Testicular Cancer
General Information(Symptoms and Treatment)
Stages of Testicular Cancer
Treatment Options
The testicles are two glands inside the scrotum (a sac of
loose skin below the penis). The testicles make sperm and the hormone
testosterone.
Testicular cancer is the most common cancer in men 15-34 years
of age. The two main types of testicular tumors are seminoma and
nonseminoma. Nonseminomas tend to grow and spread more quickly than
seminomas.
The most common sign of testicular cancer is a lump or
swelling in the testicle. Most testicular cancers can be cured, even if
they are diagnosed at an advanced stage.
Treatment for testicular cancer can cause infertility by
decreasing the amount of sperm made by the body. Men who want to have
children may want to use sperm banking to store sperm before they begin
treatment.
General Information About Testicular Cancer
Key Points
- Testicular cancer is a disease in which malignant (cancer)
cells form in the tissues of one or both testicles.
- Health history can affect the risk of testicular cancer.
- Signs and symptoms of testicular cancer include swelling or
discomfort in the scrotum.
- Tests that examine the testicles and blood are used to
detect (find) and diagnose testicular cancer.
- Certain factors affect prognosis (chance of recovery) and
treatment options.
- Treatment for testicular cancer can cause infertility.
Testicular
cancer is a disease in which malignant (cancer) cells form in the
tissues of one or both testicles.
The testicles are 2 egg-shaped glands located inside the scrotum (a sac of loose skin
that lies
directly below the penis).
The testicles are held within the scrotum by the spermatic cord, which also
contains the vas deferens
and vessels and nerves
of the testicles.
Anatomy of the male
reproductive and urinary systems, showing the testicles, prostate,
bladder, and other organs.
The testicles are the
male sex glands and produce testosterone
and sperm. Germ cells within the
testicles produce immature sperm that travel through a network of
tubules (tiny tubes) and larger tubes into the epididymis (a long coiled
tube next to the testicles) where the sperm mature and are stored.
Almost all testicular cancers start in
the germ cells. The two main types of testicular
germ cell tumors are seminomas
and nonseminomas.
These 2 types grow and spread differently and are treated differently.
Nonseminomas tend to grow and spread more quickly than seminomas.
Seminomas are more sensitive to radiation.
A testicular tumor
that contains both seminoma and nonseminoma cells
is treated as a nonseminoma.
Testicular cancer is the
most common cancer
in men 20 to 35 years old.
Health history can affect the risk of testicular cancer.
Anything that increases
the chance of getting a disease is called a risk
factor. Having a risk factor does not mean that you will
get cancer; not having risk factors doesn't mean that you will not get
cancer. Talk with your doctor if you think you may be at risk. Risk
factors for testicular cancer include:
- Having had an undescended
testicle.
- Having had abnormal
development of the testicles.
- Having a personal
history of testicular cancer.
- Having a family
history of testicular cancer (especially in a father or
brother).
- Being white.
Signs
and symptoms of testicular cancer include swelling or discomfort in the
scrotum.
These and other signs and symptoms may be caused by
testicular cancer or by other conditions.
Check with your doctor if you have any of the following:
- A painless lump or swelling in either testicle.
- A change in how the testicle feels.
- A dull ache in the lower abdomen
or the groin.
- A sudden build-up of fluid
in the scrotum.
- Pain or discomfort in a testicle or in the scrotum.
Tests
that examine the testicles and blood are used to detect (find) and
diagnose testicular cancer.
The following tests and
procedures may be used:
- Physical
exam and history
: An exam of the body to check general signs of
health, including checking for signs of disease, such as lumps or
anything else that seems unusual. The testicles will be examined to
check for lumps, swelling, or pain. A history of the patient's health
habits and past illnesses and treatments will also be taken.
- Ultrasound
exam: A procedure in which high-energy sound waves
(ultrasound) are bounced off internal tissues
or organs and make
echoes. The echoes form a picture of body tissues called a sonogram.
- Serum
tumor marker test : A procedure in which a
sample of blood is
examined to measure the amounts of certain substances released into the
blood by organs, tissues, or tumor cells in the body. Certain
substances are linked to specific types of cancer when found in
increased levels in the blood. These are called tumor markers. The following
tumor markers are used to detect testicular cancer:
- Alpha-fetoprotein
(AFP).
