Testicular Cancer

What are the testicles?

The testicles are the male sex glands and are part of the male reproductive system. Testicles are also called testes or gonads. They are located behind the penis in a pouch of skin called the scrotum.

The testicles produce several male hormones, including testosterone and sperm. The hormones control the development of the reproductive organs, as well as other male characteristics - body and facial hair, low voice, and wide shoulders.

What is testicular cancer?

Cancer that develops in a testicle is called testicular cancer. The American Cancer Society estimates that in the year 2007 about 7,920 new cases of testicular cancer will be diagnosed in the United States. An estimated 380 men will die of testicular cancer in the year 2007.

Testicular cancer is one of the most curable forms of cancer.

When testicular cancer spreads, the cancer cells are carried by blood or by lymph, an almost colorless fluid produced by tissues all over the body. The fluid passes through lymph nodes, which filter out bacteria and other abnormal substances such as cancer cells.

What are the symptoms of testicular cancer?

The following are the most common symptoms for testicular cancer. However, each individual may experience symptoms differently. The National Cancer Institute (NCI) suggests that a man see a physician if any of the following symptoms lasts two weeks or longer:

• lump in either testicle
• enlargement of a testicle
• feeling of heaviness in the scrotum
• dull ache in the lower abdomen or in the groin
• sudden collection of fluid in the scrotum
• pain or discomfort in a testicle or in the scrotum
• enlargement or tenderness of the breasts

The symptoms of testicular cancer may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

What causes testicular cancer?

The exact cause of testicular cancer is not known. However, there are a number of factors that increase the risk for the disease.

What are the risk factors for testicular cancer?

The exact cause of this disease is unknown. However, research does show that some men are more likely than others to develop testicular cancer. Possible risk factors include the following:

• age
  Testicular cancer is the most common form of cancer in young men between the ages of 20 and 54.
• cryptorchidism
  Undescended testicle(s) is the main risk factor for this cancer.
• Klinefelter’s syndrome - a sex chromosome disorder.
• family history
• personal history of cancer in the other testicle
• race and ethnicity
  The rate of testicular cancer is higher in Caucasians than in other populations.
• HIV infection
• men whose mother took a hormone called DES (diethylstilbestrol) during pregnancy to prevent miscarriage

Can testicular cancer be prevented?

Currently, there is not a method for preventing the disease because:

• currently, there is not a known cause for the disease.
• many of the suggested risk factors are those that cannot be changed.
• many men with testicular cancer do not have the suggested risk factors.

However, testicular self-examination can improve the chances of finding a cancerous tumor early.

Testicular Self-Examination (TSE) Procedure

The best time for testicular self-examination is just after a warm bath or shower when the scrotal tissue is more relaxed. While standing in front of a mirror, place the thumbs on the front side of the testicle and support it with the index and middle fingers of both hands. Gently roll the testicle between the fingers and thumbs. Feel for lumps, hardness, or thickness. Compare the feelings in each testicle. If you find a lump, see your physician as soon as possible. Testicular self examination is not a substitute for routine physical examinations by your physician.

How is testicular cancer diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for testicular cancer may include the following:

• ultrasound - a diagnostic technique that uses high-frequency sound waves to create an image of the internal organs.
• blood tests - assessment of blood samples to check for increased levels of certain proteins and enzymes (also called serum tumor markers) to determine if cancerous cells are present, or to determine how much cancer is present. Tumor markers that may be used to detect testicular cancer include alpha-fetoprotein (AFP), lactase dehydrogenase (LDH), and human chorionic gonadotropin (HCG).
• biopsy - a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present.

When testicular tumors are present, the entire tumor, as well as the testicle and spermatic cord, may be removed to prevent the spread of cancerous cells through the blood and lymph systems.

Staging of testicular cancer:

When testicular cancer is diagnosed, tests will be performed to determine how much cancer is present, and if the cancer has spread from the testis to other parts of the body. This is called staging, and is an important step toward planning a treatment program.

As defined by the National Cancer Institute (NCI), the stages of testicular cancer include the following:

Stage I	the cancer is limited to the testis
Stage II	the cancer involves the testis and has spread to lymph nodes in the lower abdomen
Stage III	the cancer has spread to lymph nodes outside of the lower abdomen, to the lungs, or to another organ

Procedures for determining stage include the following:

• computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• lymphangiography - images of the lymph system in which dye is injected into a lymph vessel to improve images.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

In addition to these imaging procedures, chest x-rays, bone scans, or other scans may be requested.

Treatment for testicular cancer:

Specific treatment for testicular cancer will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

There are several types of treatments for testicular cancer, including:

• radical inguinal orchiectomy surgery (to remove the tumor and the testicle)
• external radiation (external beam therapy) - a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.
• chemotherapy - the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual.
• high-dose chemotherapy followed by stem cell transplantation - removing stem cells from the patient's bone marrow or blood stream before chemotherapy and re-infusing them into the patient to help in production of healthy blood cells.

Various treatments for testicular cancer may affect fertility and sexual function. Discuss any concerns with your physician.

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