Posted Date: Jun 6, 2003
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.
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:
Cancer is found only in the testicle.
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).
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 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.
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 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 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.
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:
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:
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:
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.
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.
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