- Beta-human
chorionic gonadotropin (B-hCG).
Tumor marker levels are measured before inguinal
orchiectomy and biopsy,
to help diagnose
testicular cancer.
- Inguinal orchiectomy: A
procedure to remove the entire testicle through an incision in the groin. A
tissue sample from the testicle is then viewed under a microscope to check for
cancer cells. (The surgeon
does not cut through the scrotum into the testicle to remove a sample
of tissue for biopsy, because if cancer is present, this procedure
could cause it to spread into the scrotum and lymph nodes. It's important
to choose a surgeon who has experience with this kind of surgery.) If cancer is
found, the cell type (seminoma or nonseminoma) is determined in order
to help plan treatment.
Certain
factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment
options depend on the following:
- Stage
of the cancer (whether it is in or near the testicle or has spread to
other places in the body, and blood levels of AFP, B-hCG, and LDH).
- Type of cancer.
- Size of the tumor.
- Number and size of retroperitoneal
lymph nodes.
Testicular cancer can
usually be cured in
patients who receive adjuvant
chemotherapy or radiation therapy after
their primary treatment.
Treatment
for testicular cancer can cause infertility.
Certain treatments for
testicular cancer can cause infertility
that may be permanent. Patients who may wish to have children should
consider sperm banking
before having treatment. Sperm banking is the process of freezing sperm
and storing it for later use.
Stages of Testicular Cancer
Key Points
- After testicular cancer has been diagnosed, tests are done
to find out if cancer cells have spread within the testicles or to
other parts of the body.
- There are three ways that cancer spreads in the body.
- Cancer may spread from where it began to other parts of the
body.
- The following stages are used for testicular cancer:
- Stage 0 (Testicular Intraepithelial Neoplasia)
- Stage I
- Stage II
- Stage III
After
testicular cancer has been diagnosed, tests are done to find out if
cancer cells have spread within the testicles or to other parts of the
body.
The process used to find
out if cancer has
spread within the testicles
or to other
parts of the body is called staging.
The information gathered from the
staging process determines the stage
of the disease. It is important to know
the stage in order to plan treatment.
The following tests and
procedures may be used in the staging process:
- Chest
x-ray : An x-ray
of the organs and
bones inside the chest. An x-ray is a type of energy beam that can go
through the body and onto film, making a picture of areas inside the
body.
- CT
scan (CAT scan): A procedure that makes a
series of detailed pictures of areas inside the body, taken from
different angles. The pictures are made by a computer linked to an
x-ray machine. A dye may be injected
into a vein or
swallowed to help the organs or tissues
show up more clearly. This procedure is also called computed
tomography, computerized tomography, or computerized axial tomography.
- PET
scan (positron emission tomography scan): A
procedure to find malignant
tumor cells in the body. A small
amount of radioactive
glucose (sugar)
is injected into a vein. The PET scanner
rotates around the body and makes a picture of where glucose is being
used in the body. Malignant tumor cells show up brighter in the picture
because they are more active and take up more glucose than normal cells
do.
- MRI
(magnetic resonance imaging): A procedure that uses a
magnet, radio waves,
and a computer to make a series of detailed pictures of areas inside
the body. This procedure is also called nuclear magnetic resonance
imaging (NMRI).
- Abdominal
lymph node dissection
: A surgical
procedure in which lymph nodes
in the abdomen are
removed and a sample of tissue is checked under a microscope for signs of
cancer. This procedure is also called lymphadenectomy. For patients
with nonseminoma,
removing the lymph nodes may help stop the spread of disease. Cancer
cells in the lymph nodes of seminoma
patients can be treated with radiation
therapy.
- Serum
tumor marker test : A procedure in which a
sample of blood is
examined to measure the amounts of certain substances released into the
blood by organs, tissues, or tumor
cells in the body. Certain substances are linked to specific types of
cancer when found in increased levels in the blood. These are called tumor markers. The following
3 tumor markers are used in staging testicular
cancer:
- Alpha-fetoprotein
(AFP)
- Beta-human
chorionic gonadotropin (B-hCG).
