What is Testicular Cancer?

As its name infers, testicular cancer translates to mean “cancer of the testes.” The term testes is actually a short form of the word testicles, which are a pair of organs that form an important part of the greater male reproductive anatomy. Males have two testicles that are housed inside a loose sack underneath the penis. This sack is called the scrotum. The testes perform two critical functions for a mature male: they produce male sex hormones to keep the body balanced, and they also produce sperm, which is used in reproduction.

Testicular cancer is considered to be a relatively rare form of cancer, with one notable exception. For males between the ages of 15 and 45, it is considered the most common form of cancer. Cases of testicular cancer have been reported in males as early as infancy. Testicular cancer represents one to two percent of all diagnosed tumors for infants and very young boys. It makes up approximately one percent of cancers diagnosed for males older than mid-childhood.

However, rates of testicular cancer are increasing from year to year. Medical experts state that rates have doubled over the last three decades. At this point, researchers are not sure why this increase is. However, current estimates indicate an American male has a one in 268th chance of contracting testicular cancer over his lifetime.

This works out to between one and six cases diagnosed per every 100,000 male persons, or about 7,500 to 8,500 newly diagnosed cases per year. The good news is that testicular cancer is considered highly treatable and curable for patients.

Assuming early detection and diagnosis and prompt treatment, the following survival statistics currently apply:

  • Cancer is in the testes with only a 99 percent survival rate.
  • Cancer reaches nearby lymph nodes 96 percent survival rate.
  • Cancer reaches more distant lymph glands and organs 71 percent survival rate.

Every year, around 350 patients succumb to testicular cancer (a risk rate of about one in every 300,000 men). However, close to 200,000 men have successfully survived testicular cancer. Cyclist Lance Armstrong is one of the most prominent and well-known testicular cancer survivors. Armstrong beat testicular cancer once, but then his cancer recurred and spread to his lymph nodes and lungs and then his brain. He was then able to beat it back a second time.

Armstrong founded the Lance Armstrong Foundation (LAF) following his personal battle. This non-profit charitable organization funds research, public education, advocacy, and outreach to cancer patients and survivors, including but not limited to testicular cancer.

Today, the foundation operates independently of Armstrong as the Livestrong Foundation. It continues its mission to help newly diagnosed and existing cancer patients, loved ones, and survivors cope with the presence of cancer in their lives.

History

It can be shocking to realize that testicular cancer patients of past decades were far more likely to succumb to their disease than to recover. Before 1970, an estimated 90 percent of all testicular cancer patients died, despite aggressive treatment using the most advanced techniques of the day. The physician credited with the development of chemotherapy (“chemical therapy”) was a German chemist by the name of Paul Ehrlich. Ehrlich’s research focused on developing a class of drugs designed to target and treat the infection. When Ehrlich was conducting his research, the treatment of the day for cancer was radiotherapy (radiation).

This continued until the mid-1960s, when researchers discovered patients enjoyed an improved prognosis when the treatment approach combined radiotherapy with chemotherapy and surgery. However, in the early 1960s, there was no such thing as medical oncology (or the specific study of cancer diagnosis, treatment, and remission). Chemotherapy itself was considered so poisonous that its use relegated the physicians treating cancer to a lesser status among their medical peers. Some hospitals did not even want the chemotherapy drugs on their premises.

Yale University was the first medical institution that permitted human patients to receive chemotherapy. This decision was made under one of the so-called “founding fathers” of chemotherapy-based cancer treatment, Dr. Paul Calabresi.

However, Dr. Calabresi was such a controversial figure that he was eventually forced to depart Yale over his continued use of chemotherapy drugs on cancer patients. While antagonism towards chemotherapy was still strong, in 1971, then-President Richard Nixon signed the National Cancer Act into law. This Act was considered the official national launch of the “war on cancer.”

This Act was especially significant in the history of cancer research because cancer had become the second leading cause of death nationwide by then. The Act also established the National Cancer Institute (NCI) and gave it the authority to outline and institute a National Cancer Program (NCP).

