|The Testicular Cancer Resource Center|
Let's start off with some quick facts:
What are the testicles?
For more information on this topic, click HERE
What is cancer?
Healthy cells that make up the body's tissues grow, divide, and replace themselves in an orderly way. This process keeps the body in good repair. Sometimes, however, some cells lose the ability to limit and direct their growth. They grow too rapidly and without any order. Too many cells are produced, and tumors are formed. Tumors can be either benign or malignant.
Benign tumors are not cancer. They do not spread to other parts of the body and are seldom a threat to life. Benign tumors can often be removed by surgery, and they are not likely to return. Some tumors of the testicle are benign, but most are not.
Malignant tumors are cancer. They can invade and destroy nearby healthy tissues and organs. Cancerous cells can also spread, or metastasize, to other parts of the body and form new tumors.
Cancer that develops in a testicle is called testicular 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. Doctors use CT scans of the abdomen and chest in an attempt to determine if the cancer has spread to the lymph nodes or lungs.
What is testicular cancer?
According to the American Cancer Society, an estimated 8250 cases of testicular cancer will be diagnosed in the United States in 2006, and a little less than 400 of them will die. Caucasians are more likely to get it than Hispanics, and are much more likely to get it than Blacks or Asians. The incidence of TC is highest in Denmark and lowest in the far east. Disturbingly, the incidence of testicular cancer around the world has basically doubled in the past 30-40 years. For more statistics, click HERE.
Most testicular cancers are found by men themselves, by accident or while doing a testicular self-examination. The testicles are smooth, oval-shaped, and rather firm. Men who examine themselves regularly (once a month) become familiar with the way their testicles normally feel. Any changes in the way they feel from month-to-month should be checked by a doctor, preferably a Urologist.
In men under 60, 95% of testicular tumors originate in the germ cells, the special sperm-forming cells within the testicles. These tumors fall into one of two types, seminomas or nonseminomas. (Note that in the UK and a few other places, nonseminomas are called teratoma instead.) Other forms of testicular cancer include leydig and sertoli cell tumors. Rarely, tumors such as PNET, leiomyosarcoma, rhabdomyosarcoma, mesothelioma and others can arise in the testicle. These tumors are much harder to treat and patients with them should absolutely get a second opinion from an expert. Men over the age of 60 can still get a germ cell tumor, but they are more likely to get leukemia, lymphoma, or a benign tumor called spermatocytic seminoma. Unless otherwise noted, all the information on this web site concerns testicular germ cell tumors. Pure Seminomas account for about 40 percent of all testicular cancer and are made up of immature germ cells. Usually, seminomas are slow growing and tend to stay localized in the testicle for long periods. Nonseminomas are a group of cancers that often occur in combination with one another, including choriocarcinoma, embryonal carcinoma, immature teratoma and yolk sac tumors. Nonseminomas arise from more mature, specialized germ cells and tend to be more aggressive than seminomas.
There are three stages of testicular cancer:
For more detailed information on the different stages of testicular cancer, please click HERE.
What's the prognosis? Can Testicular Cancer be cured?
Specifically, the survival rate for men diagnosed with Stage I seminoma is about 99%. The survival rate for men with Stage I non-seminoma is about 98%. Cure rates for Stage II tumors range above 90%, while cure rates for Stage III tumors vary between 50-80%. In addition to Stage, a variety of institutions have created classifications of Good and Poor risk tumors. Good risk tumors are generally those that have not spread outside of the retroperitoneal lymph nodes or lungs and do not have overly elevated tumor markers. Poor risk tumors generally have very high tumor markers or have spread outside of the lungs and lymph nodes. As you might expect, the survival rate for good risk tumors is high (more than 90%), while the survival rate for poor risk tumors is lower (50-60%). For a more detailed look at the definition of good and poor risk tumors, click HERE.
What are the causes of testicular cancer?
Testicular cancer is not contagious: no one can "catch" it from another person. Exactly what causes this disease is unknown and seldom can it be explained why one person gets it while another doesn't. Research does show that some men are more likely than others to develop testicular cancer. For example, the risk is higher than average for boys born with their testicles in the lower abdomen rather than in the scrotum (called undescended testicles or cryptorchidism). The cancer risk for boys with this condition is increased regardless of whether the condition is corrected, and in fact, the risk exists even in the normal testicle. The theory is that the increased risk of testicular cancer is due to whatever caused the undescended testicle, not just by the fact that the testicle was undescended.