- Lactate
dehydrogenase (LDH).
Tumor marker levels are measured again, after inguinal orchiectomy and
biopsy, in order to determine the stage of the cancer. This helps to
show if all of the cancer has been removed or if more treatment is
needed. Tumor marker levels are also measured during follow-up as a way of
checking if the cancer has come back.
There
are three ways that cancer spreads in the body.
Cancer can spread
through tissue, the
lymph system, and
the blood:
- Tissue. The cancer spreads from where it began by growing
into nearby areas.
- Lymph system. The cancer spreads from where it began by
getting into the lymph system. The cancer travels through the lymph vessels to other parts
of the body.
- Blood. The cancer spreads from where it began by getting
into the blood. The cancer travels through the blood vessels to other parts
of the body.
Cancer
may spread from where it began to other parts of the body.
When cancer spreads
to another part of the body, it is called metastasis.
Cancer cells break
away from where they began (the primary
tumor) and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system,
travels through the lymph vessels, and forms a tumor (metastatic tumor) in another
part of the body.
- Blood. The cancer gets into the blood, travels through the
blood vessels, and forms a tumor (metastatic tumor) in another part of
the body.
The metastatic tumor is
the same type of cancer as the primary tumor. For example, if
testicular cancer spreads to the lung,
the cancer cells in the lung are actually testicular cancer cells. The
disease is metastatic testicular cancer, not lung cancer.
The
following stages are used for testicular cancer:
Stage
0 (Testicular Intraepithelial Neoplasia)
In stage 0, abnormal cells are found in the tiny
tubules where the sperm
cells begin to develop. These abnormal cells may become cancer and spread into
nearby normal tissue.
All tumor marker
levels are normal. Stage 0 is also called testicular intraepithelial
neoplasia and testicular intratubular germ cell neoplasia.
Stage
I
In stage I, cancer has formed. Stage I
is divided into stage IA, stage IB, and stage IS and is determined
after an inguinal orchiectomy
is done.
- In stage IA,
cancer is in the testicle
and epididymis and
may have spread to the inner layer of the membrane
surrounding the testicle. All tumor
marker levels are normal.
- In stage IB,
cancer:
- is in the testicle
and the epididymis
and has spread to the blood
vessels or lymph
vessels in the testicle; or
- has spread to the outer layer of the membrane surrounding the
testicle; or
- is in the spermatic
cord or the scrotum
and may be in the blood vessels or lymph vessels of the testicle.
All tumor marker
levels are normal.
- In stage IS,
cancer is found anywhere within the testicle,
spermatic cord,
or the scrotum and
either:
- all tumor marker
levels are slightly above normal; or
- one or more tumor marker levels are moderately above
normal or high.
Pea, peanut, walnut, and
lime show tumor sizes.
Stage
II
Stage II is divided into
stage IIA, stage IIB, and stage IIC and is determined after an inguinal orchiectomy is done.
- In stage IIA,
cancer:
- is anywhere within the testicle,
spermatic cord,
or scrotum; and
- has spread to up to 5 lymph
nodes in the abdomen,
none larger than 2 centimeters.
All tumor marker
levels are normal or slightly above normal.
- In stage IIB,
cancer is anywhere within the testicle,
spermatic cord,
or scrotum; and
either:
- has spread to up to 5 lymph
nodes in the abdomen;
at least one of the lymph nodes is larger than 2 centimeters, but none are
larger than 5 centimeters; or
- has spread to more than 5 lymph nodes; the lymph nodes
are not larger than 5 centimeters.
All tumor marker
levels are normal or slightly above normal.
- In stage IIC,
cancer:
- is anywhere within the testicle,
spermatic cord,
or scrotum; and
- has spread to a lymph
node in the abdomen
that is larger than 5 centimeters.
All tumor marker
levels are normal or slightly above normal.
Stage
III
Stage III is divided into
stage IIIA, stage IIIB, and stage IIIC and is determined after an inguinal orchiectomy is done.
- In stage IIIA,
cancer:
- is anywhere within the testicle,
spermatic cord,
or scrotum; and
- may have spread to one or more lymph nodes in the abdomen; and
- has spread to distant lymph nodes or to the lungs.
