Testicular Cancer

What Is Testicular Cancer?

Testicular cancer is a disease in which cancer cells form in the
tissues of one or both testicles. The testicles are 2 egg-shaped
glands located inside the scrotum (a sac of loose skin that lies
directly below the penis). The testicles are held within the scrotum
by the spermatic cord, which also contains the vas deferens and
vessels and nerves of the testicles.
The testicles are the male sex glands and produce testosterone
and sperm. Germ cells within the testicles produce immature
sperm that travel through a network of tubules (tiny tubes) and
larger tubes into the epididymis (a long coiled tube next to the
testicles) where the sperm mature and are stored.
Almost all testicular cancers start in the germ cells. The two
main types of testicular germ cell tumors are seminomas and
non-seminomas. These 2 types grow and spread differently and
are treated differently. Non-seminomas tend to grow and spread
more quickly than seminomas. Seminomas are more sensitive to
radiation. A testicular tumor that contains both seminoma and
non-seminoma cells is treated as a non-seminoma.
Testicular cancer is the most common cancer in men 20 to 35
years old. Health history can affect the risk of testicular cancer.

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What Are the Risk Factors for
Testicular Cancer?
Anything that increases the chance of getting a disease is called
a risk factor. Having a risk factor does not mean that you will
get cancer; not having risk factors does not mean that you will
not get cancer. Risk factors for testicular cancer include:
• Having had an undescended testicle
• Having had abnormal development of the testicles
• Having a personal history of testicular cancer
• Having a family history of testicular cancer (especially in
a father or brother)
• Being white

What Are the Signs and Symptoms of

Testicular Cancer?
Signs and symptoms of testicular cancer include swelling or
discomfort in the scrotum. These and other signs and symptoms
may be caused by testicular cancer or by other conditions:
• A painless lump or swelling in either testicle
• A change in how the testicle feels
• A dull ache in the lower abdomen or the groin
• A sudden build-up of fluid in the scrotum
• Pain or discomfort in a testicle or in the scrotum

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 What Tests Are Used to Detect (Find)
And Diagnose Testicular Cancer?
The following tests and procedures may be used:
• Physical exam and history
• Ultrasound exam of the testes: A procedure in which
high-energy sound waves (ultrasound) are bounced off
internal tissues or organs and make echoes. The echoes
form a picture of body tissues called a sonogram.
• Serum tumor marker test: A procedure in which a sample
of blood is examined to measure the amounts of certain
substances released into the blood by organs, tissues, or
tumor cells in the body. Certain substances are linked to
specific types of cancer when found in increased levels in
the blood. These are called tumor markers. The following
tumor markers are used to detect testicular cancer:
– Alpha-fetoprotein (AFP).
– Beta-human chorionic gonadotropin (β-hCG).
Tumor marker levels are measured before inguinal
orchiectomy and biopsy, to help diagnose testicular cancer.
• Inguinal orchiectomy: A procedure to remove the entire
testicle through an incision in the groin. A tissue sample
from the testicle is then viewed under a microscope to
check for cancer cells. (The surgeon does not cut through
the scrotum into the testicle to remove a sample of tissue
for biopsy, because if cancer is present, this procedure could
cause it to spread into the scrotum and lymph nodes. It’s
important to choose a surgeon who has experience with
this kind of surgery). If cancer is found, the cell type
(seminoma or non-seminoma) is determined in order to
help plan treatment.

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What Determines How Testicular
Cancer Is Treated and Prognosis?
Certain factors affect prognosis (chance of recovery) and
treatment options:
• Stage of the cancer (whether it is in or near the testicle or
has spread to other places in the body, and blood levels of
AFP, β-hCG, and LDH)
• Type of cancer
• Size of the tumor
• Number and size of retroperitoneal (low back-side)
lymph nodes
Testicular cancer can usually be cured in patients who receive
chemotherapy or radiation therapy after their primary treatment.
Treatment for testicular cancer can cause infertility that may be
permanent. Patients who may wish to have children should
consider sperm banking before having treatment. Sperm banking
is the process of freezing sperm and storing it for later use.
The process used to find out if cancer has spread within the
testicles or to other parts of the body is called staging. The
information gathered from the staging process determines the
stage of the disease. It is important to know the stage in order
to plan treatment.

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 How Does Testicular Cancer Spread?
Cancer can spread through tissue, the lymph system, and
the blood:
• Tissue. The cancer spreads from where it began by growing
into nearby areas.
• Lymph system. The cancer spreads from where it began by
getting into the lymph system. The cancer travels through
the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting
into the blood. The cancer travels through the blood vessels
to other parts of the body.
When cancer spreads to another part of the body, it is called
metastasis. The metastatic tumor is the same type of cancer as
the primary tumor. For example, if testicular cancer spreads to
the lung, the cancer cells in the lung are actually testicular cancer
cells. The disease is metastatic testicular cancer, not lung cancer.