The NCP was subject to review by the National Cancer Advisory Board (NCAB), a group of 18 presidential appointees who were tasked with overseeing the NCI’s activities.

The NCAB reported to the President’s Cancer Panel (NCP), who in turn reported directly to the President with an annual report as well as breaking news.

With the full support of the federal government under its wings, the NCI swiftly got to work creating cancer centers and programs, training a new generation of cancer physicians and researchers, establishing an international cancer knowledge and research bank, and collaborating with public and private agencies to expand cancer research and develop new viable treatment options.

While the NCI was very publicly mobilizing to declare its war on cancer, much more quietly, a physician and bio-physics researcher named Dr. Barnett Rosenberg stumbled upon a discovery that in time became the anti-testicular cancer drug Cisplatin.

At first, this new chemotherapy drug was especially controversial because it was based on a heavy metal, platinum. Platinum, like other heavy metals, can be highly toxic if ingested.

But after several successful clinical trial studies showed Cisplatin could successfully reduce cell-reproduction and attack tumors, the U.S. Food and Drug Administration (FDA) approved Cisplatin as the first anti-cancer drug explicitly designed to treat cancers of the testes and bladder.

However, Cisplatin was known to be toxic to the kidneys in high doses. For this reason, today, Cisplatin is most commonly combined with other medications when used to treat testicular cancer. This combination of use decreases the overall toxicity of Cisplatin-based chemotherapy while improving patient remission outcomes.

Today, literally millions of testicular cancer survivors owe their lives to Dr. Rosenberg’s discovery.

This is also particularly good news for patients with testicular cancer and their loved ones, as many other cancers have not fared so well to date in terms of finding their own targeted drugs, even with the vigorous and proactive advocacy provided by the NCI.

Testicular cancer is one of only a handful of cancers with such a positive prognosis and high recovery and remission rate.

Today, the discovery and development of a targeted medication, Cisplatin, is recognized to be the key to the unprecedented turnaround on the nationwide war against testicular cancer.

Risk Factors

While researchers are still not clear what actually causes testicular cancer to form in the male body, several risk factors for testicular cancer have been identified as follows:

  • Family history of testicular cancer, especially in a father, uncle, or brother.
  • When one testicle does not descend down into the scrotum (called “cryptorchidism”) at or after birth.
  • Being between the ages of 15 and 45.
  • Being Caucasian is currently the highest-risk ethnicity, followed by Asian, American-Indian, and black men.
  • Being a United States citizen. American men have the highest incidence of testicular cancer, followed by European men. Rates fall drastically for men living in Asia and Africa.
  • When one testicle does not develop normally.
  • Prior diagnosis of Klinefelter Syndrome (being born with one extra X-chromosome).
  • Prior diagnosis of Carcinoma in situ translates to “cancer in place,” or a type of abnormal cell growth in the testes that is considered “Stage Zero cancer.”
  • Prior diagnosis of infertility or atrophy of one or both testicles.
  • Prior diagnosis of testicular cancer (as in a recurrence).
  • Prior diagnosis of testicular cancer in one testicle only.
  • Prior diagnosis of HIV or AIDS.
  • There is also a possible correlation with height, with tall men being slightly more at risk of developing testicular cancer in the future. However, only a handful of studies have highlighted this potential risk factor, with the remainder delivering neutral results.

Researchers continue to investigate a particularly controversial theory in some circles that prior injury to the groin area or generalized high-intensity physical activity may raise the risk of developing testicular cancer in the future.

To date, insufficient evidence has been found to establish a direct link.

What may be more likely is that athletes (such as in the case of Lance Armstrong, testicular cancer’s most prominent advocate) are more likely to delay seeking medical care due to a demanding schedule, which can delay diagnosis and treatment and raise the risk commensurately. Testicular cancer can develop in just one or in both testicles.

In cases where the cancer forms in just one testicle, the patient has a three to four percent chance of developing cancer in the other testicle, even after the first testicle has been declared completely cancer-free.