Tumor marker
levels may range from normal to slightly above normal.
- In stage IIIB,
cancer:
- is anywhere within the testicle,
spermatic cord,
or scrotum; and
- may have spread to one or more lymph nodes in the abdomen, to distant lymph
nodes, or to the lungs.
The level of one or more tumor
markers is moderately above normal.
- In stage IIIC,
cancer:
- is anywhere within the testicle,
spermatic cord,
or scrotum; and
- may have spread to one or more lymph nodes in the abdomen, to distant lymph
nodes, or to the lungs.
The level of one or more tumor
markers is high.
or
Cancer:
- is anywhere within the testicle, spermatic cord, or
scrotum; and
- may have spread to one or more lymph nodes in the
abdomen; and
- has not spread to distant lymph nodes or the lung but
has spread to other parts of the body.
Tumor marker levels may range from normal to high.
Recurrent Testicular Cancer
Recurrent testicular cancer is cancer that has recurred (come back) after
it has been treated. The cancer may come back many years after the
initial cancer, in the other testicle
or in other parts of the body.
Treatment Option Overview
Key Points
- There are different types of treatment for patients with
testicular cancer.
- Testicular tumors are divided into 3 groups, based on how
well the tumors are expected to respond to treatment.
- Good Prognosis
- Intermediate Prognosis
- Poor Prognosis
- Five types of standard treatment are used:
- Surgery
- Radiation therapy
- Chemotherapy
- Surveillance
- High-dose chemotherapy with stem cell transplant
- New types of treatment are being tested in clinical trials.
- Patients may want to think about taking part in a clinical
trial.
- Patients can enter clinical trials before, during, or after
starting their cancer treatment.
- Follow-up tests may be needed.
There
are different types of treatment for patients with testicular cancer.
Different types of
treatments are available for patients with testicular
cancer. Some treatments are standard
(the currently used treatment), and some are being tested in clinical trials. A treatment
clinical trial is a research
study meant to help improve current treatments or obtain
information on new treatments for patients with cancer. When clinical trials
show that a new treatment is better than the standard treatment, the
new treatment may become the standard treatment. Patients may want to
think about taking part in a clinical trial. Some clinical trials are
open only to patients who have not started treatment.
Testicular
tumors are divided into 3 groups, based on how well the tumors are
expected to respond to treatment.
Good
Prognosis
For nonseminoma, all of the
following must be true:
- The tumor
is found only in the testicle
or in the retroperitoneum
(area outside or behind the abdominal
wall); and
- The tumor has not spread to organs
other than the lungs;
and
- The levels of all the tumor
markers are slightly above normal.
For seminoma, all of the
following must be true:
- The tumor has not spread to organs other than the lungs; and
- The level of alpha-fetoprotein
(AFP) is normal. Beta-human
chorionic gonadotropin (B-hCG) and lactate dehydrogenase (LDH)
may be at any level.
Intermediate
Prognosis
For nonseminoma, all of
the following must be true:
- The tumor is found in one testicle only or in the
retroperitoneum (area outside or behind the abdominal wall); and
- The tumor has not spread to organs other than the lungs; and
- The level of any one of the tumor markers is more than
slightly above normal.
For seminoma, all of the
following must be true:
- The tumor has spread to organs other than the lungs; and
- The level of AFP is normal. B-hCG and LDH may be at any
level.
Poor
Prognosis
For nonseminoma, at
least one of the following must be true:
- The tumor is in the center of the chest between the lungs;
or
- The tumor has spread to organs other than the lungs; or
- The level of any one of the tumor markers is high.
There is no poor prognosis grouping for
seminoma testicular tumors.
Five
types of standard treatment are used:
Surgery
Surgery to remove the
testicle (inguinal orchiectomy)
and some of the lymph nodes
may be done at diagnosis
and staging. (See
the General Information and Stages sections of this summary.) Tumors
that have spread to other places in the body may be partly or entirely
removed by surgery.
Even if the doctor
removes all the cancer that can be seen at the time of the surgery,
some patients may be given chemotherapy
or radiation therapy
after surgery to kill any cancer cells
that are left. Treatment given after the surgery, to lower the risk
that the cancer will come back, is called adjuvant
therapy.
