Testicular Cancer
Most testicular cancers develop in men younger than age 40. Among the types of cancer that develop in the testes are seminoma, teratoma, embryonal carcinoma, and choriocarcinoma.
The cause of testicular cancer is not known, but men whose testes did not descend into the scrotum (cryptorchidism (see Section 23, Chapter 267)) by age 3 have a greater chance of developing the disease than do men whose testes descended by that age. Cryptorchidism is best corrected surgically in childhood. Sometimes, removal of a single undescended testis in adults is recommended to reduce the risk of cancer.
Symptoms and Diagnosis
Testicular cancer may cause an enlarged testis or a lump elsewhere in the scrotum. Most lumps elsewhere in the scrotum are not caused by testicular cancer, but most lumps in the testes are. A testis normally feels like a smooth oval, with the epididymis attached behind and on top. Testicular cancer produces a firm, growing lump in or attached to the testis. With cancer, the testis loses its normal shape, becoming large, irregular, or bumpy. Although testicular cancer is often painless, the testis or lump may hurt when lightly touched and may even hurt without being touched. A firm lump on the testis requires prompt medical attention. Occasionally, blood vessels rupture within the tumor, yielding a suddenly enlarged, severely painful swelling.
Physical examination and ultrasound scanning may indicate whether a lump is part of the testis and whether it is solid (and thus more likely to be cancer) or filled with fluid (cystic). Determining the blood levels of two proteins, alpha-fetoprotein and human chorionic gonadotropin, may help in diagnosis. The levels of these proteins often increase in men with testicular cancer. If cancer is suspected, surgery to examine the testis is performed.
Treatment
The initial treatment for testicular cancer is surgical removal of the entire affected testis (radical orchiectomy). The other testis is not removed, so the man retains adequate levels of male hormones and remains fertile. Infertility sometimes occurs with testicular cancer but may subside after treatment.
With certain types of cancers, lymph nodes in the abdomen are also removed (retroperitoneal lymph node dissection) because the cancer often spreads there first. Radiation therapy may also help, especially for a seminoma.
A combination of surgery and chemotherapy often cures testicular cancer that has spread. Blood levels of alpha-fetoprotein and human chorionic gonadotropin that were elevated at diagnosis decline after successful treatment. If levels rise after treatment, the cancer may have recurred. After surgery and any other necessary treatments are completed, a surgeon can replace the removed testis with an artificial one.
The prognosis for a man with testicular cancer depends on the type and extent of the cancer. Almost all men with seminomas, teratomas, or embryonal carcinomas that are not widespread survive 5 years or more. Most men with cancer that has spread survive 5 years or more. However, very few men with choriocarcinomas, which spread rapidly, survive even 5 years.
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