Testicular cancer develops in one or both of the testicles, which are the male reproductive organs that produce sperm and hormones such as testosterone. Testicular tumors are often benign (noncancerous), but they can also be malignant (cancerous and able to spread). Testicular cancer is less common than many other types of cancer; each year, between 8,000 and 8,500 American men are diagnosed with cancer of the testicles. Most testicular cancers develop in the germ cells (the tissues that produce sperm), but a smaller percentage develop in the stroma (the tissues that produce hormones). Both types of tumors are highly responsive to treatment, with survival rates as high as 99 percent.
How is testicular cancer diagnosed?
For many men, the first step in the diagnostic process is a physical examination, as the early signs of testicular cancer include having a swollen testicle or finding a lump on a testicle. During the examination, the doctor will examine the testicles to detect any swelling, tenderness or lumps. He or she will also examine the patient’s stomach, lymph nodes and other areas of the body where testicular cancer commonly spreads. If the doctor is concerned about the possibility of a tumor, additional testing may be ordered, such as:
During an ultrasound, sound waves produce images of the inside of the body. This is the most common diagnostic imaging test used to detect testicular cancer. An ultrasound can also help a physician determine if a mass is benign or malignant.
Blood tests can be ordered to determine the presence of tumor markers, which can indicate testicular cancer. For example, having high levels of alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) are signals of testicular cancer. Not all types of testicular cancer markedly increase AFP or HCG protein levels so blood tests are typically combined with an ultrasound for the most accurate diagnosis.
While many types of cancers can be diagnosed using a biopsy, with testicular cancer, there is increased risk of spreading the cancer during this procedure. Instead, clinicians may recommend a radical inguinal orchiectomy to remove the entire testicle, which will be sent to a lab to determine if cancer cells are present. A radical inguinal orchiectomy is typically used to diagnose testicular cancer in patients who have had an ultrasound and blood test to identify tumor markers, and both diagnostic tools strongly indicate testicular cancer.
What are the types of testicular cancer?
Once testicular cancer is diagnosed, the type of cancer must be determined. This information will help the oncology team identify the most appropriate treatment regimen, as each type of testicular tumor responds differently to treatment. The two main subtypes of testicular cancer are:
- Seminomas – Accounting for approximately 40% of testicular cancer cases, seminomas develop from the sperm-producing germ cells of the testicle. These tumors can be further classified as classic seminomas and spermatocytic seminomas.
- Nonseminomas – The other 60% of testicular tumors are classified as nonseminomas, which are more common among men younger than 45 and tend to grow and spread more quickly than seminomas. Nonseminomas can be further classified as embryonal carcinoma, yolk sac carcinoma, choriocarcinoma and teratoma.
How is testicular cancer staged?
Staging testicular cancer is an important part of the diagnostic process, as it helps to inform a patient’s treatment plan. Testicular cancer is staged using the TNMS system, which stands for:
- Tumor – What is the size of the tumor and where is it located?
- Node – Are the lymph nodes at the back of the stomach affected?
- Metastasis – Has the cancer spread to other parts of the body? If so, where?
- Serum tumor marker – Does the patient have elevated tumor markers, specifically for AFP and HCG?
Testicular cancer is classified as Stage 1, 2 or 3, and each stage has its own subtypes. Stage 1, the earliest stage, means the cancer has not spread to nearby lymph nodes or other organs. Stage 2 means the cancer has begun to spread to nearby lymph nodes. Stage 3, the most advanced stage, means the cancer has spread to distant lymph nodes and/or another organ in the body.
How is testicular cancer treated?
There are three common ways that testicular cancer is treated: surgery, radiation therapy and chemotherapy. Each patient’s treatment plan is highly individualized based on the type of testicular cancer he has, the stage of the cancer and his overall health. Here’s what a patient may expect from treatment:
Radical inguinal orchiectomy is the most common surgery for testicular cancer, and it is often used in the diagnostic phase to determine the type and stage of the cancer. A patient may also need a retroperitoneal lymph node dissection, which removes lymph nodes at the back of the stomach.
Chemotherapy for testicular cancer is used to destroy any cancer cells that have broken off from the main tumor and spread to lymph nodes and other parts of the body. As such, it’s typically recommended for patients with cancer that has spread outside the testicle. Patients who have a testicle removed may also benefit from chemotherapy to reduce the risk of the cancer recurring.
Some patients may require higher doses of chemotherapy to destroy all of the cancer cells. In this case, a stem cell transplant may be done after the chemotherapy regimen. Before chemotherapy begins, stem cells will be collected from the patient’s own bloodstream, frozen and stored. Once chemotherapy is complete, the stem cells will be infused back into the patient’s body intravenously and begin replacing any blood cells that were lost during treatment.
Radiation therapy is most commonly recommended for patients with seminoma testicular cancer. It uses external beam radiation to send high-energy beams to a specific part of the body to destroy cancer cells. This treatment may also be used after a radical inguinal orchiectomy to destroy cancer cells in the lymph nodes at the back of the stomach.
Moffitt Cancer Center’s approach to testicular cancer treatment
At Moffitt Cancer Center, we take a unique approach to treating testicular cancer. The multispecialty testicular cancer team in our Urologic Oncology Program creates a tailored treatment plan for every patient, taking into account individualized factors such as the stage and cell type of a tumor. This helps us achieve the best possible outcome and quality of life for every patient we treat. No matter which testicular cancer treatments are most appropriate for a patient’s specific needs, Moffitt provides all of them in one convenient location. As a National Cancer Institute-designated Comprehensive Cancer Center, we are widely recognized for our groundbreaking research that has led to advances in treatments such as:
- Surgical resection (removal), including the latest robotic techniques and surgeries for cancerous lymph nodes
- Chemotherapy, including novel combinations of multiple drugs
- Radiation therapy, delivered through highly precise methods
- Supportive care and assistance with the management of side effects
- Clinical trials, through which patients can access novel therapies before they are made available elsewhere
While a patient is receiving testicular cancer treatment at Moffitt, our tumor board will collaboratively review his progress on an ongoing basis. If any modifications are necessary, our oncologists will make evidence-based recommendations for different therapies or additional options.