Research has also shown that testicular cancer is sometimes linked to certain other rare conditions in which the testicles do not develop normally. There is even some line of thought that pollutants may be contributing to this problem, evidenced by the considerable increase in occurrences over the last few decades and paralleled with industrial growth and waste. Click HERE to see some articles detailing this hypothesis.
Some men whose mothers took a hormone called DES (diethylstilbestrol) during pregnancy to prevent miscarriage have testicular abnormalities. But scientists have never proven that prenatal exposure to DES (or any other female hormone) increases the risk of testicular cancer. To date, this link has never been verified.
Some patients with testicular cancer have a history of injury to the scrotum. But again, no one knows whether such an injury can actually cause cancer. Many doctors think such an injury simply calls attention to a tumor that was already growing.
What are the symptoms of testicular cancer?
These symptoms are not sure signs of cancer, they can also be caused by other conditions. There are numerous other causes of swelling of the testis that are harmless, including hydrocele, a collection of fluid in the scrotum; epididymitis, a swelling of the epididymis (the structure behind the testis where sperm mature) which may also cause fever and discharge from the penis; and varicocele, varicose veins in the scrotum which is described as feeling like "a bag of worms". Inflammation of the testis can also be related to bacterial infections. Torsion of the testis occurs when a testicle rotates and the spermatic cord becomes obstructed and the blood supply is cut off. This most commonly occurs around puberty and causes excruciating pain and swelling of the testis. (If this happens, it is a surgical emergency and the patient should be rushed to an emergency room.)
However, it is important to see a doctor, preferably a urologist, if any of these symptoms occur -- any illness should be diagnosed and treated as soon as possible. Early diagnosis of testicular cancer is especially important because the sooner cancer is found and treated, the better a man's chance for complete recovery and the easier the treatment protocol. We realize that it may be difficult to discuss this or let yourself be examined, but it is very important. Cancer is not going to go away on its own, and neither will your concern. If you are suspicious that something is going on down there, get it checked out. You will feel better that you did, even if it turns out to be nothing serious!
For more information on these topics, click HERE.
How is testicular cancer diagnosed?
The only sure way to know whether cancer is present is for a pathologist to examine a sample of tissue under a microscope. To obtain the tissue, the affected testicle is removed through the groin. This operation is called inguinal orchiectomy. The surgeon does not cut through the scrotum and does not remove just a part of the testicle because, if the problem is cancer, cutting through the outer layer of the testicle might cause a local spread of the disease. For more information on the orchiectomy, click HERE.
How is testicular cancer treated?
If a man has testicular cancer, it is important to find out the extent, or stage, of the disease (whether it has spread from the testicle to other parts of the body). Staging procedures include a thorough physical exam, blood tests, x-rays and scans, and, in some cases, additional surgery.
Most patients will have a CT or CAT scan of their abdomen and chest. A CT scan is a series of x-rays of various sections of the body that gives the doctors a good look to see if the cancer has spread. Special blood tests can also reveal certain substances in the blood. These substances are called tumor markers because they often are found in abnormal amounts in some patients with testicular cancer. The levels of specific tumor markers in the blood can help the doctor determine what type of testicular cancer the patient has and how advanced it is.
Surgery may be recommended to remove the lymph nodes deep in the abdomen (called RPLND surgery). A pathologist then examines the nodes to determine whether they contain cancer cells. For patients with nonseminoma, removing the nodes can also help stop the spread of their disease. Seminoma patients do not usually need this surgery because cancer cells in their lymph nodes can be destroyed with radiation therapy.
Testicular cancer can be treated with surgery, radiation therapy, chemotherapy, and surveillance. One method or a combination of methods may used. Often, the patient is referred to medical centers that specialize in testicular cancer treatment.
In most cases, surgery is initially performed to remove the testicle (called an Inguinal Orchiectomy). Sometimes it is also necessary to remove lymph nodes in the abdomen (called RPLND surgery). Additionally, tumors that have spread to other parts of the body may be partly or entirely removed by surgery.
For more information on the RPLND surgery, click HERE.
In radiation therapy (also called x-ray therapy, radiotherapy, cobalt treatment, or irradiation), high-energy rays are used to damage cancer cells and stop their growth. Like surgery, radiation therapy is a local treatment and affects only the cells in the treated area. The patient usually receives radiation therapy on an outpatient basis.
Seminomas are highly sensitive to radiation. Following surgery, men with seminomas often have radiation therapy to their abdominal lymph nodes.
