National Cancer Institute


Posted Date: Jun 6, 2003

TABLE OF CONTENTS


Description

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What is cancer of the testicle?

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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 Explanation

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Stages of cancer of the testicle

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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

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Cancer is found only in the testicle.


Stage II

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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

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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

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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

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How cancer of the testicle is treated

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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

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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

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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

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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

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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).

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

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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.


Changes to This Summary (06/06/2003)

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The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.


To Learn More

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Call

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Web sites and Organizations

The NCI's Cancer.gov Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

LiveHelp

The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write

For more information from the NCI, please write to this address:

  • NCI Public Inquiries Office
  • Suite 3036A
  • 6116 Executive Boulevard, MSC8322
  • Bethesda, MD 20892-8322


About PDQ

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PDQ is a comprehensive cancer database available on Cancer.gov.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov, the NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ and are available online at Cancer.gov. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


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