Testicular Cancer

The testicles or testes are part of the male reproductive system. Cancer occurring anywhere in the testicles is called testicular cancer. The testicles are a bit smaller than a golf ball in adult males and are held within a supportive sac called the scrotum. The scrotum hangs under the base of the penis and helps to make the male hormones androgens like testosterone. They also make sperm, which are the male’s sexual reproduction cells needed to create a pregnancy.

Sperm cells are long, string-like tubes inside of the testicles, which are stored in small coiled tubes behind each testicle called the epididymis. During ejaculation, the sperm is carried from the epididymis through the vas deferens to the seminal vesicles. In this area, the sperm is mixed with fluids from the prostate gland and other glands which then forms the semen. The semen then enters the urethra and awaits ejaculation.

Types of Testicular Cancer

Because the testicles are made up of many types of cells, determining exactly which cancer you have is vital. This will help to put you on the proper treatment path. Once the cells have been studied under a microscope, you can tell which type of cancer it is. These are some of the most commonly diagnosed testicular cancers in the United States.

Germ cell tumors. More than ninety-percent of cancers of the testicle start in cells known as germ cells. These are the cells that make sperm. The main types of germ cell tumors in the testicles are seminomas and non-seminomas. These types occur about equally. Many testicular cancers contain both seminoma and non-seminoma cells. These mixed germ cell tumors are treated as non-seminomas because they grow and spread like non-seminomas.

-Seminomas. Seminomas tend to grow and spread more slowly than non-seminomas. The two main sub-types of these tumors are classical seminomas and spermatocytic seminomas.

  • Classical seminoma: More than ninety-five percent of seminomas are classical. These usually occur in men between twenty-five and forty-five.
  • Spermatocytic seminoma: This rare type of seminoma tends to occur in older men. The average age is about sixty-five. Spermatocytic tumors tend to grow more slowly and are less likely to spread to other parts of the body than classical seminomas.

Some seminomas can increase blood levels of a protein called human chorionic gonadotropin. HCG can be checked with a simple blood test and is considered a tumor marker for certain types of testicular cancer. It can be used for diagnosis and to check how the patient is responding to treatment.

-Non-seminomas. These types of germ cell tumors usually occur in men between their late teens and early thirties. The four main types of non-seminoma tumors are embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and teratoma. Most tumors are a mix of different types, sometimes with seminoma cells too, but this does not change the treatment of most non-seminoma cancers.

-Embryonal carcinoma. These cells are found in about forty-percent of testicular tumors, but pure embryonal carcinomas occur only three to four percent of the time. When seen under a microscope, these tumors can look like tissues of very early embryos. This type of non-seminoma tends to grow rapidly and spread outside the testicle. Embryonal carcinoma can increase blood levels of a tumor marker protein called alpha-fetoprotein, as well as human chorionic gonadotropin.

-Yolk sac carcinoma. These tumors are so named because their cells look like the yolk sac of an early human embryo. Other names for this cancer include yolk sac tumor, endodermal sinus tumor, infantile embryonal carcinoma, or orchidoblastoma. This is the most common form of testicular cancer in children, especially in infants, but pure yolk sac carcinomas, which are tumors that do not have other types of non-seminoma cells in them, are rare in adults. When they occur in children, these tumors usually are treated successfully. But they are of more concern when they occur in adults, especially if they are pure. Yolk sac carcinomas respond very well to chemotherapy, even if they have spread. This type of tumor almost always increases blood levels of AFP.

-Choriocarcinoma. This is a very rare and fast-growing type of testicular cancer in adults. Pure choriocarcinoma is likely to spread rapidly to other parts of the body, including the lungs, bones, and brain. More often, choriocarcinoma cells are seen with other types of non-seminoma cells in a mixed germ cell tumor. These mixed tumors tend to have a somewhat better outlook than pure choriocarcinomas, although the presence of choriocarcinoma is always a worrisome finding. This type of tumor increases blood levels of human chorionic gonadotropin.

-Teratoma. Teratomas are germ cell tumors with areas that, under a microscope, look like each of the three layers of a developing embryo: the endoderm or innermost layer, mesoderm or middle layer, and ectoderm or outer layer. Pure teratomas of the testicles are rare and do not increase alpha-fetoprotein or human chorionic gonadotropin levels. Most often, teratomas are seen as parts of mixed germ cell tumors.

Secondary Cancers of the Testicles. Different types of cancer that begin in different places of the body and then metastasize to the testicle are called secondary testicular cancers. Lymphoma is the most common form of secondary testicular cancer in men older than fifty, and the outlook depends on the stage at the time of diagnosis. In those males that have acute leukemia, the leukemia cells can often form a tumor in the testicle. With chemotherapy and radiation, most cases are treatable. However, secondary cancers that have spread throughout the body usually have a poor prognosis. Treatment depends solely on the type or types of cancer you have.