Radiation
therapy
Radiation therapy is a
cancer treatment that uses high-energy x-rays
or other types of radiation
to kill cancer cells or keep them from growing. There are two types of
radiation therapy:
- External radiation
therapy uses a machine outside the body to send radiation
toward the cancer.
- Internal radiation
therapy uses a radioactive
substance sealed in needles, seeds,
wires, or catheters
that are placed directly into or near the cancer.
The way the radiation
therapy is given depends on the type and stage
of the cancer being treated. External radiation therapy is used to
treat testicular cancer.
Chemotherapy
Chemotherapy is a cancer
treatment that uses drugs
to stop the growth of cancer cells, either by killing the cells or by
stopping the cells from dividing. When chemotherapy is taken by mouth
or injected into a vein or muscle, the drugs
enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When
chemotherapy is placed directly into the cerebrospinal
fluid, an organ, or a body cavity
such as the abdomen,
the drugs mainly affect cancer cells in those areas (regional chemotherapy). The
way the chemotherapy is given depends on the type and stage of the
cancer being treated.
See Drugs Approved for
Testicular Cancer for more information.
Surveillance
Surveillance is closely
following a patient's condition
without giving any treatment unless there are changes in test results.
It is used to find early signs
that the cancer has recurred (come back). In surveillance, patients are
given certain exams and tests on a regular schedule.
High-dose
chemotherapy with stem cell transplant
High-dose chemotherapy with stem cell transplant is a
method of giving high doses
of chemotherapy and replacing blood
-forming cells destroyed by the cancer treatment. Stem cells (immature blood
cells) are removed from the blood or bone
marrow of the patient or a donor
and are frozen and stored. After the chemotherapy is completed, the
stored stem cells are thawed and given back to the patient through an infusion. These reinfused
stem cells grow into (and restore) the body's blood cells.
See Drugs Approved for
Testicular Cancer for more information.
Stem cell transplant. (Step
1): Blood is taken from a vein in the arm of the donor. The patient or
another person may be the donor. The blood flows through a machine that
removes the stem cells. Then the blood is returned to the donor through
a vein in the other arm. (Step 2): The patient receives chemotherapy to
kill blood-forming cells. The patient may receive radiation therapy
(not shown). (Step 3): The patient receives stem cells through a
catheter placed into a blood vessel in the chest.
New
types of treatment are being tested in clinical trials.
Information about
clinical trials is available from the NCI website.
Patients
may want to think about taking part in a clinical trial.
For some patients,
taking part in a clinical trial
may be the best treatment choice. Clinical trials are part of the
cancer research process. Clinical trials are done to find out if new
cancer treatments are safe and effective or better than the standard treatment.
Many of today's
standard treatments for cancer are based on earlier clinical trials.
Patients who take part in a clinical trial may receive the standard
treatment or be among the first to receive a new treatment.
Patients who take
part in clinical trials also help improve the way cancer will be
treated in the future. Even when clinical trials do not lead to
effective new treatments, they often answer important questions and
help move research forward.
Patients
can enter clinical trials before, during, or after starting their
cancer treatment.
Some clinical trials
only include patients who have not yet received treatment. Other trials
test treatments for patients whose cancer has not gotten better. There
are also clinical trials that test new ways to stop cancer from recurring (coming back) or
reduce the side effects
of cancer treatment.
Clinical trials are
taking place in many parts of the country. See the Treatment Options
section that follows for links to current treatment clinical trials.
These have been retrieved from NCI's
listing of clinical trials.
Follow-up
tests may be needed.
Some of the tests
that were done to diagnose
the cancer or to find out the stage
of the cancer may be repeated. Some tests will be repeated in order to
see how well the treatment is working. Decisions about whether to
continue, change, or stop treatment may be based on the results of
these tests.
Some of the tests
will continue to be done from time to time after treatment has ended.
The results of these tests can show if your condition
has changed or if the cancer has recurred
(come back). These tests are sometimes called follow-up tests or check-ups.
