Testicular Cancer


General Information

What is cancer of the testicle?

Cancer of the testicle (also called the testis), a rare kind of cancer in men, is a disease in which cancer (malignant) cells are found in the tissues of one or both testicles. Sperm (the male germ cells that can join with a female egg to develop into a baby) and male hormones are made in the testicles. There are two testicles located inside of the scrotum (a sac of loose skin that lies directly under the penis). The testicles are similar to the ovaries in women (the small sacs that hold the female egg cells).

Cancer of the testicle is the most common cancer in men 15 to 35 years old. Men who have an undescended testicle (a testicle that has never moved down into the scrotum) are at higher risk of developing cancer of the testicle than other men whose testicles have moved down into the scrotum. This is true even if surgery has been done to place the testicle in the appropriate place in the scrotum.

A doctor should be seen if there is any swelling in the scrotum. The doctor will examine the testicles and feel for any lumps. If the scrotum doesn't feel normal, the doctor may need to do an ultrasound examination, which uses sound waves to make a picture of the inside of the testes. The doctor may need to cut out the testicle and look at it under a microscope to see if there are any cancer cells. It is very important that this be done correctly.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the testicle or has spread to other places) and the patient's general state of health.

Stage Information

Stages of cancer of the testicle:

Once cancer of the testicle has been found, more tests will be done to find out if the cancer has spread from the testicle to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the testicle:

Stage I
Cancer is found only in the testicle.

Stage II
Cancer has spread to the lymph nodes in the abdomen (lymph nodes are small, bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).

Stage III
Cancer has spread beyond the lymph nodes in the abdomen. There may be cancer in parts of the body far away from the testicles, such as the lungs and liver.

Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the same place or in another part of the body. A patient should regularly examine the opposite testicle for possible recurrence for many years after treatment. Patients will probably have check-ups once per month during the first year after surgery, every other month during the next year, and less frequently after that.

Treatment Option Overview

How cancer of the testicle is treated:

There are treatments for all patients with cancer of the testicle, and most patients can be cured with available treatments. Four kinds of treatment are used:

-surgery (taking out the cancer in an operation)
-radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
-chemotherapy (using drugs to kill cancer cells)
-bone marrow transplantation

Surgery is a common treatment of most stages of cancer of the testicle. A doctor may take out the cancer by removing one or both testicles through an incision (cut) in the groin. This is called a radical inguinal orchiectomy. Some of the lymph nodes in the abdomen may also be removed (lymph node dissection).

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation therapy for testicular cancer usually comes from a machine outside the body (external-beam radiation).

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the testicle.

Bone marrow transplantation is a newer type of treatment. For autologous bone marrow transplant, bone marrow is taken from the patient and treated with drugs to kill any cancer cells. The marrow is then frozen and the patient is then given high-dose chemotherapy with or without radiation therapy to destroy all of the remaining marrow. The marrow that was taken out is then thawed and given back to the patient through a needle in a vein to replace the marrow that was destroyed.

Treatment By Stage

Treatment of cancer of the testicle depends on the stage and cell type of the disease, and the patient's age and overall condition.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in many parts of the country for all stages of cancer of the testicle. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Stage I Testicular Cancer
Treatment depends on what the cancer cells look like under a microscope (cell type). If a tumor called a seminoma is found, treatment will probably be surgery to remove the testis (radical inguinal orchiectomy), followed by external-beam radiation to the lymph nodes in the abdomen. Clinical trials are also being performed on radical inguinal orchiectomy alone followed by careful testing to see if the cancer comes back.

If a tumor called a nonseminoma is found, treatment may be one of the following:

1. Radical inguinal orchiectomy and removal of some of the lymph nodes in
the abdomen (lymph node dissection). Patients may undergo surgery that
will preserve fertility. Blood tests and chest x-rays must be done once
each month for the first year following the operation and at least every
2 months during the second year. A CT scan, a special kind of x-ray, may
also be done. If results of the tests don't look normal and the cancer
has recurred (come back), the doctor will give the patient systemic
chemotherapy as soon as possible.
2. Radical inguinal orchiectomy alone followed by careful testing to see if
the cancer comes back. Regular check-ups during the first 2 years
following surgery may include questions about the patient's post-treatment
period, a physical examination, and blood samples drawn for testing. A
computed tomographic scan (a diagnostic device used to take
cross-sectional images of the body) may also be used every 2 to 4 months
during the first year following surgery.

Stage II Testicular Cancer
Treatment depends on what the cancer cells look like under a microscope (cell type). If a tumor called a seminoma is found and the tumor is nonbulky (no lymph nodes can be felt in the abdomen, and no lymph nodes block the ureters [the tubes that carry urine from the kidney to the bladder]), treatment will probably be surgery to remove the testis (radical inguinal orchiectomy). External-beam radiation is then given to the lymph nodes in the abdomen.

If a tumor called a seminoma is found and the tumor is bulky (lymph nodes can be felt in the abdomen and/or the lymph nodes block the ureters, or if a CT scan shows them to be large), treatment will probably be a radical inguinal orchiectomy followed by systemic chemotherapy or external-beam radiation therapy.

If a tumor called a nonseminoma is found, treatment will probably be one of the following:

1. Radical inguinal orchiectomy and removal of the lymph nodes in the
abdomen (lymph node dissection). The doctor will check the patient each
month and do blood tests, chest x-rays, and CT scans. If the test results
are not normal, patients will probably receive systemic chemotherapy.
2. Radical inguinal orchiectomy and lymph node dissection, followed by
systemic chemotherapy. Blood tests and chest x-rays must be done once
each month for the first year after the operation. CT scans are also
done regularly.
3. Radical inguinal orchiectomy followed by systemic chemotherapy. If
x-rays following chemotherapy show that cancer remains, surgery may be
done to remove the cancer. After the operation, the doctor will check
the patient each month and do blood tests, chest x-rays, and CT scans. In
some cases, chemotherapy may be given before the radical inguinal
orchiectomy.
4. Clinical trials of systemic chemotherapy instead of lymph node dissection
(in selected patients).

Stage III Testicular Cancer
Treatment depends on what the cancer cells look like under a microscope (cell type). If a tumor called a seminoma is found, treatment will probably be surgery to remove the testis (radical inguinal orchiectomy), followed by systemic chemotherapy. Clinical trials are testing radical inguinal orchiectomy followed by systemic chemotherapy. If a tumor called a nonseminoma is found, treatment will probably be one of the following:

1. Systemic chemotherapy. Clinical trials are testing new chemotherapy
drugs.
2. Systemic chemotherapy, followed by surgery to take out any masses that
remain to see if there are any cancer cells left. If cancer cells
remain, patients will probably receive more systemic chemotherapy.
3. Clinical trials of systemic chemotherapy.
4. Clinical trials of high-dose systemic chemotherapy with autologous bone
marrow transplantation (in some patients).

Note: A review of patient outcome from patients who participated in the same clinical trial at different institutions from 1990 to 1994 has shown that institutions that enrolled more than 15 patients into the clinical trial had better 2-year survival rates than institutions that enrolled fewer than 5 patients. These results may indicate that the institution's experience in performing complicated treatments can have an impact on patient survival. However, these data are not conclusive because the differences that cause patients and health care providers to choose one institution or treatment are unclear.

Recurrent Testicular Cancer
Treatment depends on what the cancer cells look like under a microscope, where the cancer recurred (came back), and other factors. Treatment options include systemic chemotherapy, high-dose systemic chemotherapy with autologous bone marrow transplantation, surgery, and clinical trials testing new chemotherapy drugs.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.





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