testicular cancer

Overview

Testicular cancer is a rare form of cancer arising from the male organs that produce sex hormones and sperm known as the testicles. While rare overall, it is the most common cancer in men between the ages of 18 and 35, a population in which other forms of cancer are uncommon.

In general, testicular cancer has a high cure rate, even in cases where it has spread outside of the testicle. Common areas of spread include lymph nodes and other organs. Removal of the affected testicle is necessary in most cases but the opposite (contralateral) testicle may be left intact to carry out sperm and hormone production.

In general, men from ages 16-35 should perform monthly self-examinations to check for one of the most common symptoms of testicular cancer, a lump in the testicle.   

Most testicular cancers occur in patients without any known risk factors so all men should do screening self-exams until age 35. The most common known risk factor associated with an increased risk for testicular cancer is being born with an undescended testicle on one or both sides. This risk persists even after surgical correction. Other conditions linked to testis cancer are rare and typically associated with abnormal testicular development. 

Evaluation typically includes the physician performing a physical examination to verify any lumps on the testicles, evaluate associated structures, and assess for any findings suggestive of spread. Ultrasound imaging is the standard way to image the testicles and evaluate any masses. Laboratory testing for tumor “markers” is done prior to and following any surgical intervention. Additional testing such as CT scans may be used to stage the cancer after the testicle is removed and the diagnosis is confirmed.

Treatment

Treatment requires the surgical removal of the affected testicle(s). Patients may opt for a prosthetic replacement, which surgeons insert into the scrotum to retain the appearance and feel of the removed testicle. This may be done after completion of treatment or less commonly at the time of removal.

After testicle removal, some men, depending on the status of the tumor and tumor markers, go on surveillance. They have serial blood work of their tumor markers, CT scans of the chest, abdomen, and pelvis, and may not require further intervention. Some men will require further surgery after initial diagnosis or while they are under surveillance. This would be determined by the urologist based upon the CT findings and lab work. If indicated, further surgery would typically involve removal of lymph nodes near the aorta and inferior vena cava behind the abdominal cavity. In some cases, these surgeries are the only treatment needed. In others, chemotherapy or radiation would then be added at the discretion of the oncologist and urologist. In all cases, regular checkups will be necessary for several years to monitor for recurrence.

Radiation therapy as well as surveillance are standard treatments specifically for the seminoma type of testicular cancer. In some cases, radiation therapy can negatively affect fertility.

Chemotherapy is typically only used in cases of testicular cancer where cancer has or may have spread. It is sometimes prescribed in cases after lymph node removal.

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