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Testicular cancer is curable and responds well to treatment, with high survival rates even when the cancer has spread beyond the testicles
Testicular cancer is curable and responds well to treatment, with high survival rates even when the cancer has spread beyond the testicles.
Testicular cancer occurs in the testicles, which are held inside the scrotum below the penis and are responsible for producing the male sex hormone testosterone. It is estimated that 1 out of 250 men develop testicular cancer at some point during their lifetime.
How long can you survive with testicular cancer?
According to the American Cancer Society (ACS), the 5-year survival rate for men with testicular cancer is 95%. Survival rates are higher for early-stage cancer and lower for later-stage cancer.
Limited to testicles (localized)
99%
Spread to retroperitoneal lymph nodes in the back of the abdomen (regional)
96%
Spread to other organs (distant)
73%
What causes testicular cancer?
In most cases, it is unclear what causes testicular cancer.
Approximately 90% of testicular cancers begin in the germ cells, which are involved in sperm production. The two main types of germ cell tumors are:
- Seminoma
- Cancerous cells grow gradually and respond well to chemotherapy and radiation
- Raises human chorionic gonadotropin (tumor marker) levels
- Nonseminoma
- Divided into subtypes: choriocarcinoma, embryonal carcinoma and teratoma, and yolk sac tumors
- Cancerous cells grow rapidly and are less responsive to treatment
- Raises alpha-fetoprotein and human chorionic gonadotropin levels
What are the risk factors for testicular cancer?
Testicular cancer is most often diagnosed in men between ages 15-39 and is less common among men over 50.
Risk factors for testicular cancer include:
- Family history of testicular cancer
- Ethnicity (White men are 4-5 times more at risk than Black or Asian American men)
- Inguinal hernia at birth
- Undescended testicle (cryptorchidism)
- Abnormally developed testicles
- Carcinoma in situ of the testicle
- Human immunodeficiency virus (HIV) infection
- Testicular microlithiasis (small clusters of calcium accumulates in the testicles)
- History of testicular cancer (3%-4% of people treated for testicular cancer will develop cancer in the other testicle)
What are the symptoms of testicular cancer?
While some men may never experience symptoms of testicular cancer, others may notice warning signs such as:
- Painless lump in the testicles
- Swelling or fluid accumulation in the scrotum (with or without pain)
- Pain and discomfort in the scrotum
- Dull pain or heaviness in the lower abdomen or groin
- Tenderness in the breasts
Additional symptoms may include:
- Weight loss
- Fatigue
- Malaise
- Fever
- Shortness of breath or chest pain
- Back pain
What are the stages of testicular cancer?
Depending on the spread, testicular cancer is divided into four stages:
- Stage 0: Warning sign of cancer called germ cell neoplasia in situ is found in the seminal tubules.
- Stage I (IA, IB, IS)
- Stage IA
- Cancerous cells are limited to only the testicles and epididymis
- Tumor markers are normal
- Stage IB
- Cancer has invaded the vessels or lymph nodes within the testicles
- Cancer has spread to the spermatic cord and scrotum
- Tumor markers are normal
- Stage IS
- Cancer is within the testicle, spermatic cord, or scrotum
- Tumor markers are elevated
- Stage IA
- Stage II (IIA, IIB, IIC)
- Stage IIA: Cancer has spread to 5 or fewer lymph nodes in the abdomen not larger than 2 cm.
- Stage IIB: Cancer has spread to more than 5 lymph nodes not larger than 5 cm.
- Stage IIC: Cancer has spread to at least 1 lymph node larger than 5 cm.
- Stage III (IIIA, IIIB, IIIC): Cancer has spread to distant lymph nodes or to the lungs, brain, or liver with moderately or highly elevated tumor markers.
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How is testicular cancer diagnosed?
- Self-examination: Regular self-examinations are encouraged to help detect testicular cancer early:
- In a standing position, check each testicle at a time between the thumb and fingers (firmness should be the same on both)
- Feel for painless lumps or swelling in the scrotal area
- Check for changes in size, shape, or firmness of any lumps
- Physical examination: Your urologist will examine the scrotal area and the lymph nodes to check for lumps or any other signs of cancer.
- Ultrasound of the testicles: An imaging test can be done to check and evaluate a suspicious lump in the groin.
- Abdominal lymph node dissection: This procedure removes lymph nodes and a sample of tissue to check for signs of cancer.
- Serum tumor marker: Tumor markers, such as alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH) are measured to confirm a diagnosis.
How is testicular cancer treated?
Treatment depends on the cancer cell type, stage, risk of recurrence, spread, and overall health.
- Monitoring
- Recommended for stage 0 to I cancers
- Requires regular check-ups, including physical examination, tumor markers, and imaging tests
- Experts prefer close monitoring for 10 years and recommend physical examinations and blood tests every 3-6 months for the first year and every 6-12 months after
- Surgery
- Inguinal orchiectomy
- Removal of the entire testis along with the spermatic cord
- Regular monitoring after surgery
- Testis-sparing surgery (TSS)
- Removes only tumor tissue instead of the entire testis
- Only in selected cases, if the tumor is small and tumor markers are negative
- Retroperitoneal lymph node dissection (RPLND)
- Removes affected lymph nodes from the back of the abdomen
- Recommended for nonseminomatous germ cell tumors and stage IIA or IIB nonseminoma tumors
- Inguinal orchiectomy
- Chemotherapy
- Used to stop the growth of cancer cells and helps lower the risk of recurrence
- Recommended for cancer that has spread distantly and with high tumor marker levels
- Radiation therapy
- Uses high energy X-rays to kill cancer cells
- Recommended for seminoma-cell cancers or cancer that has spread to distant organs, such as the brain