Screening

The goal of all cancer screenings, including testicular cancer, is to detect the presence of cancer before any symptoms become noticeable. The earlier testicular cancer is discovered and diagnosed, the more positive the patient’s prognosis becomes.

To date, the U.S. Preventative Services Task Force has not recommended that any special screening protocols be put in place for the early screening of testicular cancer. This is due to the low incidence of testicular cancer nationwide.

While this may be frustrating for patients and loved ones who are struggling with testicular cancer, the Task Force also factors in several risks that can be caused by conducting preventative screenings.

These risks include false-positive test results (which can make a person think they have testicular cancer when in fact they do not), inadvertent physical harm caused by testing protocols, increased anxiety and stress as a result of undergoing screening tests, and the likelihood that the benefits of screening outweigh these risks.

In the case of testicular cancer, the benefits were found to be small to non-existent, which did not justify exposing individuals to the potential risks of early screening.

However, a self-test is recommended for all males beginning in adolescence and continuing through adulthood. The self-exam is similar to that recommended for women with breast cancer.

The screening can be done at home by the male and requires no special training:

  • With one hand, hold the penis away from the scrotum.
  • Gently grasp the first testicle between the thumb and fingers.
  • Next, gently roll the testicle between your thumb and fingers.
  • Be aware that one testicle is usually slightly larger than the other – this is normal.
  • Pay careful attention to any lumps, bumps, nodules, changes in consistency or size, or tenderness/pain.
  • If you find anything that is of concern during the self-exam, schedule an appointment with a physician.

This self-exam is most helpful when done regularly. The current recommendation is to do the self-exam once per month. The exam is best done after bathing since this is when the scrotal skin will be the loosest and most relaxed. No current data exists to indicate whether performing a self-exam for testicular cancer is able to lower the risks or speed up detection and diagnosis.

However, one benefit of performing this optional self-exam is that it builds up familiarity with the testes so any abnormalities can be more readily discovered.

In cases where a patient may have a family medical history where a close male relative (father, brother, uncle) has been diagnosed with testicular cancer, a monthly self-exam may be prescribed.

Symptoms

Testicular cancer may be present without any signs or symptoms. This is called “carcinoma in situ” or “Stage Zero cancer” (see Testicular Cancer Risk Factors here).

Most cases of testicular cancer are detected purely by accident when the patient or a partner discovers some discomfort or the presence of a physical change like a lump in the testes.

Sometimes, testicular cancer is also detected when the patient visits the doctor for another reason, such as an injury to the groin area following athletic or sports activities.

It can be very helpful to learn about the early symptoms and warning signs that can indicate the onset of testicular cancer:

  • Presence of a lump, bump, hardness, consistency change, or size change in one or both testes (lump does not have to be painful to be a cause for concern).
  • Feeling of discomfort, heaviness, pain, swelling, or similar issue in the testes.
  • Feeling of bloat or ache in the groin area.
  • The presence of scrotal fluid buildup causes the area to appear enlarged or swollen.
  • Breast enlargement, discomfort, or tenderness.
  • Back or abdominal pain cannot be explained for other reasons.
  • Early-onset of puberty.
  • Coughing, chest pain, or shortness of breath (in more advanced cases).

While testicular cancer typically presents in just one testicle, it can be present in both testicles as well.

Statistically speaking, most testicular cancer patients will initially visit a physician due to a consistency change, hardness, or lump in the testes. About 40 percent may also report abdominal, anal, or groin area swelling, discomfort, or fullness. About 10 percent of patients do not catch the signs of testicular cancer until it reaches more advanced stages.

These patients will present with coughing, bloody sputum, chest pain, difficulty breathing, unexplained weight loss, nausea and vomiting, loss of bone density, bone or nerve pain, leg swelling, and/or pain in the low back area.

These are all signs of a case of testicular cancer that has spread (metastasized) beyond the testes and into the surrounding lymph nodes, glands, and/or organs.

