Testicular Cancer: Questions and Answers - National = Cancer Institute

Page=20 Options

Print=20 This Page

E-Mail=20 This = Document

View/Print=20 PDF

	Search Fact=20 Sheets by Keyword

	View Fact=20 Sheets by Topic


	Cancer = Type Risk=20 Factors and Possible Causes Preventi= on Detection= /Diagnosis Cancer=20 Therapy Support/Cop= ing/Resources Tobacco/Smo= king=20 Cessation Informa= tion=20 Sources About=20 NCI Cancer=20 Advances In Focus En=20 espa=C3=B1ol

Questions about=20 cancer?


	1-800-4-CANCER

	LiveHelp=C2=AE= =20 online chat

	Quick=20 Links


	Director's=20 Corner Dictionary of=20 Cancer Terms NCI Drug=20 Dictionary Fu= nding=20 Opportunities NCI=20 Publications Advisory=20 Boards and Groups NIH Calendar = of=20 Events Espa=C3=B1ol

Testicular Cancer: = Questions=20 and Answers

Key Points

Nearly all testicular cancers are one of two general types: seminoma or nonseminoma. Other types are rare (see Question=20 1).=20
This disease occurs most often in men between = the ages=20 of 20 and 39. It accounts for only 1 percent of all = cancers=20 in men (see Question=20 1).=20
Risk factors include having an undescended = testicle, previous testicular cancer, and = a family history of testicular cancer (see = Question=20 2).=20
Symptoms include a lump, swelling, or = enlargement=20 in the testicle; pain or discomfort in a testicle or = in the=20 scrotum; and/or an ache in the lower abdomen, back, or groin (see Question=20 3).=20
Diagnosis generally involves blood tests, ultrasound, and biopsy (see Question=20 4).=20
Treatment can often cure testicular cancer (see Question=20 5), but regular follow-up exams are extremely important = (see Question=20 6).

What is testicular = cancer?=20

Testicular cancer is a disease in which cells become malignant (cancerous) in one or both testicles. =

The testicles (also called testes or gonads) are a pair of male sex glands. They produce and store sperm and are the main source of testosterone (male hormones) in men. These hormones control the = development=20 of the reproductive organs and other male physical characteristics. = The=20 testicles are located under the penis in a sac-like pouch called the scrotum. =

Based on the characteristics of the cells in the tumor, testicular cancers are classified as = seminomas or=20 nonseminomas. Other types of cancer that arise in the = testicles=20 are rare and are not described here. Seminomas may be one = of three=20 types: classic, anaplastic, or spermatocytic. Types of=20 nonseminomas include choriocarcinoma, embryonal carcinoma, teratoma, and yolk sac tumors. Testicular tumors = may=20 contain both seminoma and nonseminoma cells.

Testicular cancer accounts for only 1 percent of all = cancers in=20 men in the United States. About 8,000 men are diagnosed = with=20 testicular cancer, and about 390 men die of this disease = each year=20 (1). Testicular cancer occurs most often in men between = the ages=20 of 20 and 39, and is the most common form of cancer in men = between=20 the ages of 15 and 34. It is most common in white men, = especially=20 those of Scandinavian descent. The testicular cancer rate = has more=20 than doubled among white men in the past 40 years, but has = only=20 recently begun to increase among black men. The reason for = the=20 racial differences in incidence is not known.
What are the risk factors for = testicular=20 cancer?

The exact causes of testicular cancer are not known. = However,=20 studies have shown that several factors increase a = man=E2=80=99s chance of=20 developing this disease.
- Undescended testicle (cryptorchidism): Normally, the = testicles=20 descend from inside the abdomen into the scrotum before = birth.=20 The risk of testicular cancer is increased in males with = a=20 testicle that does not move down into the scrotum. This = risk=20 does not change even after surgery to move the testicle into the scrotum. = The=20 increased risk applies to both testicles.
- Congenital abnormalities: Men born = with=20 abnormalities of the testicles, penis, or kidneys, as well as those with inguinal hernia = (hernia=20 in the groin area, where the thigh meets the abdomen), = may be at=20 increased risk.=20
- History of testicular cancer: Men = who have=20 had testicular cancer are at increased risk of = developing cancer=20 in the other testicle.=20
- Family history of testicular cancer: = The=20 risk for testicular cancer is greater in men whose = brother or=20 father has had the disease.=20
How is testicular cancer = detected? What are=20 symptoms of testicular cancer?

