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Testes

This information should not be used for self-diagnosis or in place of a qualified physician's care.

Reviewed March 2016

The basics
  • Guidelines for treating this cancer have been developed by the Genitourinary (GU) Tumour Group.
  • For health professional information on treating this cancer, please see our Cancer Management Guidelines.
  • This cancer is also called testicular cancer, testicular neoplasms, testis cancer, germ cell tumor of the testis, seminoma or nonseminoma.
  • The testes, or testicles, are the pair of male genital glands (gonads) that produce sperm and testosterone.
  • Testicular cancers usually grow from the gonadal cells that create sperm.
  • This cancer tends to occur in younger men (starting in the teens).
  • Early detection is important. It can result in a complete cure and less treatment.
  • Any lump felt in the testicles should be checked immediately.
  • Sexuality and fertility can worry newly diagnosed testicular cancer patients. Sexuality is not usually affected by treatment. 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.

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.
 
  • This is an uncommon cancer, but it is the most common cancer diagnosed in young male adults.
  • The cause of testicular cancer is not known.
  • Testicular cancer happens a bit more frequently in white men.
  • Men with a history of undescended testicle may have increased risk.
  • Men whose testicles have developed abnormally may have increased risk.
  • First-degree relatives of a person with testicular cancer may have an increased risk of developing this cancer.
  • Having had cancer in one testis increases the chances of a second cancer developing in the other testis.
  • Vasectomy does not increase the risk of testis cancer.
  • This cancer is usually diagnosed in men between ages 15 - 35, but it has been found in newborns and older men.
    • This is the most frequent cancer found in men between the ages of 20 to 44 years.
    • This is the third most frequent cancer found for males between ages 0 to 19.
  • The number (incidence) of testicular cancer cases is rising for unknown reasons. However 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.
  • There were 126 new cases of testicular cancer diagnosed in B.C in 2012.
  • Statistics

Can I help to prevent it?

There is no known way to prevent this cancer.

Screening for this cancer

  • No effective screening program exists for this cancer yet.
  • All men from their teens through their 30s are encouraged to do TSE (testicular self-examination). TSE performed monthly may help find this cancer early.
  • TSE is very 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 the right side of this page for links to recommended websites.
  • Men who have had a previous testis cancer should be regularly examined by a physician.

Signs and Symptoms

The following is a list of symptoms that may indicate a cancer of the testis. Sometimes there are no early symptoms for this cancer. Some of these symptoms may also be caused by conditions other than cancer.
 
  • 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 & staging
Diagnosis

These are tests that may be 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.
    • CT scan of pelvis, abdomen and chest (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 tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section.

Types and Stages

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.
      • The cure rate for 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 in adults, but occur more frequently in children.
    • Non germ cell tumours are usually treated surgically.

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)

Stage I
Tumour is confined to the testis.

Stage II
Involvement of the lymph nodes in the retroperitoneal area (back portion of the abdomen)

  • Non-bulky
  • Enlarged nodes less than 5 cm in size.
  • Bulky
  • Enlarged nodes, greater than 5 cm (2 inches)
Stage III
Extension beyond retroperitoneal lymph nodes

Treatment

Treatment

Cancer therapies can be highly individualized – your treatment may differ from what is described below.
 
  • Cure rate for patients with early stage seminoma and nonseminoma is almost 100%.
  • Depending on the type of treatment you receive, fertility may be a concern, and sperm banking may be desired.
  • Information on B.C. sperm banks is available from the Vancouver Centre Library.
Surgery
  • Surgery is usually the first treatment for all testicular cancers.
  • Radical inguinal orchiectomy is the removal of the testis plus spermatic cord, through a small cut made just above the pubic area. The surgeon ties off the spermatic cord before removal to prevent cancer cells from spreading.
  • The complete testis is sent to a pathologist for biopsy.
  • Removal of abdominal lymph nodes may be recommended depending on the type and stage of the cancer. This type of surgery is called retroperitoneal lymph node dissection, and it requires a larger incision in the abdomen.
Ongoing Surveillance (Follow-up) after Surgery
  • Following the orchiectomy and staging of the tumour, many patients with early disease (Stage I) need no further treatment.
  • All patients should be monitored for at least five years for potential recurrence of the cancer.
  • Initial assessment at a cancer centre is strongly recommended and then ongoing surveillance is the standard.
  • Follow-up visits will occur with a specialist several times per year for the first five years. Follow-up for the next five years should be done once a year and can be done by the family doctor.
  • Follow-up visits will include clinical examination, blood tests and imaging tests such as CT scans, or chest x-rays.
Chemotherapy
  • Early stage patients who are not able to comply with a surveillance program may be offered adjuvant chemotherapy.
  • Patients with more advanced stage seminomas and nonseminomas are offered chemotherapy.
  • Chemotherapy is also offered to patients with more advanced stage nonseminomas.
  • Chemotherapy may temporarily or permanently decrease the sperm count. If future fertility is a concern, patients might want to consider sperm banking. 
Radiation
  • Radiation therapy is no longer recommended as a routine therapy for early stage seminoma.
  • Radiation may be used for patients who are not able to undergo chemotherapy or ongoing surveillance.
  • Radiation therapy is a standard therapy for patients with Stage II A seminomas, and is a treatment option for patients with Stage II B seminomas
  • Radiation may also be used for recurrences of this cancer.

Follow-up after Treatment

  • You will be returned to the care of your family doctor or specialist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer Agency oncologist or nurse.
  • Follow-up testing is based on your type of cancer and your individual circumstances.
  • For cancer of the testis, ongoing surveillance for five to ten years is suggested, as detailed above.
  • Life after Cancer focuses on the issues that cancer survivors can face.
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SOURCE: Testes ( )
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