Testicular Cancer

Every year, hundreds of thousands of men are diagnosed with cancers specific to men. The good news is that these cancers are treatable if found early. Diets and programs also exist that can help to lessen the risk of these diseases.

Many men hesitate to be screened for these cancers because of traditional male stereotypes, and a fear that if diagnosed, a surgical treatment will be necessary. A diagnosis of testicular cancer does not automatically mean surgery. Depending on the stage of the cancer, there are a number of other options that can be explored.

Testicular cancer is a relatively rare, but highly curable, disease. Though it accounts for only one percent of all cancer in men, testicular cancer is the most common cancer in young men between the ages of 15 and 35. It is also more common in Caucasian men than in African American, Asian, or Hispanic men. Additionally, research has also shown that testicular cancer is sometimes linked to certain other rare conditions in which the testicles do not develop normally, including:

Undescended testicle or cryptorchidism (a testicle that has never moved down into the scrotum): Men who have undescended testicles are at higher risk of developing cancer of the testicle than other men whose testicles have moved down into the scrotum, even if they have had surgery to correct this.
Klinefelter's syndrome: Men with Klinefelter's syndrome (a sex chromosome disorder characterized by low levels of male hormones, sterility, breast enlargement, and small testes) are at greater risk of developing testicular cancer.

Types of testicular cancer

There are two main classifications of testicular cancer:

Seminomas: Pure seminomas account for about 40 percent of all testicular cancer and are made up of immature, special sperm-forming cells called germ cells. Usually, seminomas are slow growing and tend to stay localized in the testicle for long periods.
Nonseminomas: Nonseminomas arise from more mature, specialized germs cells than seminomas, and they tend to be more aggressive. Nonseminomas are a group of cancers that often occur in combination with one another, including choriocarcinoma, embryonal carcinoma, immature teratoma, and yolk sac tumors.

Symptoms of testicular cancer

Symptoms of testicular cancer may include:

A painless lump or swelling in either testicle
Any enlargement of a testicle or change in the way it feels
A feeling of heaviness in the scrotum
A significant shrinking of a testicle
A dull ache in the lower abdomen or in the groin
A sudden collection of fluid in the scrotum
Pain or discomfort in a testicle or in the scrotum

These symptoms can be caused by cancer or by other conditions. It's important to see a doctor, preferably a urologist, to determine the cause of any symptoms.

At MedStar Health, we use several tests to diagnosis testicular cancer, including:

Abdominal CT scan
Blood tests for tumor markers: alpha fetoprotein (AFP), human chronic gonadotrophin (beta HCG), and lactic dehydrogenase (LDH)
Chest X-ray
Ultrasound of the scrotum

Testicular cancer treatment

If found early, testicular cancer is almost always curable. Treatment at MedStar Health depends on the type and stage of the cancer, the patient's age and general health, and other factors.

Surgery

Surgery is the most common treatment for most stages of cancer of the testicle. A doctor may take out the cancer by removing one or both testicles. Also, surgery may be needed to remove the lymph nodes into which the testicles drain. (Surgical removal of lymph nodes usually is not necessary for patients with seminomas, which are slow growing and tend to stay localized.)

In the past, everyone with testicular cancer had some additional treatment beyond surgery. However, researchers have a better understanding of how the disease spreads and how to treat it. For instance, men whose cancer is stage one (confined to the testes) may not need any further treatment. For these patients, waiting and watching with regular testing is a reasonable option.

Men who opt to watch and wait must undergo regular testing, which may include regular chest X-rays, blood tests to measure tumor marker levels, physical exams and abdominal CT scans.

Radiation therapy

In radiation therapy, X-rays or other high-energy rays are used to kill cancer cells and shrink tumors. Like surgery, radiation therapy is a local treatment and affects only the cells in the treated area. Radiation therapy is usually done on an outpatient basis.

Seminomas are highly sensitive to radiation. Following surgery, men with seminomas may have radiation therapy to their abdominal lymph nodes. Nonseminomas are much less sensitive to radiation, so men with this type of cancer usually do not undergo radiation. Radiation therapy affects normal as well as cancerous cells.

The side effects of radiation therapy depend mainly on the treatment dose. Common side effects include fatigue, skin changes at the site where the treatment is given, loss of appetite, nausea, and diarrhea.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer. Anticancer drugs are recommended when there are signs that the cancer has spread. These medications also are sometimes used when the doctor suspects that undetected cancer cells remain in the body after surgery or irradiation. This is known as "adjuvant therapy."

Chemotherapy may be given by mouth or intravenously injected into a muscle or a blood vessel. Chemotherapy is a systemic therapy, meaning that drugs travel through the blood stream and affect normal as well as cancerous cells all over the body. Common side effects may include nausea, hair loss, fatigue, diarrhea, vomiting, fever, chills, coughing/shortness of breath, mouth sores, or skin rash. Other side effects are dizziness, numbness, loss of reflexes, or difficulty hearing.

Testicular cancer and infertility

Many men worry that losing one testicle will affect their ability to have sexual intercourse or make them sterile. But a man with one healthy testicle can still have a normal erection, produce sperm, and father a child. Therefore, surgery to remove just one testicle does not make a patient impotent.

However, some treatments can affect a man's fertility. Radiation therapy interferes with sperm production, but most patients regain their fertility within a matter of months. Some anticancer drugs also interfere with sperm production. Although the reduction in sperm count is permanent for some patients, many others recover their fertility.

Also, surgery to remove the lymph nodes can cause infertility because it may interfere with the nerves involved in ejaculation. Some men may recover the ability to ejaculate without further treatment; others may be helped by medication. For many, though, it could be permanent. Men should talk to their doctor about a nerve-sparing surgical technique that may protect the ability to ejaculate.