• Patients with testicular cancers are treated by members of the BC Cancer Agency’s Genitourinary (GU) Tumour Group.
• For healthcare professional information on treating this cancer, please see our Cancer Management Guidelines.
• The testes (or testicles) are the male genital glands (gonads) that produce sperm and testosterone. The plural is testes, the singular is testis.
• Testicular cancers usually grow from the gonadal cells that create sperm.
• These cancers are uncommon but can be very malignant.
• Usually, the cancer is only in one testis.  Tumours of both testes are uncommon. 
• This cancer tends to occur in younger men (starting in the teens).  Highest incidence (peak) is in the 30’s.
• Early detection is important.  It can result in a complete cure and less treatment.
• Very few lumps in the testes are harmless, so all lumps should be checked immediately.
• Sexuality and fertility can worry newly diagnosed testicular cancer patients.  Sexuality is not usually affected by treatment.  If the ability to sustain an erection is affected by treatment, there are ways to restore sexuality. For men with concerns about fertility, sperm banking is available.  Please discuss these issues with your oncologist.  The BC Cancer Agency Library is able to provide information about sperm banking in British Columbia.
• Links to the best websites on sexuality and fertility.

What causes it and who gets it?
Listed below are some of the known causes of this cancer.  Not all of the risk factors below may cause this cancer, but they may be contributing factors.

• The cause of this type of cancer is not known.
• Testicular cancer happens a bit more frequently in white men.
• It can happen in a man with a history of undescended testicle.
• It can happen in a man whose testicles developed abnormally.
• Rarely, there may be a family tendency to testicular cancer.
• The age range is usually between 15 - 35, but it has been found in newborns and older men.
• If you’ve had cancer in one testicle, it’s more likely that you’ll get a second cancer in your other testicle.
• This is an uncommon cancer, but is the most common cancer for young male adults.
• This is the most frequent cancer for men between 20 and 34 years old.
• This is the second most frequent cancer for men aged 35 to 39 years old.
• This is the third most frequent cancer for those between ages 15 and 19.
• These days, death from testicular cancer is rare.
• The number (incidence) of testicular cancer cases is rising for unknown reasons.  Mortality rates have dropped sharply since 1994 and are continuing to decline, in spite of the rising number of cases.  This is mainly because of improvements in treatment.
• In 2010, it is estimated that there will be 115 new cases of testicular cancer in B.C.
• Statistics
• BC
• Canada

Can I help to prevent it?

• There is no known way to prevent this cancer.

Screening for this cancer

• There is no screening test available for testicular cancer.
• All men from their teens through their 30s are strongly encouraged to do TSE (testicular self-examination).  TSE performed monthly may help find this cancer early.  It’s easy to learn and only takes a couple of minutes. 
• TSE is even more important for individuals with
• a history of abnormal descent of the testicle (undescended testicle.)
• a close family member has been diagnosed with testicular cancer.
• having a previous cancer of the other testicle.  
• Most websites with information on testicular cancer will also have information on TSE.  See at the bottom of this page for some links to good websites.

Signs and Symptoms

• Sometimes there are no symptoms. 
• An enlarged testicle is the most common sign.
• A painless lump in the testicle.
• A dull ache in the groin, abdomen or back.
• A feeling of heaviness in the scrotum, the sac that holds the testes.
• A build-up of fluid in the scrotum.
• Shortness of breath from spread to lungs (uncommon).
• Hormonal imbalance that causes breast enlargement (rare).

Diagnosis
This is a list of some or all of the tests used to diagnose this type of cancer.  

• Complete medical history.
• Physical examination.
• Laboratory tests focus on blood particularly.  In addition to other blood tests, the three main tumour markers are:
• HCG (Human chorionic gonadotropin)
• AFP (Alpha feto protein)
• Both HCG and AFP detect substances secreted by the cancer which act as "tumour markers".  They can also tell whether or not patient is responding to treatment.
• LDH (Lactate dehydrogenase) may be useful sometimes, but is not as specific for testis cancer as HCG and AFP.
• Ultrasound scanning of the scrotum.
• The biopsy of the testicle is not done until the actual surgery for removal of the testicle.
• Once a diagnosis of testicular cancer is confirmed, then the doctors need to check and see if the cancer has spread.  These are some of the tests that may be done:
• Chest X-ray.
• CAT scan of abdomen (usually done after removal of the affected testicle).
• If the scans are not definite, or are unclear, the doctor might want to take some lymph nodes (lymphadenectomy) from the retroperitoneum in a second surgical procedure.
• For more information on all cancer diagnostic tests, see our Recommended Websites, Diagnosis section.

Types and Stages
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.

• T  describes the site and size of the main tumour (primary)
• N  describes involvement of lymph nodes
• M  relates to whether the cancer has spread (presence or absence of distant metastases)

Types (histology)

• Germ cell tumours – these are divided into two groups:
• Seminomas
• This is the most common type (75% of cases) and is usually confined to the testicle.
• Cure rates in seminomas is close to 100%.
• Seminomas are slower-growing than non-seminomas.
• They are very sensitive to radiation and/or chemotherapy.
• Seminomas are more common in the 25 to 45 age group.
• Tumours that are found to contain both seminoma and nonseminoma cells are treated as nonseminomas.
• Nonseminomas
• All germ cell cancers which are not pure seminomas are called nonseminomas.  They are also known as a “mixed germ cell tumour”.
• These tumours can spread through the bloodstream.
• They usually occur in men in their mid-twenties.
• Nonseminomas are less sensitive to radiation but are very sensitive to chemotherapy.
• Nonseminomas are composed of various cell types:
• Teratomas.
• Embryonal-cell tumour (aggressive tumour).
• Yolk sac carcinoma - very rare in adult men.  Usually found in children under 15, which accounts for 90% of those cases.
• Choriocarcinomas (rare but very malignant).
• Teratocarcinoma - mixture of embryonal cell carcinoma and teratoma.
• Some others may be mixed-cell types.
• Non germ cell tumours
• These tumours are rare.
• Non germ cell tumours are usually treated surgically.