Men who have had
testicular cancer have an increased risk of developing cancer in the
other testicle. A patient is advised to regularly check the other
testicle and report any unusual symptoms to a doctor right away.
Long-term clinical exams are very
important. The patient will probably have
check-ups frequently during the first year after surgery and less often
after that.
Treatment Options by Stage
Stage 0 (Testicular Intraepithelial
Neoplasia)
Treatment of stage 0 may include the
following:
- Radiation therapy.
- Surveillance.
- Surgery
to remove the testicle.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with testicular cancer. For more specific results, refine the
search by using other search features, such as the location of the
trial, the type of treatment, or the name of the drug. Talk with your
doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stage I Testicular Cancer
Treatment of stage I testicular cancer
depends on whether the cancer
is a seminoma or a nonseminoma.
Treatment of seminoma
may include the following:
- Surgery
to remove the testicle,
followed by surveillance.
- For patients who want active treatment rather than
surveillance, treatment may include:
- Surgery to remove the testicle, followed by chemotherapy.
Treatment of nonseminoma
may include the following:
- Surgery to remove the testicle, with long-term follow-up.
- Surgery to remove the testicle and lymph nodes in the
abdomen, with long-term follow-up.
- Surgery followed by chemotherapy for patients at high risk
of recurrence, with
long-term follow-up.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage I testicular cancer. For more specific results,
refine the search by using other search features, such as the location
of the trial, the type of treatment, or the name of the drug. Talk with
your doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stage II Testicular Cancer
Treatment of stage II testicular cancer
depends on whether the cancer
is a seminoma or a nonseminoma.
Treatment of seminoma
may include the following:
- When the tumor
is 5 centimeters or
smaller:
- Surgery
to remove the testicle,
followed by radiation therapy
to lymph nodes in
the abdomen and pelvis.
- Combination
chemotherapy.
- Surgery to remove the testicle and lymph nodes in the
abdomen.
- When the tumor is larger than 5 centimeters:
- Surgery to remove the testicle, followed by combination
chemotherapy or radiation therapy to lymph nodes in the abdomen and
pelvis, with long-term follow-up.
Treatment of nonseminoma
may include the following:
- Surgery to remove the testicle and lymph nodes, with
long-term follow-up.
- Surgery to remove the testicle and lymph nodes, followed by
combination chemotherapy and long-term follow-up.
- Surgery to remove the testicle, followed by combination
chemotherapy and a second surgery if cancer remains, with long-term
follow-up.
- Combination chemotherapy before surgery to remove the
testicle, for cancer that has spread and is thought to be
life-threatening.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage II testicular cancer. For more specific results,
refine the search by using other search features, such as the location
of the trial, the type of treatment, or the name of the drug. Talk with
your doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stage III Testicular Cancer
Treatment of stage III testicular cancer
depends on whether the cancer
is a seminoma or a nonseminoma.
Treatment of seminoma
may include the following:
- Surgery
to remove the testicle,
followed by combination
chemotherapy. If there are tumors
remaining after chemotherapy,
treatment may be one of the following:
- Surveillance
with no treatment unless tumors grow.
- Surveillance for tumors smaller than 3 centimeters and surgery to
remove tumors larger than 3 centimeters.
- A PET scan
two months after chemotherapy and surgery to remove tumors that show up
with cancer on the scan.
- A clinical trial
of chemotherapy.
Treatment of nonseminoma
may include the following:
- Surgery to remove the testicle, followed by combination
chemotherapy.
- Combination chemotherapy followed by surgery to remove the
testicle and all remaining tumors. Additional chemotherapy may be given
if the tumor tissue
removed contains cancer cells
that are growing or if follow-up
tests show that cancer is progressing.
- Combination chemotherapy before surgery to remove the
testicle, for cancer that has spread and is thought to be
life-threatening.
- A clinical trial of chemotherapy.
Treatment Options for Recurrent Testicular Cancer
Treatment of recurrent testicular cancer may
include the following:
- Combination
chemotherapy.
- High-dose
chemotherapy and stem
cell transplant.
- Surgery
to remove cancer
that has either:
- come back more than 2 years after complete remission; or
- come back in only one place and does not respond to chemotherapy.
-NIH