Risks and Causes of Testicular Cancer

Risk factors are anything that change your chances of getting a disease or long-term illness like cancer. Some risk factors are controllable, like smoking and diet. Other risk factors, like a person’s gender or family history, cannot be changed. Doing what you can to lower and avoid certain risk factors in life can help you to lower your overall chance of getting cancer. This cannot protect you from getting cancer. Scientists and specialists have studied risk factors related to testicular cancer and have stated that these things do interfere with your risk factors:

  • An undescended testicle
  • A family history of testicular cancer
  • HIV infection
  • Carcinoma in situ of the testicle
  • Having had testicular cancer before
  • Being of a certain race/ethnicity
  • Body size

The direct causes of testicular cancer are unknown, but most cases are linked to other cancers and illnesses.

Undescended Testicles with an Increased Cancer Risk

Having an undescended testicle is one of the main risk factors for developing testicular cancer. Having cryptorchidism or an undescended testicle means that one or both testicles fail to move from the abdomen into the scrotum before birth. Males with cryptorchidism are many times more likely to get testicular cancer than those with normally descended testicles.

Normally, the testicles develop inside the abdomen of the fetus and they go down into the scrotum before birth. But in about three percent of boys, the testicles do not make it all the way down before the child is born. Sometimes one or both testicles stay in the abdomen. In other cases, the testicles start to descend but stay in the groin area.

Most of the time, undescended testicles continue moving down into the scrotum during the child’s first year of life. If the testicle has not descended by the time a child is a year old, it probably is not going to do it on its own. Sometimes a surgical procedure known as orchiopexy is needed to move the testicle down into the scrotum.

The risk of testicular cancer might be a little higher for men whose testicle stayed in the abdomen as opposed to one that has descended at least partway. If cancer does develop, it is usually in the undescended testicle, but about one out of four cases occur in the normally descended testicle. Because of this, some doctors conclude that cryptorchidism does not actually cause testicular cancer, but that there is something else that leads to both testicular cancer and abnormal positioning of one or both testicles.

Orchiopexy may reduce the risk of testicular cancer if it is done when a child is younger, but it is not as clear if it is helpful if the child is older. The best time to do this surgery is not clear. Experts in the United States recommend that orchiopexy is done soon after the child’s first birthday for reasons that are not related to cancer.

The Signs and Symptoms of Testicular Cancer

Many symptoms and lumps that appear in the testicles are not related to cancer, but other medical issues. Inflammation of the testicle or epididymis can cause swelling, pain and lumps, which can be linked to bacterial and viral infections. Many men with testicular cancer have no symptoms at all and the cancer is found during routine exams. If you experience any of these symptoms, contact your doctor right away to schedule an appointment for testing.

Lump or swelling in the testicle. Most often, the first symptom of testicular cancer is a lump on the testicle, or the testicle becomes swollen or larger. It is normal for one testicle to be slightly larger than the other, and for one to hang lower than the other. Some testicular tumors might cause pain, but most of the time they do not. Men with testicular cancer can also have a feeling of heaviness or aching in the lower abdomen or scrotum.

Breast growth or soreness. In rare cases, germ cell tumors can make breasts grow or become sore. This happens because certain types of germ cell tumors secrete high levels of a hormone called human chorionic gonadotropin (HCG), which stimulates breast development. Some Leydig cell tumors can make estrogens (female sex hormones), which can cause breast growth or loss of sexual desire.

Early puberty in boys. Some Leydig cell tumors can make androgens (male sex hormones). Androgen-producing tumors may not cause any symptoms in men, but in boys they can cause signs of puberty at an abnormally early age, such as a deepening voice and the growth of facial and body hair.

Watch for these common symptoms:

  • Low back pain, from cancer, spread to the lymph nodes, which are bean-sized collections of immune cells, in back of the belly.
  • Shortness of breath, chest pain, or a cough– even coughing up blood may develop from cancer spread in the lungs.
  • Belly pain, either from enlarged lymph nodes or because cancer has spread to the liver.
  • Headaches or confusion, from cancer, spread in the brain.

Questions to Ask your Doctor about Testicular Cancer

As you go through the process of diagnosis, treatment, and life after testicular cancer, you may have questions for your health care provider. Ask any question no matter how small! Here are questions for you to consider:

  • What kind of testicular cancer do I have?
  • Has cancer spread beyond my testicle?
  • What is the stage of my cancer? What does this mean for me?
  • Will I need other tests before we can decide on treatment?
  • Will I need to see other doctors?
  • How much experience do you have treating this type of cancer?
  • What are my treatment choices? What do you recommend? Why?
  • Do I need a retroperitoneal lymph node dissection? If so, how many have you done?
  • What should I do to be ready for treatment?
  • How long will treatment last? What will it be like? Where will it be done?
  • What risks or possible side effects can I expect from my treatment?
  • How long will it take me to recover from treatment?
  • How soon after treatment can I have sex?
  • What are the chances I will become infertile? Should I bank sperm?
  • What are the chances that the cancer will come back? What will we do if that happens?
  • Does one type of treatment reduce the risk of recurrence more than another?
  • Should I get a second opinion before I start treatment, and when would a second opinion be helpful to me?
  • What type of follow-up will I need after treatment?

If you suspect that you have testicular cancer or another issue affecting your testicles, do not hesitate to contact your doctor and make an appointment for further testing and diagnosis.

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