Treatment 
Cancer therapies can be highly individualized – your treatment may differ from what is described below.

• A sperm sample should be taken and analysed, if fertility is an issue.
• Sperm banking may be what the patient wants.  Information on B.C. sperm banks is available from the Vancouver Centre Library.
• Cure rate for patients with early stage seminoma and nonseminoma approaches 100%.

Surgery

• Surgery is usually the first, best treatment and is required for a final diagnosis.  Orchiectomy is the removal of the testicle.  The surgeon takes the whole testicle because taking only part of the testicle could cause any cancer to spread to the other testicle.   What happens during a radical orchiectomy:
• An incision (a cut) is made through the groin.
• The affected testicle is removed.
• If cancer has not involved the scrotum an artificial testicle can be inserted, usually in another operation later.
• If one testicle is removed, testosterone and sperm counts usually rise within a few months to normal levels, because the remaining testicle starts producing more.
• If both testicles are removed (very rare) the patient will become infertile and will also require male hormone replacement.
• Orchiectomy is usually all the treatment required for a Stage I seminoma.
• Lymph node removal is not usually necessary in seminomas because a CT scan works well to find any affected lymph nodes.
• Lymph node removal is sometimes performed in patients who have nonseminomas if some cancer remains after chemotherapy. It consists of removing all of the lymph nodes on one side of the abdomen up to the kidneys. If necessary, it may be done on both sides.  
• An uncommon complication of lymph node removal is failure of ejaculation.  A man with one testicle may continue to produce active sperm but after lymph node removal the sperm may not be able to make their way out of the penis when he ejaculates.   New surgical techniques can sometimes avoid this problem, and sperm can still be harvested from the remaining testicle. 
• Chemotherapy may be required if cancer is found to be present in the lymph nodes at the time of surgery. 

Surveillance of Stage I Seminomas

• After surgery and staging have been done, usually no further treatment is needed for most of these patients.
• Less than 20% of these patients have their cancer return after surgery. 
• If the cancer returns, almost all (close to 100%) are cured with further treatment.
• A cancer recurrence (return of the cancer) usually happens in the first 2 years after surgery.
• These patients need to have regular visits with their doctor to make sure the cancer has not come back.  These followup visits need to happen for up to 10 years after their diagnosis was made.
• Followup tests can include CT scans, blood tests and chest x-rays.  These tests will decrease over time.

Radiation

• For seminomas, radiation therapy is one of the standard treatment options after orchiectomy for:
• non-bulky Stage II seminomas.
• Stage I seminomas for men who are unable to be part of the surveillance program, or who strongly prefer further treatment.
• The radiation is directed to the abdominal lymph nodes and occasionally the pelvic lymph nodes.
• Steps can be taken to minimize the risk of infertility (see sperm bank information above):
• The design of how the radiation fields will hit the body.
• Shielding areas of the body with lead. 
• If the seminoma has advanced, chemotherapy may be given (with or without radiation), which also has good cure rates.

Chemotherapy

• For nonseminomas, chemotherapy might be used; radiation is rarely used.  
• The chemotherapy treatment that is required is strong and side effects are unavoidable, but the program is short at 3 - 4 months. 
• Patients with Stage I seminoma who are unable to comply with the surveillance program or have a strong preference for treatment may be offered 2 cycles of chemotherapy.
• Alopecia (hair loss) will occur but hair will return within two to six months after chemotherapy is stopped.
• Chemotherapy may temporarily or permanently decrease the sperm count.  The patient might want to consider sperm banking. (see sperm bank information above)
• 80% - 90%  of recurrences happen in first 2 years after treatment.

Follow-up after Treatment

• You will be returned to the care of your family doctor or specialist for regular follow-up.
• Follow-up testing is based on your type of cancer and your individual circumstances.
• The BCCA Survivorship Research Centre focusses on the issues that cancer survivors can face.

Coping with Cancer

The Coping with Cancer section of our website is a joint project among different BC Cancer Agency departments and programs. This website section provides information and links that can help cancer patients with the physical, emotional, psychological and practical aspects of care. Each cancer experience is different, but in one way or another, many cancer patients share the same needs.

The effects of cancer and its treatment can present unique challenges: from practical concerns like money and housing, to emotional concerns like anxiety and grief. If you need support with the practical and emotional impacts of cancer, or in managing symptoms and side effects you can use the information in Coping with Cancer to connect to these resources.

Search our library catalogue

• The BC Cancer Agency Library has many resources about cancer, coping, talking to children, etc.  Please visit the Library in your Centre, call a librarian, or visit the Library online to see the many resources available.
• Automatically get a bibliography of books, videos and other items available through our library.

Recommended websites 
The BC Cancer Agency has selected and evaluated these useful websites for your further information.

Testicular cancer
Fertility and sexuality
Cancer in young adults
Websites for cancer survivors, and how to stay healthy after treatment.

How can I help with research at BCCA?
BC Cancer Agency patients are very helpful when it comes to the fight against cancer.  Here are a few ways that you can help:

• The BCCA is deeply involved in cancer research.  We operate various Research Programs, the BC Cancer Research Centre and Canada's Michael Smith Genome Sciences Centre.
• Clinical Trials – join our treatment-based research.  Ask your oncologist if you qualify for a clinical trial. What are the pros and cons of joining a clinical trial?
• Tumour Tissue Repository – support our research by donating some of your cancer tissue.
• BC Cancer Foundation – support our research with a donation of money.

This information is awaiting Tumour Group approval.