Malignant testicular tumors are the most prevalent solid tumors in men ages 20 to 40. Testicular cancer is rare in nonwhite men and accounts for less than 1% of all male cancer deaths. Rarely, testicular cancer occurs in children.

With few exceptions, testicular tumors originate from germinal cells. About 40% become seminomas. These tumors, which are characterized by uniform, undifferentiated cells, resemble primitive gonadal cells. Other tumors-nonseminomas-show various degrees of differentiation.

The prognosis depends on the cancer cell type and stage. When treated with surgery, chemotherapy, and radiation therapy, almost all patients with localized disease survive beyond 5 years. Typically, when testicular cancer extends beyond the testes, it spreads through the lymphatic system to the iliac, paraaortic, and mediastinal nodes. Metastases affect the lungs, liver, viscera, and bone.

Causes of Testicular Cancer

The cause of testicular cancer is unknown. One theory suggests that testicular germ cell tumors form when germ cells develop into sperm cells with 46 chromosomes. Normally, germ cells with 46 chromosomes develop into sperm cells with 23 chromosomes (during a process called meiosis).

Signs & Symptoms of Testicular Cancer

Testicular cancer can result in a number of signs and symptoms. These may include:

A lump or enlargement in either testicle
A feeling of heaviness in the scrotum
A dull ache in the abdomen or groin
A sudden collection of fluid in the scrotum
Pain or discomfort in a testicle or the scrotum
Enlargement or tenderness of the breasts
Unexplained fatigue or a general feeling of not being well

Cancer usually affects only one testicle.

Diagnostic Tests

Serum analyses may be done to evaluate betasubunit human chorionic gonadotropin (HCG) and alphafetoprotein (AFP) levels. Elevated levels of these proteins (tumor markers) suggest testicular cancer and can differentiate a seminoma from a nonseminoma: elevated HCG and AFP levels point to a nonseminoma; elevated HCG and normal AFP levels indicate a seminoma.

Computed tomography scanning can detect metastases. Chest X-rays may demonstrate pulmonary metastases. Lymphangiography, ultrasonography, and magnetic resonance imaging may disclose additional metastases.

Excretory urography may detect ureteral displacement, which is caused by metastasis to a paraaortic lymph node.

Biopsy can confirm the diagnosis, help stage the disease, and plan treatment.

Treatment

In testicular cancer, treatment includes surgery, radiation therapy, and chemotherapy. Treatment intensity varies with the tumor cell type and stage.

Surgical options include orchiectomy and retroperitoneal node dissection to prevent disease extension and assess its stage. Most surgeons remove just the restis, not the scrotum. The patient may need hormonal replacement therapy after bilateral orchiectomy.

Treatment of seminomas involves postoperative radiation to the retroperitoneal and homolateral iliac nodes. Patients whose disease extends to retroperitoneal structures may be given prophylactic radiation to the mediastinal and supraclavicular nodes. Treatment of nonseminoma includes radiation directed to all cancerous lymph nodes.

Chemotherapy is most effective for late-stage seminomas and most nonseminomas when used for recurrent cancer after orchiectomy and removal of the retroperitoneal lymph nodes.

Autologous bone marrow transplantation is usually reserved for patients who don't respond to standard therapy. It involves giving high-dose chemotherapy, removing and treating the patient's bone marrow to kill remaining cancer cells, and returning the processed bone marrow to the patient.

Prevention Tips

There is no prevention for testicular cancer, but finding it early is important to successful treatment and survival. Young men should learn to perform testicular self-examination (TSE) shortly after puberty. A TSE performed on a monthly basis may play a major role in detecting tumors at earlier stages -- before they spread.

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