Most testicular cancers are found by men themselves. = Also,=20 doctors generally examine the testicles during routine = physical=20 exams. Between regular checkups, if a man notices anything = unusual=20 about his testicles, he should talk with his doctor. Men = should=20 see a doctor if they notice any of the following = symptoms:
- a painless lump or swelling in a testicle=20
- pain or discomfort in a testicle or in the scrotum=20
- any enlargement of a testicle or change in the way = it feels=20
- a feeling of heaviness in the scrotum=20
- a dull ache in the lower abdomen, back, or groin=20
- a sudden collection of fluid in the scrotum
These symptoms can be caused by cancer or by other = conditions.=20 It is important to see a doctor to determine the cause of = any of=20 these symptoms.
How is testicular cancer diagnosed? =

To help find the cause of symptoms, the doctor = evaluates a=20 man=E2=80=99s general health. The doctor also performs a = physical exam and=20 may order laboratory and diagnostic tests. These tests=20 include:
- Blood tests that measure the levels = of tumor markers. Tumor markers are substances = often=20 found in higher-than-normal amounts when cancer is = present.=20 Tumor markers such as alpha-fetoprotein (AFP), Beta-human chorionic gonadotropin (=C3=9FHCG), = and lactate dehydrogenase (LDH) may suggest the presence of a testicular = tumor,=20 even if it is too small to be detected by physical exams = or imaging tests.=20
- Ultrasound, a test in which = high-frequency=20 sound waves are bounced off internal organs and tissues. Their echoes produce a picture called = a sonogram. Ultrasound of the scrotum can show = the=20 presence and size of a mass in the testicle. It is also = helpful=20 in ruling out other conditions, such as swelling due to = infection or a collection of fluid unrelated = to=20 cancer.=20
- Biopsy (microscopic examination of testicular tissue = by a pathologist) to determine whether cancer is = present.=20 In nearly all cases of suspected cancer, the entire = affected=20 testicle is removed through an incision in the groin. This procedure is = called=20 radical inguinal orchiectomy. In rare cases (for = example, when=20 a man has only one testicle), the surgeon performs an inguinal biopsy, removing = a sample=20 of tissue from the testicle through an incision in the = groin and=20 proceeding with orchiectomy only if the pathologist finds = cancer=20 cells. (The surgeon does not cut = through the=20 scrotum to remove tissue. If the problem is cancer, this = procedure could cause the disease to spread.)=20
If testicular cancer is found, more tests are needed to = find=20 out if the cancer has spread from the testicle to other = parts of=20 the body. Determining the stage (extent) of the disease helps the doctor = to plan=20 appropriate treatment.
How is testicular cancer treated? What = are the=20 side effects of treatment?

Although the incidence of testicular cancer has risen = in recent=20 years, more than 95 percent of cases can be cured. = Treatment is=20 more likely to be successful when testicular cancer is = found=20 early. In addition, treatment can often be less aggressive = and may=20 cause fewer side effects.

Most men with testicular cancer can be cured with = surgery, radiation therapy, and/or chemotherapy. The side effects depend on the = type of=20 treatment and may be different for each person.

Seminomas and nonseminomas grow and spread differently = and are=20 treated differently. Nonseminomas tend to grow and spread = more=20 quickly; seminomas are more sensitive to radiation. If the tumor contains both seminoma = and=20 nonseminoma cells, it is treated as a nonseminoma. = Treatment also=20 depends on the stage of the cancer, the patient=E2=80=99s = age and general=20 health, and other factors. Treatment is often provided by = a team=20 of specialists, which may include a surgeon, a medical oncologist, and a radiation oncologist.