Nonseminomas are much less sensitive to radiation. Patients with this type of cancer usually have other types of treatment, such as surgery and/or chemotherapy. Nonseminomas were treated with radiation in Europe until the late 1980's. The only time radiation is used on nonseminomas now is as a last ditch effort to kill chemo resistant cancer.
For more information on radiation therapy for testicular cancer, click HERE.
The use of drugs to treat cancer is called chemotherapy. Anticancer drugs are recommended when there are signs that the cancer has spread and the type and stage of the tumor is appropriate for this treatment. Chemotherapy is also sometimes used when the doctor suspects that undetected cancer cells remain in the body after surgery or irradiation--this is known as "adjuvant therapy".
Chemotherapy may be given by mouth or injected into a muscle or a blood vessel via an IV. Chemotherapy is a systemic treatment--the drugs enter the bloodstream and reach cells all over the body. Depending on the specific drugs and the patient's general age and condition, chemotherapy may be taken: as an outpatient at the hospital or at the doctor's office, but many patients must be hospitalized during chemotherapy so that effects of the treatment can be monitored and fluids can be infused.
Several drugs are typically used to treat testicular cancer: Platinol (cisplatin), Vepesid or VP-16 (etoposide) and Blenoxane (bleomycin sulfate). Additionally, Ifex (ifosamide), Velban (vinblastine sulfate) and others may be used. Many medical professionals regard Platinol as the "magic bullet" for treating testicular cancer. It is the primary reason that testicular cancer is considered to be a curable disease.
For more information on chemotherapy for testicular cancer, click HERE.
For stage I testicular cancer waiting and regular testing, called surveillance, is an option. The theory is that for many Stage I patients the cancer was cured by the orchiectomy. Since the doctors know that chemotherapy can cure the patient if the cancer comes back, why not just avoid any further treatment until there is evidence that the cancer has indeed spread. It can NOT be stressed enough that men under surveillance must follow the exact directions of their medical team to ensure that recurrent disease is caught as early as best possible! Surveillance is only effective if you actually follow the protocol.
For more information on surveillance for testicular cancer, click HERE.
What are the side effects of treatment for testicular cancer?
Many men worry that losing one testicle will affect their ability to have sexual intercourse or make them sterile. But a man with one healthy testicle can still have a normal erection and produce sperm. Therefore, an operation to remove just one testicle does not make a patient impotent and seldom interferes with fertility. .
Men can also have an artificial testicle, called a prosthesis, placed in the scrotum. The implant has the weight and feel of a normal testicle. Note that finding a source for this implant in the USA is not impossible, but can be difficult. Check the TCRC implants page for more information on availability.
Surgery to remove the lymph nodes does not change a man's ability to have an erection or an orgasm, but the operation can cause infertility because it may interfere with the nerves involved in ejaculation. Severing these nerves causes the bladder neck to relax during an ejaculation allowing the semen to travel backwards into the bladder instead of forward through the penis. Some men may have temporary stoppage then recover the ability to ejaculate without treatment; others may be helped by medication - for many it will be permanent. Patients should talk with their doctor about the possibility of removing the lymph nodes using a nerve sparing surgical technique that may protect the ability to ejaculate. This may not be possible in every given case, and not every doctor is capable of performing this surgery.
Radiation therapy affects both normal and cancerous cells, but normal cells are able to recover, and recent updates in radiation therapy have greatly reduced the amount of collateral "scatter". Having treatments 5 days a week, for several weeks, spreads out the total dose of radiation and gives the patient weekend rest breaks to recover. Nevertheless, the body must work very hard during radiation therapy to repair the tissues injured by the treatment. Patients may feel unusually tired with periods of nausea, and they should try to rest as much as possible. Radiation therapy does not change the ability to have sex. Radiation therapy may, however, interfere with sperm production. Usually the effect is temporary, and most patients regain their fertility within a matter of months. Some other unpleasant effects of radiation therapy include diarrhea and vomiting. These problems can usually be controlled with medication. There may also be skin reactions in the area being treated, and it is important to treat the skin gently. Lotions and creams should not be used on these areas without the doctor's advice.
