Several types of cancer may occur in the testicles. These are the small egg-shaped sex glands in men that produce sperm and hormones, especially testosterone. This site of cancer typically affects young males. When caught early, it is among the most curable forms of cancer.

The exact cause of testicular cancer is not known, and many men get the disease without having any of the associated risk factors. Testicular cancer is diagnosed in approximately 8,250 American men a year, according to the American Cancer Society. It accounts for about 1 percent of cancers in men but is the most common cancer in males from age 15 to 34. It is far more common in white men than in African American men.

Testicular cancer occurs when any of the various cells that make up the testicles become cancerous. Cancer results when the body cannot repair damage to DNA and cells reproduce abnormally and become malignant.

Testicular cancer is diagnosed through biopsy, blood tests and imaging diagnostic methods. The type of cell that becomes cancerous will influence the method of treatment the patient will receive, as well as the prognosis for recovery. In deciding on an appropriate treatment plan, physicians will use a technique known as staging that measures how far the cancer has spread in the body.

Treatment methods include chemotherapy, radiation therapy and surgical removal of the testicle. Some treatment methods result in infertility to the cancer patient. Men who have been diagnosed with cancer in one testicle are at increased risk of developing cancer in the other testicle. Patients are encouraged to do regular self–exams and to promptly report unusual symptoms to a physician.

Testicular cancer occurs in one or both testicles and typically affects younger men. When caught early, this type of cancer is among the most curable of all forms of the disease. However, the prognosis for some kinds of testicular cancer is guarded.

The testicles (also called testes) are two small egg-shaped glands in the scrotum, a sac of skin that hangs beneath the base of the penis in males. The testicles are the male sex glands that make sperm and hormones, such as testosterone. Sperm cells travel from the testicles to the vas deferens and on to the seminal vesicles, which produce fluid from the prostate gland that mixes with the sperm. The resulting fluid then travels through a tube in the center of the penis known as the urethra. The urethra carries urine and sperm at different times.

Testicular cancer occurs when any of the various cells that make up the testicles become cancerous. Cancer results when the body cannot repair damage to DNA and cells reproduce abnormally and become malignant. The type of cell that develops cancer will influence the patient’s type of treatment the patient will receive, as well as his prognosis for recovery.  

Some treatment methods result in infertility to the cancer patient. Because testicular cancer most often strikes young men, the disease can be a significant issue for those who plan to start or continue families. Patients may consider making arrangements to store samples of their sperm at a sperm bank before starting treatments.

The American Cancer Society estimates about 8,250 men in the United States  will be diagnosed with testicular cancer in 2006. It accounts for about 1 percent of cancers in men but is the most common cancer in males from age 15 to 34. The rate of testicular cancer is several times higher in white men than African American men, for unknown reasons.

The lifetime risk of dying from this disease is 1 in 5,000 and about 400 men are estimated to die from testicular cancer in 2006. According to the National Cancer Institute, the 5-year survival rate for all  men with this cancer is 95 percent. The survival rate increases to 99 percent if the cancer has not spread outside of the testicle. If the cancer has spread beyond the lymph nodes, the survival rate drops to 72 percent. Early detection greatly improves the prognosis for men with testicular cancer.

There are three major types of testicular cancer:

Germ cell tumors

More than 90 percent of testicular cancers start in the germ cells, according to the American Cancer Society. Germ cells in a male’s testicles form sperm. Most testicular germ cell tumors begin as carcinoma in situ (CIS), or cancer that has not spread from the area where it began. After about five years, these cancers may become invasive and spread to surrounding tissues and to other parts of the body through the blood or lymph system.

Germ cell tumors can be further divided into seminomas and nonseminomas:

• Seminomas. Testicular cancer that begins in immature germ cells. It accounts for somewhat less than half of germ cell tumors. Seminomas usually grow slowly, remain in the testicles and are diagnosed in early stages. If this cancer does spread, it tends to do so in a systematic manner that begins in the lymph nodes before moving on to the lungs. Spermatocytic seminomas are rare tumors that occur primarily in elderly men.
  
