About Testicular Cancer

Testicular cancer is a cancer that occurs in the testicles (testes). The testes are located inside the scrotum, a loose bag of skin underneath the penis. The testicles produce male sex hormones and sperm for reproduction. Compared with other types of cancer, testicular cancer is rare. But testicular cancer is the most common cancer in American males between the ages of 15 and 34. The cause of testicular cancer is unknown.

Testicular Cancer Statistics

In the United States, between 7,500 and 8,000 diagnoses of testicular cancer are made each year. However, only 400 men are expected to die of the disease. Much of this improvement is due to advances in adjuvant therapy. 

Testicular Cancer Risk

Over his lifetime, a man's risk of testicular cancer is roughly 1 in 250 (four tenths of one percent, or 0.4%). Only 5% of those diagnosed with testicular cancer are  expected to die of the disease.

Prevalence

Testicular cancer is most common among Caucasians and rare among men of African descent. Worldwide incidence has doubled over the past fifty years, with the highest rates of prevalence in Scandinavia, Germany, and New Zealand.

Although testicular cancer is most common among men aged 15-40 years, it has three peaks: infancy, ages 25-40 years, and age 60 years.

Testicular Cancer Risk Factors

A major risk factor for the development of testis cancer is cryptorchidism (undescended testicles). Other risk factors include inguinal hernia, mumps orchitis.

Physical activity is associated with decreased risk and sedentary lifestyle is associated with increased risk. Early onset of male characteristics is associated with increased risk. These may reflect endogenous or environmental hormones.

Testicular Cancer Signs and Symptoms

• The testicle should normally feel smooth to the touch. Ridges may be felt because of enlarged blood vessels or tumor growth. Additionally the entire testicle may feel hard and bumpy to the touch.
• Abnormal sensitivity (either numbness or pain)
• loss of sexual activity
• sexual withdrawal
• build-up of fluid in the scrotum
• a dull ache in the lower abdomen or groin
• an increase, or significant decrease, in the size of one testis
• blood in semen
• General weak and tired feeling
• The testicle with a tumor may be severely enlarged, as much as 3 times the original size. Simultaneously the other testicle may be shrunken in size, due to the tumor taking up the majority of the blood supply to the scrotum.

Testicular Cancer Diagnosis

The cardinal diagnostic finding in the patient with testis cancer is a mass in the substance of the testis. Unilateral enlargement of the testis with or without pain in the adolescent or young adult male should raise concern for testis cancer. Several tests and exams are useful in identifying and assessing the severity of testicular cancer.  Tests may include:

• Scrotal ultrasound. The nature of any palpated lump in the scrotum is evaluated by scrotal ultrasound, which can determine exact location, size, and some characteristics of the lump, such as cystic vs solid, uniform vs heterogeneous, sharply circumscribed or poorly defined.
• CT Scans.The extent of the disease is evaluated by CT scans, which are used to locate metastases.
• Blood tests. Blood tests are also used to identify and measure tumor markers that are specific to testicular cancer. AFP alpha1 feto protein, Beta-HCG, and LDH are the typical markers used to identify testicular cancer. The diagnosis is made by performing an orchiectomy, surgical excision of the entire testis along with attached structures epididymis and spermatic cord; the resected specimen is evaluated by a pathologist. A biopsy should not be performed, as it raises the risk of migrating cancer cells into the scrotum. The reason why inguinal orchiectomy is the preferred method is that the lymphatic system of the scrotum links to the lower extremities and that of the testicle links to the retroperitoneum. A transscrotal biopsy or orchiectomy will potentially leave cancer cells in the scrotum and create two vectors for cancer spread, while in an inguinal orchiectomy only the retroperitoneal route exists.The differential diagnosis of testicular cancer requires examining the histology of tissue obtained from an orchiectomy specimen. Orchiectomy, rather than transcrotal biopsy, is preferred to reduce the risk of spill and thus the risk of metastasis, in the event that the tumor is malignant. For orchiectomy, an inguinal surgical approach is preferred.
  

Testicular Cancer Self Exam

A simple procedure called testicular self-exam (TSE) can increase your chances of finding a tumor early.

It is important for men to become familiar with the size and feeling of their normal testicles, so that they can detect changes if they occur. Because testicular cancer is curable (stage I can have a success rate of >95%) when detected early.  Men should examine each testicle, feeling for pea-shaped lumps.

Men should perform testicular self-exams once a month, after a warm bath or shower. The heat causes the scrotal skin to relax, making it easier to find anything unusual. Testicular self-exams are simple and only takes a few minutes. 

During a testicular self exams men should examine each testicle, feeling for pea-shaped lumps.If they find a lump they should see a physcian immediately for further diagnosis.

Testicular Cancer Prognosis

Testicular cancer has one of the highest cure rates of all cancers: in excess of 90%; essentially 100% if it has not metastasized.

Even for the relatively few cases in which malignant cancer has spread widely, chemotherapy offers a cure rate of at least 85% today.