Testicular cancer occurs in the testes, the 2 small organs in males that make sperm.
Testicular cancer is most common among young men but usually curable.
Usually a painless lump is present.
Ultrasonography and blood tests are done.
The testis is removed and radiation or chemotherapy may be given or additional surgery may be done.
Most testicular cancers develop in men younger than age 40. It is one of the most common cancers in young men. The American Cancer Society estimates that in 2023 about 9,190 men will be diagnosed with testicular cancer, and there will be about 470 deaths. Among the types of cancer that commonly develop in the testes are seminoma and various nonseminomatous germ cell tumors (NSGCT), such as teratoma, embryonal carcinoma, choriocarcinoma, and yolk sac tumor.
The cause of testicular cancer is not known, but men whose testes did not descend into the scrotum (cryptorchidism) by age 3 have a greater chance of developing testicular cancer than do men whose testes descended by that age. Cryptorchidism is best corrected surgically in childhood. Correcting cryptorchidism decreases the risk of testicular cancer. However, even if cryptorchidism is corrected, the risk of cancer is still higher than for men who never had cryptorchidism. Cancer can also occur in the other testis even if it descended normally. Sometimes in adults, doctors recommend removal of a single undescended testis to reduce the risk of cancer.
Symptoms of Testicular Cancer
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Testicular cancer may cause an enlarged testis or a lump. A testis normally feels like a smooth oval, with the epididymis attached behind and on top. Testicular cancer causes a firm, growing lump in or attached to the testis. With cancer, the testis loses its normal shape, becoming large, irregular, or bumpy. Although testicular cancer is usually painless, the testis or lump may hurt when lightly touched and may even hurt without being touched. A firm lump on the testis requires prompt medical attention. Occasionally, blood vessels rupture within the tumor, yielding a suddenly enlarged, severely painful swelling.
Rarely, the first symptoms of people with testicular cancer that has spread widely (metastatic cancer) are abdominal pain, low back pain, confusion or headaches, shortness of breath, and/or chest pain.
Diagnosis of Testicular Cancer
Ultrasonography
Blood tests (alpha-fetoprotein, human chorionic gonadotropin)
Physical examination and ultrasonography may indicate whether a lump is part of the testis and whether it is solid (and thus more likely to be cancer) or filled with fluid (cystic). Determining the blood levels of 2 proteins, alpha-fetoprotein and human chorionic gonadotropin, may help in making the diagnosis but is not definitive. The levels of these proteins often increase in men with testicular cancer. Additional testing, including chest x-rays and computed tomography, may be done to determine whether the cancer has spread. Most doctors recommend that young men check their own testes for lumps about once per month.
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Treatment of Testicular Cancer
Surgery
The initial treatment for testicular cancer is surgical removal of the entire affected testis (radical orchiectomy). An artificial testis (prosthesis) can be placed if the man desires. The other testis is not removed, so men retain adequate levels of male hormones and can remain fertile. Infertility sometimes occurs in men with testicular cancer, but fertility may return after treatment. Sperm banking may be recommended before treatment.
Subsequent treatment depends on the type of testicular cancer and extent of disease, which become clear after surgery. For most men, cancer is localized and in early stages. Computed tomography (CT) scans of the chest, abdomen, and pelvis as well as a physical examination and blood work (tumor markers) are done to rule out spread (metastasis) of the cancer. If it has not spread, the recommended treatment is active surveillance (close monitoring with periodic blood tests and CT scans).
In some men without evidence of metastases who have high-risk features, surgery to remove lymph nodes in the abdomen (retroperitoneal lymph node dissection) or 1 to 2 doses of chemotherapy may be recommended to lower the risk of recurrence.
In men with metastatic disease at the time of diagnosis or those who develop recurrence later, treatment options include chemotherapy, retroperitoneal lymph node dissection, or radiation therapy (for seminoma only). A combination of treatments often cures testicular cancer.
Prognosis for Testicular Cancer
The prognosis for men with testicular cancer depends on the type and extent of the cancer but is usually excellent if the cancer has not spread. Even if the cancer has spread, cure is often possible.
