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Testicular Cancer

Testicular Cancer Symptoms and Causes

The Urologic Oncology Program at the North Shore-LIJ Health System brings together experts from departments including Urology, Radiation Medicine and Medical Oncology. Among the conditions the Urologic Oncology Program treats are testicular cancer, prostate cancer, kidney cancer and bladder cancer.

In conjunction with the Department of Radiation Medicine, the Urologic Oncology Program utilizes advanced therapies in the treatment of testicular cancer, including the use of the Calypso© Localization System, an innovative procedure using miniature sensors that track the movement of the prostate, ensuring a more accurate application of the treatment.

Urology specialists at the Arthur Smith Institute for Urology offer superior comprehensive and multidisciplinary treatments of prostate cancer and other urologic malignancies, including:

  • Minimally-invasive surgeries
  • Novel chemotherapeutic protocols
  • Immunotherapy — a type of treatment that uses the body's immune system to halt the growth of cancer cells and usually produces fewer side effects
  • Cryoablation — a minimally-invasive treatment using extreme cold to freeze and kill cancer cells
  • Robotic Surgery
  • Radiation Therapy

Testicular Cancer: An Overview

Testicular cancer is the most common solid malignancy diagnosed in men between the ages of 15-34. In the United States, it is estimated that over 8,000 men will be diagnosed with testis cancer in 2011. Although these tumors are relatively uncommon accounting for only 2% of all malignancies, the incidence of testicular cancer is rising.

The treatment of testicular cancer has become a paradigm for many other cancers with the integration of surgery, chemotherapy, and radiation therapy achieving cancer control rates of greater than 90% in all patients and 70-80% of patients with advanced disease.

What Are the Risk Factors for Testicular Cancer?

No specific genetic cause has been identified in the etiology of testis cancer. There are, however, several risk factors associated with its occurrence:

  • Cryptorchidism (undescended testes) — This is a condition in which the testicles fail to descend into the scrotum in early infancy.
  • Positive family history — Researchers have noted that patients with a family history of testicular cancer (father, brother) are at increased risk as compared to the general population.
  • Previous diagnosis of testicular cancer — Approximately 2-3% of testicular tumors are bilateral. Therefore, patients with a previous diagnosis are at increased risk of developing testicular cancer in the remaining testicle and require close follow up.
  • Testicular dysgenesis, Klinefelter's syndrome — These are rare diseases in which patients have higher than normal rates of the development of testicular cancer.

As with women and breast cancer, the only method of prevention of the complications and mortality associated with testicular cancer is early diagnosis. All men starting at age 15 should perform regular self-examinations.

What Are the Types of Testicular Cancer?

There are two types of tumors that arise from the testicle:

  • Germ cell tumors — These tumors are the most common type and account for over 90% of all cases.
  • Stromal tumors — These tumors are less aggressive and rarely affect more than 10% of all patients with testicular cancer.

Although the precise causes of testicular cancer are unknown, these tumors, like all cancers, start with a change in the cellular DNA that leads to uncontrolled cellular growth.

What Are the Symptoms of Testicular Cancer?

Typically, testicular cancer that is confined to the testis is not associated with any specific symptoms. The most common presentation is a painless, lump that is found in the scrotum on self-examination. Less commonly, patients will present with scrotal/testicular pain or swelling.

Due to the relatively asymptomatic presentation of testicular cancer, some patients will not be diagnosed until the cancer has spread to the lymph nodes or other organs. In these cases, the symptoms are often unrelated to the testicle, but rather, related to the part of the body with metastatic cancer. These patients may have symptoms such as:

  • Fatigue
  • Fevers/chills
  • Nausea/vomiting
  • Shortness of breath
  • Cough
  • Persistent back pain
  • Breast enlargement if the cancer arises from stromal cell tumors

How Is Testicular Cancer Diagnosed?

The first test usually ordered by your doctor will be a testicular ultrasound. The ultrasound images will confirm that the lump that is felt on physical examination is in the testicle and not in one of the other scrotal structures.

The testicle is surrounded by the epididymis and the vas deferens. These anatomic structures are involved in the maturation process of sperm. Although benign tumors of the epididymis are common, cancerous tumors are extremely rare. Therefore, if a nodule is found in the epididymis, your doctor may recommend that it be followed and not treated.

Once the ultrasound confirms the presence of a lesion in the testicle, your doctor will order a series of laboratory tests to help determine the type of testicular cancer as well as the stage of the cancer (to what extent the tumor has spread):

  • AFP (alpha-fetoprotein)
  • Beta-hCG (human chorionic growth hormone)
  • LDH (lactate dehydrogenase)

Unfortunately, none of the above laboratory tests or imaging studies can reliably determine whether a testicular lesion is indeed a cancer. Therefore, the next step is to undergo surgery to remove the affected testicle (orchiectomy). Prior to surgery, your doctor may also discuss sperm banking with you.

Finally, your doctor will order imaging studies, usually a CT scan (or in some cases, a MRI), of the chest, abdomen and pelvis. These scans are done in order to determine if the cancer has spread to the lymph nodes and/or other organs in the body.

Once all of these tests/procedures have been done and the pathology report has been reviewed, your doctor will have a full discussion with you about the recommended treatment.

How Is Testicular Cancer Treated?

The treatment of testicular cancer has evolved into one of the most successful in oncology. With current treatment regimens, testicular cancer can be cured in over 90% of patients. Even in cases with Stage IV disease, long-term control rates can be achieved in 70-80% of patients (typically, stage IV cancers have very low five-year survival rates). The treatment of testicular cancer involves a truly multidisciplinary approach. A combination of aggressive surveillance, surgery, chemotherapy, and/or radiation therapy may be employed in the treatment strategy. The primary two factors that are involved in the decision making are the pathology (seminoma versus NSCGT) and the stage of the disease (the extent to which the cancer has spread).

  • Surveillance or Expectant Management — Surveillance (expectant management) refers to close monitoring of the tumor until there is a need for further therapy (surgery or chemotherapy). This approach is generally recommended for patients who do not have any spread of the cancer outside the testicle and whose cancer does not appear to have aggressive features on the pathology assessment.
  • Surgery — For patients with tumors that have a high risk of spread to the lymph nodes in the abdomen, the doctor may recommend surgery to remove these lymph nodes. This surgery is referred to as a retroperitoneal lymph node dissection (RPLND).
  • Chemotherapy — Patients with NSGCT without definite spread of the cancer outside of the testicle but with some high risk features on the pathology assessment may be offered an abbreviated regimen of chemotherapy as an alternative to surgery (RPLND).
  • Radiation therapy — Unlike NSGCT, seminomas are extremely sensitive to radiation therapy (along with chemotherapy). Therefore, patients with pure seminoma on the pathology assessment may be recommended to undergo radiation therapy to the lymph nodes in the abdomen. This type of radiation therapy is generally a short course (2-3 weeks) and very well tolerated. If the cancer grows back after radiation, chemotherapy can then be administered with very good results.

For more information about leading-edge testicular cancer treatment, visit Arthur Smith Institute for Urology.

Testicular Cancer Clinical Trials

The North Shore-LIJ Cancer Institute offers a full array of clinical trials. The result of this research not only impacts survival, but also enhances the quality of life. For more information about clinical trials for Testicular Cancer, visit Cancer Clinical Trials.

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