Chemotherapy causes side effects because it damages not only cancer cells, but other rapidly growing cells as well, such as hair and gum tissue. Often anticancer drugs are given in cycles, with treatment periods alternating with rest periods. The side effects of chemotherapy depend on the specific drugs that are given and the response of the individual patient. These drugs commonly affect hair cells, blood-forming cells, and cells that line the digestive tract. As a result, they may cause various problems, including hair loss, lowered resistance to infection, loss of appetite, nausea and vomiting, and mouth sores. Most men who receive chemotherapy for testicular cancer can continue to function sexually, although some anticancer drugs interfere with sperm production. Although this effect is permanent for some patients, many recover their fertility within a few years. Patients about to have chemotherapy who are interested in having children just attempt to bank sperm, just in case.
Loss of appetite can be a serious problem for patients receiving either radiation therapy or chemotherapy. Researchers are learning that patients who eat well are better able to withstand the side effects of their treatment. Therefore, good nutrition is important. Eating well means getting enough calories to prevent weight loss and having enough protein to build and repair skin, hair, muscles and organs. Many patients find that having several small meals and snacks throughout the day is easier than trying to eat three large meals.
The side effects of cancer therapy vary from person to person and may even be different from one treatment to the next in the same patient. Attempts are made to plan treatment to minimize problems. Fortunately, most side effects are temporary. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and suggest ways to deal with them.
What happens after patients are treated for testicular cancer?
Follow-up care regimens vary for the different types and stages of testicular cancer. Generally, patients are checked and have blood tests to measure tumor marker levels every month or two for the first 2 years after treatment. They also have regular x-rays and CT scans. After that, checkups may be needed just once or twice a year. For more detailed information on follow-up protocols, click HERE. Nonseminoma seldom recurs (less than 5%) after a patient has been free of the disease for 2 years. Seminoma seldom recurs (less than 5%) after a patient has been cancer free for 5 years. Patients who have been treated for cancer in one testicle have about a 3 percent chance of developing cancer in the remaining testicle. If cancer does arise in the second testicle, it is nearly always a new disease rather than a metastasis from the first tumor.
Testicular cancer surviors are also at increased risk of additional medical problems later in life (the exact risks depend on the type of treatment they received). Therefore, survivors should continue to have regular physical exams by their doctor and should continue to perform testicular self-examinations every month. Any unusual symptoms should be reported to the doctor without delay. As with the patient's first cancer, the earlier a new tumor is detected and treated, the greater the chance of cure - which is also very good, even in secondary TCs.
How can patients and their families cope with testicular cancer?
Concerns about the future--as well as about medical tests and treatments, hospital stays, medical bills, and sexuality--are common. Talking with doctors, nurses, or other members of the health care team may help ease fear and confusion. Patients should ask questions about their disease and its treatment and take an active part in decisions about their medical care. Patients and family members often find it helpful to write down questions as they think of them to prepare for the next visit to the doctor. Taking notes during talks with the doctor can be a useful aid to memory. Patients should ask the doctor to repeat or explain anything that is not clear.
Most people want to know what kind of cancer they have, how it can be treated, and how successful the treatment is likely to be. The patient's doctor is the best person to answer questions and give advice about working or other activities. If it is difficult to talk with the doctor about feelings and other very personal matters, patients may find it helpful to talk with others facing similar problems. This kind of help is available through support groups, such as those described in the next section. If the patient or his family finds that emotional problems become too hard to handle, a mental health counselor may be able to help.
We here at the TCRC offer TC-NET, an email support network of more than 600 TC patients, survivors, medical professionals, family and friends. This list is good for answering common questions on almost any related topic. Another list, TC-SUPPORTERS, exists for those people who are providing support to a patient. This list is less medically oriented than TC-NET and mostly deals with helping the helpers.
Adapting to the changes that are brought about by having cancer is easier for patients and those who care about them when they have helpful information and support services. Often, the social service office at the hospital or clinic can suggest local and national agencies that will help with emotional support, financial aid, transportation, home care or rehabilitation.
What does the future hold for testicular cancer?
Scientists at hospitals and medical centers throughout the United States are studying testicular cancer. They are working toward a better understanding of its causes, prevention, diagnosis, and treatment. Researchers are looking for additional tumor markers that may be present in abnormal amounts in the blood or urine of a person with very early testicular cancer. If such markers are found, it might be possible to detect testicular cancer even before any symptoms are noticed. Several such markers have been studied, and research is continuing. Researchers are also looking for treatment methods that are more effective and easier for patients to tolerate. They are studying new drugs and drug combinations, varied doses, and different treatment schedules.
Further Internet links for testicular and other cancer / medical information can be found HERE