  
• Nonseminomas. Cancer that begins in mature, specialized germ cells. It accounts for more than half of germ cell tumors. Patients tend to get nonseminoma earlier in life (late teens to early 40s). These tumors are usually not found in early stages but may respond to treatment nonetheless. Subtypes are identified by the kind of cell in which they begin and include:
  
  
• Teratoma. Usually does not metastasize.
• Yolk sac carcinoma. More common in boys.
• Embryonal carcinoma. Often spreads.
• Choriocarcinoma. Rare, but can spread.

Many nonseminomas involve cancer in more than one type of cell, such as teratocarcinoma (a mixture of embryonal carcinoma and teratoma).

Stromal tumors

This cancer develops in the cells that make hormones and in the supportive tissues (stroma) of the testicles. These tumors usually are benign, meaning they are not cancer and do not spread beyond the testicle. In such cases stromal tumors can be cured by surgical removal of the testicle. In rare cases, malignant stromal tumors can metastasize. Chemotherapy and radiation therapy often are not effective in treating these cancers, and the prognosis may be poor. The two major types of stromal tumors are:

• Leydig cell tumors. Develop in the cells that make testosterone.
  
  
• Sertoli cell tumors. Develop in the cells that nourish sperm.

Secondary testicular tumors

This type of cancer begins in another part of the body and spreads to the testicles. Lymphoma is the most common source of these cancers. Testicular lymphoma is the most common type of testicular cancer in men over age 50. Surgery to remove the testicle is the typical treatment for this type of cancer, with systemic treatment of the primary lymphoma with chemotherapy and/or radiation therapy.The prognosis depends on the type and stage of lymphoma.

Other cancers that can spread to the testicles include those of the:

• Prostate
• Lung
• Skin
• Kidney
• Acute leukemia in children

The prognosis is usually poor in these cases, because the cancer that has spread to the testicle usually has spread to other organs as well.

The exact cause of testicular cancer is not known, and many men get the disease without having any of the associated risk factors. However, there are several risk factors that increase a person’s risk of getting testicular cancer. These include:

• Cryptorchidism. Failure of a testicle to descend into the scrotum during a boy’s development. About 14 percent of testicular cancer cases occur in men who have had this condition. Researchers believe that cryptorchidism is not a direct cause of cancer. Instead, they believe that another problem may cause both the risk of testicular cancer and cryptorchidism.
  
  
• Young age. Testicular cancer typically affects males ages 15 to 40. However, any male can be affected, from infants to the elderly.
  
  
• Race and ethnicity. The rate of testicular cancer in white American males has more than doubled in the past four years, according to the American Cancer Society (ACS). White American males are five to 10 times more likely to be diagnosed with testicular cancer than African-American men, and twice as likely to get testicular cancer as Asian-American men. The risk for Hispanic men is higher than that of Asian-Americans, and lower than that of non-Hispanic whites.
  
  Worldwide, the risk is greatest among men living in the United States and Europe, and lowest among African and Asian men.
  
  
• Family history. If a man gets testicular cancer, it is more likely that his brothers also will be diagnosed with the disease.
  
  
• HIV infection. Men infected with human immunodeficiency virus (HIV) appear to have a greater risk of testicular cancer. This is especially true of men who have AIDS.
  
  
• Carcinoma in situ (CIS).  CIS develops when germ cells form a tumor but do not invade surrounding normal tissues. CIS may become an invasive cancer after a number of years. There are no lumps or symptoms associated with CIS, but it is sometimes detected when a man is tested for infertility or when a man has had a testicle removed due to cryptorchidism (developmental failure of the testicles to descend into the scrotum) or trauma. 
  
  
• Cancer of other testicle. Men cured of cancer in one testicle have a 3 percent to 4 percent chance of being diagnosed with cancer in the other testicle, according to the ACS.
  
  
• Certain congenital conditions. Disorders that reduce male hormones, such as Klinefelter’s syndrome, increase the odds of getting testicular cancer.
  
  
• Moles. A condition that produces several moles appears to be linked to greater incidence of testicular cancer. The moles appear on the back, chest, belly and face.
  
  
• Body size. Recent research has indicated that men who are tall and slim may have the greatest risk of developing testicular cancer. Since this cancer is not a common disease, physicians believe that the health benefits associated with being thin outweigh the risk of developing the disease.

