Testicular cancer is a rare form of malignancy that develops in the testes, the male reproductive organs located in the scrotum. Testicular cancer occurs in about 1 in 300 men in their lifetime and typically affects men aged 15 to 35. When detected early, it can be treated successfully in over 95% of cases. Education and self-exams are the key to discovering testes cancer early.

Risk Factors

While the cause of testicular cancer is not known, the following conditions are associated with increased risk.

  • Age — young men aged 15 to 35 are at highest risk
  • An undescended testicle, called cryptorchidism
  • Klinefelter’s Syndrome, where an extra X chromosome results in failure of the testicles
  • Family or personal history of testicular cancer
  • Race — Caucasian men are at higher risk

Types

Most (95%) testicular cancer originates in germ cells. These are cells that eventually mature into sperm. There are two main types of germ cell testicular cancer:

  • Seminomas — tend to be less aggressive and are responsive to radiation therapy
  • Non-seminomas — tend to grow and spread rapidly but are responsive to chemotherapy

A small percentage (5%) of testicular cancer develops in the stroma, the hormone producing tissue of the testicles.

Symptoms

Men with testicular cancer usually have no symptoms except for finding a lump in a testicle, often found when performing a self-exam or during a doctor’s visit. Symptoms may include:

  • Testicular swelling, hardness or pain
  • Heavy or aching feeling in the scrotum or lower abdomen
  • Pain is not always a sign of cancer but should still be evaluated

Diagnosis

Your doctor will first perform a history and physical exam that includes checking your testicles and abdomen for lumps, swelling, or enlarged lymph nodes. He may order an ultrasound, CT scan, chest X-ray, and blood tests to provide more information to make the diagnosis. Alpha-fetoprotein and HCG (human chorionic gonadotropin) are proteins that are sometimes produced in high volumes by testicular cancer. These are considered tumor markers and may be monitored through blood tests.

Biopsy — Although the diagnosis of testes cancer may be suspect based on exam and testes ultrasound, the true diagnosis requires testes biopsy. This biopsy is always performed on the testes after it has been removed to avoid tumor spread.

Stages

Staging requires pathological evaluation of the testes under the microscope, measuring serum tumor markers, and usually CT scan imaging. The staging is then assigned based on the extent and size of the tumor in the testes and whether metastasis is present. Testes cancer when it spreads is usually into lymph nodes first and later may include other organs like the lungs. A TNM (tumor, lymph nodes, metastasis) system is used for staging and treatment varies depending on these variables.