If any symptoms or warning signs are detected, especially if there is a family medical history of testicular cancer or if the patient is between the ages of 15 and 45, it is critically important to make an appointment with a physician right away.

The early testicular cancer is diagnosed, the better the patient’s prognosis becomes.

Diagnosis and Stages

Diagnosing testicular cancer begins with a presentation of personal symptoms.

The physician will want to take a complete personal and family medical history, paying close attention to any cases of testicular cancer in close male relatives. Then, the doctor will perform a physical exam with a focus on the groin and scrotal area.

The physical exam will include the steps in a testicular self-exam and an examination of lymph node sites throughout the body (armpits, neck area, abdomen, groin) to check if there is any swelling or tenderness. The breasts will be palpated to check for swelling or tenderness as well. In addition, the doctor may ask to listen to your breathing to check for any lung issues.

Following the physical exam, if sufficient information indicates further testing for testicular cancer may be needed, the next step is usually a groin-area ultrasound test.

  • Ultrasound test

An ultrasound test is painless and non-invasive, which makes it a great first step test.

A gel will be applied to the groin and scrotal areas, and the ultrasound technician will use a wand to direct sound waves to make an image of the testicles. This image can be analyzed to detect lumps, bumps, or other abnormalities that may indicate testicular cancer.

If the ultrasound test returns sufficient evidence of testicular cancer in one or both testicles, the next step will be a blood test.

  • CBC (complete blood count and blood chemistry) test

A CBC delivers a complete picture of what is going on with your blood. It will look for markers called “tumor markers” that are considered to be early warning signs that one or more tumors may be present. Usually, the tumor markers are proteins or hormones.

This is not considered a definitive test, however, since not all cases of testicular cancer will deliver markers.

  • CT (computed tomography) or MRI (magnetic resonance imaging) tests

These tests can provide greater detail of internal organ and tissue structure. A CT scan can also deliver a fine needle biopsy of suspicious tissue without the risks of doing a traditional biopsy (see below here).

  • PET (positron emission tomography) scan test

This test looks specifically at small areas of tissue that may contain cancer. It is a minimally invasive test that uses a special radioactive sugar solution to highlight areas of cancer inside the body during the test. CT and PET scan tests are often done together to generate maximum diagnostic detail prior to scheduling surgery.

  • Chest X-ray and/or bone scan tests

These tests are typically only ordered if it is suspected that testicular cancer has spread to the lungs and/or bones.

  • Scrotal biopsy test

A biopsy is very rarely ordered because it presents a risk of the cancer spreading. This risk is due to the proximity between the testes and the surrounding lymph nodes. So instead, the doctor will usually order surgery, and a biopsy can be done during surgery.

  • Testicular surgery

If a lump or bump is found and testing confirms that it may be a cancerous tumor, surgery is typically performed to remove it. This procedure is called radical inguinal orchiectomy, and it may also require removing the entire affected testicle. A biopsy can be done after surgery using the tissue that was removed. This is a much safer method of confirming testicular cancer than doing an advanced biopsy. There is also another method of doing a biopsy during surgery.

If it is still not clear whether the abnormality is testicular cancer, the surgeon can begin the procedure in the operating room and simply visually examine the affected testicle first.

Any suspicious matter can be biopsied and sent immediately for testing to a lab while the patient is still in surgery. If testicular cancer is found, the full surgical removal of the testicle and surrounding material can be done. If cancer is not found, the testicle can be restored to its original place with a plan to pursue an alternate diagnosis and treatment plan for whatever may be causing the issue.

  • Fertility planning

Once a diagnosis of testicular cancer is confirmed, one more step should be taken before proceeding to treatment.

Since treatment can render the patient infertile, if there is still a desire to start a family, the patient should be advised of options for banking sperm towards that goal BEFORE treatment begins.

Treatments and Drugs

Treating testicular cancer begins with a process physicians call “staging.” Staging refers to determining how it is progressing inside the body.

