)
• Stromal cell tumors

Treatment will vary depending on the cell type.

Causes

Cancer occurs when cells in the body divide without control or order. Eventually these uncontrolled cells form a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues including the lymph nodes. Cancer that has spread locally or invaded the lymph nodes can then spread to other parts of the body.

It is not clear exactly what causes these problems in the cells, but is probably a combination of genetics and environment.

Risk Factors

Testicular cancer is more common in younger men (aged 25-35 years, but can appear during adolescence). It is also more common in Caucasians. Other factors that may increase your risk of testicular cancer include:

• Personal or family history of testicular cancer
• Abnormal testicular development, such as that seen in Klinefelter syndrome
• Undescended testicle that did not move down into the scrotum before birth

Symptoms

Testicular cancer may cause:

• A painless lump or swelling in either testicle
• Enlargement or swelling of a testicle or change in the way it feels
• Feeling of heaviness in the scrotum
• A dull ache in the lower abdomen or groin
• Sudden appearance of fluid in the scrotum
• Pain or discomfort in a testicle or in the scrotum
• Lower back pain (in later stages of the cancer)
• Breast enlargement unrelated to weight gain—gynecomastia

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:

• Blood tests
• Ultrasound—a test that uses sound waves to find or examine tumors
• Excisional biopsy—removal of testicular tissue for examination under a microscope

Once testicular cancer is found, tests may be done to find out if the cancer has spread and, if so, to what extent. These imaging tests of the body may include:

• CT scan
• PET scan
• MRI scan

The physical exam, combined with all test results, will help to determine the type and stage of cancer. Staging is used to guide a treatment plan. Testicular cancer is staged from I-III. Stage I is a very localized cancer, while stage III indicates a spread to other parts of the body.

Treatment

Cancer treatment varies depending on the stage and type of cancer. It may involve multiple therapies. You and your doctor will decide the best treatment options for you. These may include:

Men undergoing treatment should use condoms because changes in or damage to sperm cells can result in an abnormal fetus. This can also create pregnancy or birth complications. Other reproductive and sexual changes a man may experience include a decrease in sexual desire, and diffiiculty getting and maintaining an erection.

In addition to changes in or damage to sperm cells, other side effects can lead to male infertility. If you and your partner are planning a family, talk to the doctor before you start treatment. There are resources, such as spermmbanking, and treatments available to preserve fertility if undergoing chemotherapy so you can have your family after. Some options may also be available for children or adolescents depending on their stage of development.

Prevention

If you were born with undescended testicles, having surgery to correct this condition might reduce your risk of getting testicular cancer.

There are no current guidelines to screen for testicular cancer. The American Cancer Society recommends that men aged 20 years and older have a testicular exam during a routine physical and/or cancer-related checkup. Your doctor may discuss self examination techniques and how to detect changes. Talk to your doctor about your testicular cancer risk factors. If you are at a high risk for testicular cancer, your doctor may advise self examination and/or more frequent check-ups starting after puberty.

It is important to notify your doctor if you notice any testicular changes or other testicular cancer symptoms, including a lump or swelling.

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