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This year, more than 8,800 men will be shocked by a diagnosis of testicular cancer. The majority of these men will be young—15 to 35—an age when serious medical problems are not expected. The good news is that most will be cured.
Who Is at Risk for Testicular Cancer?
The incidence of testicular cancer is growing for reasons that are yet unknown.
The disease is more common in non-Hispanic white males than in men of other races or ethnicities and more common in men born with undescended testes.
There is an association between testicular cancer and male infertility, and some men are diagnosed with the cancer during an infertility workup.
Only 1 percent to 2 percent of patients with testicular cancer have a family history of the disease. No one is sure whether inherited genetic susceptibility is responsible for this phenomenon.
Symptoms That Should Be Checked Out
The most common symptom of testicular cancer is a painless mass in the scrotum. The mass may become painful if it grows rapidly, bleeds, or is injured by incidental trauma.
Testicular cancer that has spread through the blood or lymph system may cause symptoms in other areas, often manifesting as back pain, abdominal pain, coughing, or shortness of breath. The tumor may produce excessive amount of hormones, causing swelling in the breasts or tender nipples.
Examine Yourself
Because testicular cancer is relatively uncommon, monthly self-examinations are not necessary.
However, it may be worthwhile to examine yourself periodically.
It is normal to have testes that are not the same size. You want to feel for changes that occur. This means changes in size, shape, or firmness.
You also want to feel for nodules (bumps), masses (lumps), and tenderness. If any of these are present, or you have any of the symptoms mentioned above, see your physician or a urologist right away.
Diagnosing Testicular Cancer
The diagnosis of testicular cancer is made with a physical exam and confirmed with ultrasound.
If this painless test reveals the presence of a mass, your doctor will take a blood sample to be examined for tumor markers.
It is recommended that men with a solid mass have the testicle removed, even if these markers are normal, since the probability of having testicular cancer is so high.
Today, the testicle is removed through a small incision in the groin that leaves the scrotum intact. If you desire, the surgeon can replace the testicle with a prosthesis in the same operation.
What to Expect After Surgery
The testicle is sent to pathology for examination after removal. The pathologist will determine what type of cancer you have, and whether there is evidence the cancer may have spread through the blood vessels or lymph system.
There are five different types of testicular cancer, depending on which cells are involved.
The key distinction we look for is whether the cancer is seminoma or non-seminoma, as the prognosis and treatment differ significantly.
Seminoma is more common. Non-seminoma can contain a mix of five tumor types or be comprised of one kind of cell, but is not a seminoma.
With pathology results in hand, the urologist will repeat the blood test for tumor markers to ensure levels are falling into the normal range.
Your doctor also will order a computed tomography scan of the abdomen and pelvis and a chest X-ray to see whether the cancer has spread.
Treatment After Surgery
The need for treatment after surgery depends on whether the cancer is seminoma or non-seminoma, and whether it has spread.
The preferred treatment for seminoma that has not spread is observation. Some patients may be given one cycle of chemotherapy or a short course of radiation.
If the seminoma has spread to the abdomen, it may first be treated with chemotherapy or radiation therapy, depending on the size of the mass.
Larger masses are treated with chemotherapy, usually followed by surgical removal of the mass, since cancer cells may remain. Small lymph nodes in the abdomen that may harbor cancer cells may be treated with radiation.
A non-seminoma that has not spread may not need further treatment, but will be closely watched.
Specific attributes of the tumor may increase the risk it has spread, even if a CT scan and chest X-ray are normal. For these patients, surgical removal of the lymph nodes or two cycles of chemotherapy may be recommended.
Chemotherapy is typically recommended for men with evidence their cancer has spread, although certain patients with enlarged abdominal lymph nodes and normal tumor marker may be successfully treated with surgery.
Surgical removal of enlarged lymph nodes after chemotherapy is frequently necessary, because residual cancer cells may be present in up to half of patients.
Impact on Fertility and Potency
Chemotherapy and radiation can cause sterility, but the condition is usually temporary and reverses in two to three years.
Surgery involving the lymph nodes can affect the ability to ejaculate. However, new surgical techniques preserve nerve function, leaving ejaculation unaffected in 95 percent of men.
Be Your Own Advocate
Delay in diagnosing testicular cancer is common, because young men tend to be reluctant to access healthcare resources.
Even when they do seek help from a primary care provider, the rarity of testicular cancer may result in a misdiagnosis of epididymitis, for which a four-week course of antibiotics often is incorrectly prescribed.
As with any form of cancer, the earlier it is treated, the higher the likelihood it can be cured.
Be your own advocate. Conduct periodic self-examinations. If you notice any potential symptom of testicular cancer, see your doctor immediately and request an ultrasound, if it is not offered.
The good news is that 90 percent to 95 percent of men with testicular cancer are cured.