The three types of standard treatment are described = below.
- Surgery to remove the testicle = through an=20 incision in the groin is called a radical inguinal = orchiectomy.=20 Men may be concerned that losing a testicle will affect = their=20 ability to have sexual intercourse or make them sterile (unable to produce children). However, = a man=20 with one healthy testicle can still have a normal erection and produce sperm. Therefore, an = operation to=20 remove one testicle does not make a man impotent (unable to have an erection) and = seldom=20 interferes with fertility (the ability to produce children). = For=20 cosmetic purposes, men can have a prosthesis (an artificial testicle) placed in = the=20 scrotum at the time of their orchiectomy or at any time=20 afterward.=20
  
  Some of the lymph nodes located deep in the abdomen may = also be=20 removed (lymph node dissection). This type of surgery = does not=20 usually change a man=E2=80=99s ability to have an = erection or an orgasm,=20 but it can cause problems with fertility if it = interferes with=20 ejaculation. Patients may wish to talk with = their=20 doctor about the possibility of removing the lymph nodes = using a=20 special nerve-sparing surgical technique that may = preserve the=20 ability to ejaculate normally.
- Radiation therapy (also called radiotherapy) uses high-energy rays to kill = cancer=20 cells and shrink tumors. It is a local therapy, meaning that it affects cancer = cells=20 only in the treated areas. External radiation (from a machine outside the = body),=20 aimed at the lymph nodes in the abdomen, is used to = treat=20 seminomas. It is usually given after surgery. Because=20 nonseminomas are less sensitive to radiation, men with = this type=20 of cancer usually do not undergo radiation therapy.=20
  
  Radiation therapy affects normal as well as cancerous = cells.=20 The side effects of radiation therapy depend mainly on = the=20 treatment dose. Common side effects include fatigue, skin changes at the site where the = treatment=20 is given, loss of appetite, nausea, and diarrhea. Radiation therapy interferes with = sperm=20 production, but many patients regain their fertility = over a=20 period of 1 to 2 years.
- Chemotherapy is the use of = anticancer drugs to kill cancer cells. When chemotherapy = is given=20 to testicular cancer patients, it is usually given as adjuvant therapy (after surgery) to destroy = cancerous=20 cells that may remain in the body. Chemotherapy may also = be the=20 initial treatment if the cancer is advanced; that is, if = it has=20 spread outside the testicle at the time of the = diagnosis. Most=20 anticancer drugs are given by injection into a vein.=20
  
  Chemotherapy is a systemic therapy, meaning drugs travel through = the=20 bloodstream and affect normal as well as cancerous cells = throughout the body. The side effects depend largely on = the=20 specific drugs and the doses. Common side effects = include=20 nausea, hair loss, fatigue, diarrhea, vomiting, fever, = chills,=20 coughing/shortness of breath, mouth sores, or skin rash. = Other=20 side effects include dizziness, numbness, loss of = reflexes, or=20 difficulty hearing. Some anticancer drugs also interfere = with=20 sperm production. Although the reduction in sperm count = is=20 permanent for some patients, many others recover their=20 fertility.
  
  Some men with advanced or recurrent testicular cancer = may=20 undergo treatment with very high doses of chemotherapy. = These=20 high doses of chemotherapy kill cancer cells, but they = also=20 destroy the bone marrow, which makes and stores blood = cells. Such=20 treatment can be given only if patients undergo a bone = marrow=20 transplant. In a transplant, bone marrow stem cells are removed from the patient before = chemotherapy is administered. These cells are frozen = temporarily=20 and then thawed and returned to the patient through a = needle=20 (like a blood transfusion) after the high-dose chemotherapy has been administered.=20
Men with testicular cancer should discuss their = concerns about=20 sexual function and fertility with their doctor. It is = important=20 to know that men with testicular cancer often have = fertility=20 problems even before their cancer is treated. If a man has = pre-existing fertility problems, or if he is to have = treatment=20 that might lead to infertility, he may want to ask the doctor about = sperm banking (freezing sperm before treatment = for use=20 in the future). This procedure allows some men to have = children=20 even if the treatment causes loss of fertility.
Is follow-up treatment necessary? What = does it=20 involve?

