Testicular Cancer

Testicular cancer is an uncommon malignancy that highly treatable and usually curable, if diagnosed early. But while the numbers of those diagnosed are low, testicular cancer is the most common malignancy in men ages 20 to 34.

The following information addresses the most common questions about testicular tumors and serves as a supplement to a discussion with an experienced urologist at Georgia Urology.

What happens under normal conditions?

The testicle is an egg-shaped structure with a firm, slightly spongy feel. At the top and outside edge is a separate rubbery tube-like structure, the epididymis, where sperm mature before eventually being ejaculated from the body. The consistency of the testicle should be uniform. The size of the testicles should be roughly the same.

What are the symptoms of a testicular tumor?

1. Lump or firm area within the testicle
2. Painless swelling or enlargement of the testicle
3. Pain or tenderness in the testicle
4. Dull ache in association with the lump.

It is important contact a physician for evaluation immediately when you have any of these symptoms.

How is testicular cancer diagnosed?

1. History and physical exam: Including feeling for lumps, swelling and enlarged lymph nodes in the testicles and other parts of the body.
2. Ultrasound or CT scan: To confirm any suspicious lump.
3. Blood tumor markers tests: Proteins produced by most testicular cancer
4. Biopsy: Suspicious tumors are treated initially by surgical removal of the testicle through a small groin incision. Tissue samples a sent to pathology to examine under a microscope In some instances, a testicular prosthesis may be inserted at the time for cosmetic effect

What are the stages of testicular cancer?

Stage 1: Cancer is found only in the testicle (testis).
Stage 2: Cancer has spread to the lymph nodes in the abdomen
Stage 3: Cancer has spread beyond the lymph nodes in the abdomen. There may be cancer in parts of the body far away from the testicles, such as the lungs and liver.

How are testicular tumors treated?

Subsequent treatment will depend on the tumor, since testicular cancers are categorized by their cell type, which determines both how they behave biologically and respond therapeutically.
The most common cell type is seminoma, a tumor responsive to both radiation and chemotherapy. Radiation is commonly utilized for treating low stage seminomas.
All other cell types are called non-seminomatous tumors. Treatment options for non-seminomatous tumors include observation, surgery or chemotherapy, depending on the cell type and extent of spread.
A Georgia urologist will use a variety of imaging tools, such as chest X-rays and CT scans, along with blood tumor markers to “stage” or assess the cancer for treatment.

With more advanced testis cancer or in more aggressive tumors, surgical removal of lymph nodes in the abdomen may be required to check just how far the cancer has spread.

Chemotherapy may be the primary treatment for more advanced disease. Very often, the urological oncologist will prescribe a drug “cocktail” or combination of two or three agents. Sometimes surgical removal of residual tumors may be required after completion of chemotherapy.

What can be expected after treatment for testicular tumors?

Removal of one testicle should not impair a patient’s sexual potency or, in general, their fertility. They may experience a brief decrease in sperm production but the remaining gland should produce adequate amounts of testosterone.

After surgery to remove the lymph nodes, some patients’ ability to ejaculate may be impaired, although this problem is uncommon with today’s nerve-sparing techniques. Also, there are some medications available to help reverse ejaculation problems. In most cases, a normal erection is possible after the surgery.

However, because ejaculation can be impaired with surgery and because chemotherapy can lower sperm counts (usually only temporary), you may wish to sperm bank prior to treatments. Once you have had a testicular tumor, you can expect to be followed for at least five years with periodic X-rays, CT scans and blood tests for tumor markers. Also, since you are at increased risk (approximately two percent) of developing a second tumor, it is important that you continue monthly testicular self-exams (TSE). A TSE is best done after a warm bath or shower when the skin of the scrotum is relaxed.

Frequently asked questions:

Are there any risk factors for testicular cancer?

The only risk factor associated with testicular tumors is a history of an undescended testicle (cryptochidism), a testicle that has not dropped from the abdominal cavity (where they form in fetal development) down into the scrotum by birth. Five to ten percent of patients who have had an undescended testicle remedied through surgery may develop a testicular cancer. Self-examination is particularly important for these men since a tumor can occur in either testicle.

How do I perform a testicular exam?

Monthly testicular self-exams (TSE) are the most important way to detect a tumor early. A TSE is best done after a warm bath or shower when the skin of the scrotum is relaxed. You should look for any changes in appearance and then carefully examine each testicle by rolling it between the fingers and thumbs of both hands to check for any lumps. While many lumps are benign, a high percentage of testicular masses are cancerous. It is critical to meet with an experienced urologist to get an accurate diagnosis.

 If you have concerns about testicular cancer, schedule an appointment with one of Georgia Urology’s experienced urologists.