Testicular cancer does not always present or produce signs and symptoms. In many cases, it is found during an examination of another health problem – such as fertility problems – or during a general physical examination.

In some cases, men may exhibit the following signs or symptoms:

• Lumps, swelling or aching associated with the testicle. Lumps may be painless but can be uncomfortable. Heaviness or aching in the abdomen or scrotum, including fluid buildup, may also accompany these symptoms.
  
  
• Breast growth, or tenderness or swelling of breasts
  
  
• Loss of sex drive
  
  
• Growth of hair on face and body in males before puberty

Lower back pain is a symptom associated with advanced testicular cancer that is spreading. Symptoms that may indicate cancer has spread to the lungs include:

• Shortness of breath
• Chest pain
• Coughing
• Coughing up blood (hemoptysis)

The spread of testicular cancer will differ depending on which testicle has the disease:

• Right testicle. Spread by the spermatic cord and associated blood and lymph vessels into the lymph glands surrounding and between the large blood vessels. It can then spread to the aorta, the large trunk artery that carries blood from the left ventricle of the heart to the rest of the body, and the inferior vena cava, the large vein that receives blood from the lower part of the body and empties into the heart’s right atrium.
  
  
• Left testicle. Spreads from the spermatic cord and associated vessels into the left kidney artery and venous lymphatic areas. It then moves to the lymph nodes alongside the aorta.

After testicular cancer has spread to the lymph nodes, it may next spread to the lungs. In advanced cases, it may progress to the liver, bones and brain.

Patients who experience symptoms typically associated with testicular cancer should immediately report them to a physician. The earlier the cancer is diagnosed, the more effective treatment is likely to be. In addition, these symptoms may indicate a benign disorder, such as an injured or infected testicle.

A physician will perform a physical exam and take a medical history from the patient. The physician will feel the testicles for any signs of swelling, tenderness or lumps and check the abdomen for signs of enlarged lymph nodes or liver.

Tests that may be performed include:

• Blood tests. Many cancers produce proteins and enzymes that can be revealed in blood tests. The levels of these substances might indicate how much cancer is present, how well a treatment is working or whether or not a tumor has recurred. The substances that indicate testicular cancer are called tumor markers, and include:
  
• • Alpha-fetoprotein (AFP)
  • Beta-human chorionic gonadotropin (beta-hCG)
  • Lactate dehydrogenase (non-specific)
    
    
  Elevated levels of alpha-fetoprotein and beta–human chorionic gonadotropin typically indicate a testicular tumor, even when x-rays and other examination techniques do not find cancer. Once a diagnosis has been made, these levels can be checked regularly to monitor the effectiveness of treatment and for any signs of recurrence.
  
  
• Biopsy. When lumps are found, they are surgically removed and sent to a lab to be examined under a microscope. The pathologist at the lab will examine the tissue for the presence of cancer cells. In most cases, the entire testicle will be removed as well as the spermatic cord that carries sperm, blood and lymph. Involved lymph nodes will also be removed. This is done to try to ensure that the entire tumor is removed and no cancer remains in the body.
  

Additional imaging studies may be performed to determine whether the cancer has spread to other areas of the body. Such tests include:

• Ultrasound. A test that uses sound waves to create an image of internal organs that is then displayed on a computer screen. This can help reveal if a mass is fluid-filled or solid, which is more likely to be cancer.
  
  
• Chest x-ray. Determines whether cancer has spread to the lungs.
  
  
• Computed axial tomography (CAT) scan. Takes several images to create visual cross-sectional views of the body. This can help reveal if the cancer has spread to surrounding tissues and other areas of the body.

• Magnetic resonance imaging (MRI). Uses radio waves and strong magnets instead of x-rays for images that are similar to but more detailed than CAT scans.
  
  
• Positron emission tomography (PET) scan. Radioactive sugar substance is injected into the vein and collects in cancerous tissue. A computer detects the cancerous areas as “hot spots.” PET scans can also help reveal whether enlarged lymph nodes are the result of invading cancer.