Regular follow-up exams are extremely important for men = who=20 have been treated for testicular cancer. Like all cancers, = testicular cancer can recur (come back). Men who have had testicular = cancer=20 should see their doctor regularly and should report any = unusual=20 symptoms right away. Follow-up varies for different types = and=20 stages of testicular cancer. Generally, patients are = checked=20 frequently by their doctor and have regular blood tests to = measure=20 tumor marker levels. They also have regular x-rays and computed tomography, also called CT scans or CAT scans (detailed pictures of areas inside the = body=20 created by a computer linked to an x-ray machine). Men who = have=20 had testicular cancer have an increased likelihood of = developing=20 cancer in the remaining testicle. Patients treated with=20 chemotherapy may have an increased risk of certain types = of leukemia, as well as other types of cancer. = Regular=20 follow-up care ensures that changes in health are = discussed and=20 that problems are treated as soon as possible.
Are clinical trials (research studies) available for = men with=20 testicular cancer?

Yes. Participation in clinical trials is an important treatment option = for=20 many men with testicular cancer. To develop new = treatments, and=20 better ways to use current treatments, the National Cancer = Institute (NCI) is sponsoring clinical trials (research = studies=20 with people) in many hospitals and cancer centers around = the=20 country. Clinical trials are a critical step in the = development of=20 new methods of treatment. Before any new treatment can be=20 recommended for general use, doctors conduct clinical = trials to=20 find out whether the treatment is safe for patients and = effective=20 against the disease.

People interested in taking part in a clinical trial = should=20 talk with their doctor. Information about clinical trials = is=20 available from the NCI=E2=80=99s Cancer Information = Service (CIS) (see=20 below) at 1=E2=80=93800=E2=80=934=E2=80=93CANCER and in = the NCI booklet Taking Part in=20 Clinical Trials: What Cancer Patients Need To Know, = which can=20 be found at http://www.cancer.gov/publica= tions=20 on the Internet. This booklet describes how research = studies are=20 carried out and explains their possible benefits and = risks.=20 Further information about clinical trials is available at = http://www.cancer.gov/clini= caltrials=20 on the NCI=E2=80=99s Web site. The Web site offers = detailed information=20 about specific ongoing studies by linking to PDQ=C2=AE, the NCI=E2=80=99s comprehensive = cancer information=20 database. The CIS also provides information from = PDQ.

Selected Reference

American Cancer Society, Inc. Cancer Facts and = Figures=20 2005. Atlanta: American Cancer Society, Inc., 2005. = Also=20 available at http= ://www.cancer.org/downloads/STT/CAFF2005f4PWSecured.pdf=20 on the Internet.=20

# # #

Related Resources =

Publications (available at http://www.cancer.gov/publica= tions)

National Cancer Institute Fact Sheet 5.18, Tumor=20 Markers
National Cancer Institute Fact Sheet 7.48, Fo= llow-up=20 Care: Questions and Answers
What You=20 Need To Know About=E2=84=A2 Cancer

National Cancer Institute (NCI) = Resources

Cancer Information Service = (toll-free)=20

Telephone: 1=E2=80=93800=E2=80=934=E2=80=93CANCER = (1=E2=80=93800=E2=80=93422=E2=80=936237)=20

TTY: 1=E2=80=93800=E2=80=93332=E2=80=938615=20

Online=20

NCI=E2=80=99s Web site: http://www.cancer.gov/
LiveHel= p,=20 NCI=E2=80=99s live online assistance:
https://cisse= cure.nci.nih.gov/livehelp/welcome.asp=20