Testicular Cancer

Experts don't know what causes testicular cancer. But some problems, such as having an undescended testicle or Klinefelter syndrome, may increase a man's risk for this cancer. Most men who get testicular cancer don't have any risk factors.

Some things may increase your chances of getting testicular cancer. These risk factors include:

• An undescended testicle. This is a testicle that has not moved down (descended) from the abdomen into the scrotum.
• Klinefelter syndrome. This is a genetic condition that affects males.
• A personal or family history of testicular cancer.

Most men who get testicular cancer don't have any known risk factors.

Common symptoms of testicular cancer include:

• A swelling and/or lump in one or both of the testes. You may or may not have pain in the testes or scrotum.
• A heavy feeling in the scrotum.
• A dull pain or feeling of pressure in the lower belly or groin.

Sometimes these symptoms can be caused by other problems, such as a hydrocele or epididymitis.

Symptoms of advanced testicular cancer

Testicular cancer that has spread (metastasized) beyond the testicles and regional lymph nodes to other organs may cause other symptoms depending on the area of the body affected. Symptoms of late-stage testicular cancer may include:

• Dull pain in the lower back and belly.
• Lack of energy, sweating for no clear reason, fever or a general feeling of illness.
• Shortness of breath, coughing or chest pain.
• Headache or confusion.

Most men find testicular cancer themselves by chance or during a self-exam. Or a doctor may find it during a routine physical exam.

Because other problems can cause symptoms like those of testicular cancer, your doctor may order tests to find out if you have another problem. These tests may include blood tests and imaging tests of the testicles such as an ultrasound or a CT scan.

If testicular cancer is suspected, your doctor will do some testing. Tests may include:

• Testicular ultrasound. This test may be used to rule out other possible causes of an enlarged or painful testicle before the testicle is removed.
• Blood tests. These are often done to measure the levels of these tumor markers in your blood:
  • Alpha fetoprotein (AFP)
  • Beta human chorionic gonadotropin (beta-hCG)
  • Lactate dehydrogenase (LDH)
• Imaging tests, such as chest X-ray and CT scan of the chest, abdomen, and pelvis.

If the ultrasound and blood tests suggest testicular cancer, a doctor will surgically remove your affected testicle. It will be checked for cancer. If cancer is found, you may have other tests, such as X-rays, CT scans, or MRIs, to find out the stage of your cancer.

Ongoing exams and tests   

During your treatment for testicular cancer, your doctor will schedule a thorough follow-up program to monitor your recovery, especially if you are doing surveillance. These exams and tests may continue for several years. In addition to physical exams, your follow-up program may include:

• Periodic imaging tests such as chest X-rays or CT scans.
• Blood tests to check the levels of tumor markers in your blood. Tumor marker levels that are stable or that increase after you've had treatment may be a sign of more cancer.

Early detection

Testicular self-exam may help detect testicular cancer. These cancers may be first found as a painless lump or an enlarged testicle during a self-exam.

Some doctors recommend that men ages 15 to 40 perform monthly testicular self-exams (TSE). But many doctors don't believe that monthly TSE is needed for men who are at average risk for testicular cancer. Monthly TSE may be recommended for men who are at high risk for this kind of cancer. This includes men who have a history of an undescended testicle or a family or personal history of testicular cancer.

Most testicular cancers are either seminomas or nonseminomas. The main difference between the two is that seminomas grow and spread slowly and respond to radiation therapy. Nonseminomas grow and spread more quickly than seminomas. They don't respond to radiation.

Seminomas

Seminomas are the kind of testicular cancer that grow and spread slowly. After surgery, treatments may include:

• Surveillance.
• Radiation therapy.
• Chemotherapy.

For seminomas that are more advanced (stage II or stage III cancers), treatments begin with surgery (orchiectomy) and may include radiation, chemotherapy or combination chemotherapy. After chemotherapy, tissue masses that remain may need to be removed with surgery.

Nonseminomas

Nonseminomas are the kind of testicular cancer that grow and spread more quickly than seminomas. They don't respond well to radiation therapy. After surgery, treatments may include:

• Surveillance.
• Chemotherapy.
• Surgery to remove lymph nodes.

For nonseminomas that are more advanced (stage II or stage III cancers), treatments begin with surgery (orchiectomy) and may include surgery to remove lymph nodes, chemotherapy or combination chemotherapy. After chemotherapy, any tissue masses that remain will be removed with surgery, if possible.

If you are diagnosed with testicular cancer, your doctor will explain what type of cancer you have, whether it has spread beyond the testicle (metastasized), and the potential for curing it. You and your doctor will discuss your treatment options and possible outcomes of those treatments. Testicular cancer is highly curable, especially when it's diagnosed at an early stage.

If the cancer isn't treated during its early stages, it may spread (metastasize) to the lymph nodes and to the lungs, liver, brain, and bones. But often testicular cancer that has spread can still be treated successfully.

Some cancer treatments raise your risk of infertility. Unless you are sure you won't want to father a child in the future, talk to your doctor about sperm banking before any treatment for testicular cancer.

Treatment begins with surgery (orchiectomy) to remove the affected testicle. After surgery, depending on which type of cancer cells are present and whether your cancer has spread to other areas of your body (stage), you may need only surveillance. Or you may need further treatment.

Treatment choices

If your cancer was found early, you may have a choice about further treatment. Talk with your doctor about the risks and possible side effects of each treatment option.

Surveillance

Some early-stage testicular cancers are successfully managed with a "wait-and-see" approach after surgery. This option involves frequent exams as well as blood tests and imaging tests to watch your condition. Surveillance may let you avoid the side effects from other follow-up treatments, such as chemotherapy and radiation therapy.

Follow-up care

After treatment, it is important to receive follow-up care. This care may lead to early identification and management of cancer that comes back. Your regular follow-up program may include:

• Physical exams.
• Imaging tests, including X-rays, CT scans and MRIs.
• Blood tests to check tumor marker levels. Stable or increasing tumor marker levels after treatment may mean that your cancer is still present or has returned. You may need more treatment.

A diagnosis of testicular cancer means that you will be seeing your doctor regularly for years to come. It's a good idea to build a relationship based on trust and the sharing of information. Your doctor may give you some advice on changes to make in your life to help treatment succeed.