There are three major options for treating testicular cancer. They include:

• Orchiectomy. In some cases, surgery may be necessary to remove the testicle (radical inguinal orchiectomy) and some of the lymph nodes (retroperitoneal lymph node dissection). If both testicles are removed, the patient will become infertile. In addition, the removal of a testicle will leave an empty space in the scrotum that may make some men uncomfortable. In such cases, a prosthetic testicle filled with a saline solution can replace the look and feel of the missing testicle. Lymph nodes also may be removed, either during the same procedure or during a separate operation.
  
  Surgery to remove the lymph nodes may result in damage to the nerves that control ejaculation (sexual climax). The damage can cause the sperm to remain in the man’s body and travel to his bladder. For this reason, the surgery may result in infertility for the man, despite being able to have an erection. Surgeons attempt to use nerve-sparing surgery whenever possible to avoid this complication.
  
  
• Radiation therapy. A treatment that uses high-energy x-rays or other types of radiation to destroy cancer cells. Seminoma testicular cancer is highly sensitive to radiation therapy.
  
  
• Chemotherapy. A treatment that uses one or more powerful medications to identify and destroy cancer cells. Seminoma and nonseminoma testicular cancers are highly sensitive to chemotherapy.

Men who have been diagnosed with testicular cancer are at increased risk of developing cancer in the other testicle. Patients are encouraged to do regular self-exams and to promptly report changes or unusual symptoms to a physician.

In addition, regular examinations are crucial to maintaining long–term health. Patients are likely to have checkups on a monthly basis in the first year after surgery, followed by bimonthly visits the second year and semi-regular visits thereafter.

There is no known way to prevent testicular cancer as the primary risk factors cannot be changed.  However, males who have risk factors associated with the disease are urged to do monthly self-exams and promptly report any irregularities to a physician. Some physicians do not recommend these self-exams for men who do not have risk factors associated with the disease, while others do. Men should consult with their physician about whether or not to perform these exams.

If a self-exam is recommended, it is best performed in front of a mirror after a warm shower or bath. It includes:

• Inspecting the scrotum for any swelling
  
  
• Resting each testicle between both thumbs and both index and middle fingers
  
  
• Gently rolling each testicle to note any change in size, shape, etc.
  
  
• Notifying a physician of any lumps or other irregularities

Staging is the process used to determine if cancer has spread in the body and how far it has spread. Staging is very important as it helps determine the best course of treatment for a patient's cancer. Stages for testicular cancer are stage 0 to stage III, as follows:

• Stage 0. The cancer is carcinoma in situ (CIS), meaning it is only found in one place, is not invasive and has not spread to other tissue. At this point, it may be called a precancerous state. Abnormal cells are found only in the tiny tubules where sperm cells develop and do not infiltrate normal tissues. Tumor marker levels remain normal.
  
  
• Stage l. Cancer has not spread to lymph nodes or distant organs. Blood tests remain normal.
  
  
• Stage ll. Cancer has spread to nearby lymph nodes, but not in lymph nodes in distant areas.
  
  

• Stage lll. Cancer has spread to distant lymph nodes and/or organs, such as the lung, liver or brain.
  

• Recurrent. After being removed, cancer has returned to other testicle or to another site.

Testicular cancer can also be placed into one of three groups that categorize a cancer based on how well it is likely to respond to treatment. They include:

Good prognosis

Intermediate prognosis

Poor prognosis

Five-year survival rates are very high in those treated for testicular cancer, according to the American Cancer Society. They are:

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about testicular cancer:

1. Should all men perform self-examinations for testicular cancer?
   
   
2. Am I considered high or low risk for this cancer?
   
   
3. What is the best way for me to conduct self-examinations?
   
   
4. What tests will I need to determine if I have testicular cancer?
   
   
5. What type of cancer do I have and at what stage?
   
   
6. What is the best form of treatment for my cancer?
   
   
7. What are the risks associated with these treatments?
   
   
8. What is the prognosis based on the type and stage of my cancer?
   
   
9. If I have surgery, how will it affect my sexual function and fertility?
   
   
10. Will I be able to have a prosthesis if my testicle is removed?
    
    
11. How and when will that procedure be performed?
    
    
12. What are the chances of the cancer developing in my other testicle?
    
    
13. Should I undergo any different screening procedures based on my family and medical history?
    
    
14. If I have a child with testicles that did not drop, should he receive any different tests?
    
    
15. What are the chances of my son developing testicular cancer if I have it?