The staging process is called TNMS as follows:

  • T stands for tumor (tumor means primary or main tumor).
  • N stands for lymph nodes (whether cancer has reached the lymph nodes).
  • M stands for metastasized (how far cancer has spread).
  • S stands for serum (blood tumor markers such as proteins or hormones).

Regarding assigning a stage, the numbers zero through four are used, with zero being the least severe and four being the most severe. So when a diagnosis is issued, it will follow a format that factors in each element. This is important because the recommended treatment will be closely based on the staging detail. For instance, stages one through three can also be designated as A, B, or C depending on how invasive cancer has become in a given area. There are several options for pursuing treatment depending on the designated stage and the patient’s own wishes.

Since surgery is often performed during the diagnostic stage, the treatment itself often focuses on medications designed to reduce and, ultimately, eliminate any remaining cancer left in the body.

These options for treatment are commonly prescribed:

  • Additional surgery (lymph nodes, et al)

Sometimes additional surgery may be ordered to remove nearby lymph nodes as well to further reduce the risk of any remaining cancer spreading or recurring.

A “watch and wait” approach may be recommended for the very early stages of testicular cancer, where no medication (chemotherapy, radiation) is ordered. This is often called the “Active Surveillance” approach. Some patients feel comfortable with this option, while others may not.

For patients who want a more proactive and aggressive treatment approach or whose staging recommends this type of approach, chemotherapy and/or radiation are the most frequently prescribed options.

Chemotherapy can be done alone or in conjunction with radiation.

In most cases where both treatments are prescribed, a patient will complete a course in one treatment before beginning a course in the other treatment.

  • Chemotherapy

Chemotherapy today often uses more than one drug to combat cancer from different approaches. It can be customized to the patient’s needs. Chemotherapy often comes with various side effects depending on which medication(s) are prescribed.

The goal is to use the medications to kill all the cancer cells.

NOTE: Because chemotherapy can render the patient infertile, it is critical to provide counseling on family planning and offer options such as sperm banking before proceeding!

  • Radiation

Radiation is basically just focused on energy, such as X-ray beams. The beams are aimed at the area(s) where cancer has been detected. A common area where beams may be focused on is the scrotum. Side effects tend to range from skin itching and redness to irritation and general feelings of fatigue.

NOTE: Radiation can also render the patient infertile, so it is critical to provide counseling on family planning and offer options such as sperm banking before proceeding!

Coping and Support

The internet has made finding sources of support for testicular cancer patients and loved ones much easier. One great way to find support is through support groups. These may be local or online.

Often treating hospitals will offer cancer support groups, although these may be open to patients with a wide range of cancer diagnoses. Online support groups are another good option. Many nonprofits offer online support boards, forums, and chat groups that are free to join. Some nonprofit organizations also offer financial support, education, and partner or family support.

It is also possible to find education and support webinars, podcasts, videos, and books online that can help patients, lay carers, partners, and loved ones prepare for each stage of treatment. In addition, some organizations offer toll-free support hotlines that provide information and guidance on various topics, from finances to feelings.

From navigating the complexities of submitting insurance claims for reimbursement to planning a nausea-friendly daily menu during chemotherapy treatment, these resources can help alleviate the burden of learning to cope with a cancer diagnosis.

One of the most important online support resources is information about ongoing research and clinical trials for testicular cancer patients.

While the overall prognosis for this type of cancer tends to be higher than the norm, this also depends on each patient’s personal health and medical history and the stage the cancer was in when it was diagnosed. In addition, participating in clinical trials can offer access to experimental medications and approaches not yet available to the general public.

These resources can help educate patients and loved ones about the types and stages of testicular cancer, how it can manifest and spread, and the steps for diagnosis and treatment.

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The information on this website has not been evaluated by the Food & Drug Administration or any other medical body. We do not aim to diagnose, treat, cure or prevent any illness or disease. Information is shared for educational purposes only. You must consult your doctor before acting on any content on this website, especially if you are pregnant, nursing, taking medication, or have a medical condition.

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