What Are the Stages Used for

Testicular Cancer?
In addition to stage, testicular cancer may be grouped according
to how well it may respond to treatment such as good,
intermediate or poor. Stages are described below:

Stage 0
In stage 0, abnormal cells are found in the tiny tubules where
the sperm cells begin to develop. These abnormal cells may
become cancer and spread into nearby normal tissue. All tumor
marker levels are normal. Stage 0 is also called germ cell
neoplasia in situ.

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Stages I -III (1-3)
Stages 1, 2, or 3 describes the involvement of cancer in or around
the testes or to distant sites. Other factors in the staging process
include the extent or absence of lymph node involvement and
levels of tumor markers. In addition to a number, staging will
include an additional letter such as A, B, or C.

Recurrent Testicular Cancer

Recurrent testicular cancer is cancer that has recurred (come
back) after it has been treated. The cancer may come back many
years after the initial cancer, in the other testicle or in other parts
of the body.

Treatment for Testicular Cancer

Treatment for testicular cancer depends on the type and stage
of the disease.

Surgery
Surgery to remove the testicle (inguinal orchiectomy) and some
of the lymph nodes may be done at diagnosis and staging.
Tumors that have spread to other places in the body may be
partly or entirely removed by surgery. After the doctor removes
all the cancer that can be seen at the time of the surgery, some
patients may be given chemotherapy or radiation therapy to kill
any cancer cells that are left. Treatment given after the surgery,
to lower the risk that the cancer will come back, is called
adjuvant therapy.

Radiation Therapy
Radiation therapy is a cancer treatment that uses high-energy
x-rays or other types of radiation to kill cancer cells or keep
them from growing.

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 Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the
growth of cancer cells, either by killing the cells or by stopping
them from dividing.

High-Dose Chemotherapy With Stem

Cell Transplant
High-dose chemotherapy with stem cell transplant is a method
of giving high doses of chemotherapy and replacing blood
-forming cells destroyed by the cancer treatment. Stem cells
(immature blood cells) are removed from the blood or bone
marrow of the patient or a donor and are frozen and stored.
After the chemotherapy is completed, the stored stem cells are
thawed and given back to the patient through an infusion.
These reinfused stem cells grow into (and restore) the body’s
blood cells.

Follow-Up Tests May Be Needed

Some of the tests that were done to diagnose the cancer or to
find out the stage of the cancer may be repeated. Some tests will
be repeated in order to see how well the treatment is working.
Decisions about whether to continue, change, or stop treatment
may be based on the results of these tests.
Men who have had testicular cancer have an increased risk of
developing cancer in the other testicle. A patient is advised to
regularly check the other testicle and report any unusual
symptoms to a doctor right away. Long-term clinical exams are
very important. Check-ups will be frequent during the first year
after surgery and less often after that.
Support is available for coping with changes that may have
happened because of cancer treatment. Your healthcare team
can offer ideas as well as a plan of care for long-term follow-up.

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What Are Clinical trials?
Clinical trials are done to find out if new cancer treatments are
safe and effective or better than the standard treatment.
People who take part in a clinical Many of today’s
trial may receive: standard treatments
for cancer are based
• The standard treatment alone or on earlier clinical trials.
• The standard treatment plus the Ask if there is a clinical
new treatment being studied trial right for you.

Taking part in a clinical trial helps improve the way cancer will
be treated in the future. Even when clinical trials do not lead to
effective new treatments, they often answer important questions
and help move research forward.
Some clinical trials only include people who have not yet received
treatment. Other trials test treatments for those whose cancer
has not gotten better. There are also clinical trials that test new
ways to stop cancer from coming back or reduce the side effects
of cancer treatment.

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 To Learn More About Testicular Cancer
American Cancer Society
https://www.cancer.org/
National Cancer Institute
https://www.cancer.gov/
National Comprehensive Cancer Network Guidelines
for Patients
https://www.nccn.org/patients/guidelines/cancers.aspx
MedlinePlus
https://medlineplus.gov/

Common Questions
What does the pathology report say?

What is the stage of my cancer?

What are my goals for treatment?

What are my treatment choices?

What kind of support services are available for me about

finances, emotions, spiritual questions, etc.?

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 My Health Care Team Contact Information

Surgeon:

Medical Oncologist:

Radiation Oncologist:

Primary Care Doctor:

Navigator:

Nurse:

Registered Dietitian
Nutritionist:

Other:

Other:

Adapted from: PDQ Testicular Cancer Treatment. Bethesda, MD: National Cancer Institute.

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039051-00356 PE 5/22