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Testicular Cancer

What is testicular cancer?

Testicular cancer is cancer in one or both testicles. It usually occurs in young men and, if detected early, responds to treatment well. It is one of the most common cancers in young men between the ages of 15 and 34. The disease also occurs in other age groups as well and is often found by men themselves. This year 8,010 cases of testicular cancer will be diagnosed in the United States, and about 390 men will die of the disease. It is one of the most curable forms of cancer, with over 90% of cases cured.

What causes testicular cancer?

The cause of testicular cancer is unknown. Age is the most common risk factor, and a family history of testicular cancer increases the risk. If a patient has the disease, there is an increased risk that one or more of his brothers will also develop it. Some studies have indicated that miners, oil and gas workers, leather workers, food and beverage processing workers, janitors, firefighters, and utility workers have elevated risk of developing testicular cancer. An increased risk is also linked to an unusual condition that causes a proliferation of moles on the back, chest, belly, and face. Men infected with HIV (human immunodeficiency virus) have an increased risk. Men who have been cured of cancer in one testicle have an increased risk (about 3 to 4%) of getting cancer in the other testicle. White Americans are 5 to 10 times more likely to get testicular cancer than African American men, and whites have more than twice the risk of Asian American men.

How is testicular cancer diagnosed?

Testicular cancer can cause several symptoms, including a lump in either testicle, enlargement of a testicle, a feeling of heaviness in the scrotum, a dull ache in the lower abdomen or the groin, a sudden collection of fluid in the scrotum, pain or discomfort in a testicle or in the scrotum, or enlargement or tenderness of the breasts. Although these symptoms can be caused by other conditions, early diagnosis of testicular cancer is very important for a man’s chance for complete recovery.

The testicles have many different kinds of cells which may develop into one or more types of cancer. The three main types of testicular cancer are germ cell tumors, stromal tumors and secondary testicular tumors.

• germ cell tumors - the most common type (over 9 out of 10 cases) of testicular cancer, germ cell tumors begin in the cells that make sperm. Most germ cell cancers begin as carcinoma in situ (CIS), a cancer that is not invasive (has not spread from where it started). It usually takes about five years for CIS to become the invasive form of germ cell cancer. Germ cell cancers are divided into two types: seminomas and nonseminomas. Seminomas (about 40% of cases) start from the sperm-producing germ cells of the testicle. Nonseminomas (choriocarcinoma, embryonal carcinoma, teratoma, and yolk sac tumors) tend to develop earlier in life than seminomas and are often found in men between their late teens and early forties.


• stromal tumors – tumors that begin in the cells that make hormones and in the supportive tissues (stroma) of the testicles. These tumors are often benign and do not spread beyond the testicle; however, when stromal cell tumors spread to other parts of the body, they have a poor prognosis because they do not respond well to treatments.


• secondary testicular tumors – tumors that start in another organ and then spread to the testicle. Among men over 50, secondary testicular tumors are more common that tumors that begin in the testicle. The prognosis depends on the type and stage of the original cancer.

Examination of the testicles is the most common test to find testicular cancer.

• physical examination of the scrotum


• medical history


• chest x-ray


• blood and urine tests


• biopsy

Once testicular cancer has been diagnosed, prognosis (chance of recovery) and treatment options depend on the stage of the cancer (whether it is contained in the testicles or has spread to other parts of the body). Doctors use many diagnostic tools to determine the stage, including:

• computed tomography (CT or CAT scan) or PET scan


• lab tests for tumor markers to help determine the type of testicular cancer


• surgery to remove lymph nodes deep in the abdomen

What are the treatment options?

There are different types of treatment for patients with testicular cancer. The three main standard methods are surgery, radiation therapy, and chemotherapy. The doctor may choose to use just one or a combination. Other treatments are being tested through clinical trials.

• surgery – used to remove the testicle and sometimes lymph nodes in the abdomen. Tumors that have spread to other parts of the body may be partly or entirely removed as well.


• radiation therapy – also called x-ray therapy, radiotherapy, cobalt treatment or irradiation, high-energy x rays are used to damage cancer cells and stop their growth. Seminomas are highly sensitive to radiation. Nonseminomas are somewhat less responsive to radiation and usually require other types of treatment.


• chemotherapy – drugs used to kill cancer cells.

The treatment of testicular cancer is determined by the age and health of the patient as well as the stage of the cancer.

Sometimes, for germ cell tumors that are suspected of being more difficult to cure, high dose chemotherapy and autologous stem cell transplantation is used after the initial treatment using standard chemotherapy doses.

Additionally, if the germ cell tumor doesn’t go away (into remission) with the initial chemotherapy, or if it went into remission but recurred, high dose chemotherapy and autologous stem cell transplantation is recommended.