Testicular Cancer: The Facts

What is it?

Testicular Cancer originates in the part of the male reproductive system known as the testes, or testicles. The testicles are located in the sac of skin known as the scrotum underneath the penis. The testes are responsible for the production of male hormones as well as sperm production and storage. From the testicles, the sperm travel through the vas deferens, to the seminal vesicles and out through the urethra. Other fluids from the prostate are also mixed with sperm and released during ejaculation. There are several different types of Testicular Cancer. They differ in the types of cells in which the cancer begins. Germ Cell Carcinoma - Germ cells, located in the testes, are the precursors of sperm cells. Germ Cell Carcinoma begins in these cells. Over 90% of Testicular Cancer cases are of this type. The two main types of Germ Cell Carcinoma are seminoma and nonseminoma. Seminoma germ cell cancer normally grows slowly and rarely spreads to other areas of the body. Nonseminoma germ cell cancer normally occurs at an earlier age in life (early 20s on average) and grows more aggressively than seminoma. There are several classifications of nonseminoma germ cell cancer, but they all develop similarly and are treated alike.

• Stromal Tumors - This type of cancer arises from the stroma, which is the supportive, hormone-producing tissue of the testicles. This type of Testicular Cancer is much less common than Germ Cell Cancer. The two main types of Stromal Tumors are Leydig cell tumors and Sertoli cell tumors.
  
  • Leydig cell tumors develop from the cells that normally produce the male sex hormone, androgen. Leydig cell tumors rarely spread to other areas of the body, but when they do they are particularly difficult to treat.
    
  • Sertoli cell tumors develop from the cells that nourish and support the germ cells. These also rarely spread, but when they do they are particularly difficult to treat.

Testicular Cancer is categorized by stages that describe how much the cancer has spread:

• Stage 0: This precancerous state involves a condition called carcinoma in situ. The cancer has not invaded germ cells.
  
  
• Stage I: The cancer is localized in the testicles. It has not spread to the lymph nodes or any distant organs.
  
  
• Stage II: The cancer has spread to lymph nodes near the testicles, but not in distant areas of the body. There are two categories of this stage of cancer:
  
  
  • Non-Bulky Stage II - Retroperitoneal lymph nodes (behind the abdominal wall) have not been affected.
    
    
  • Bulky Stage II - Cancer has spread to the Retroperitoneal lymph nodes.
    
    
• Stage III: The Cancer has spread to distant lymph nodes or organs.
  
  
  • Non-Bulky Stage III - Cancer spreading only to lymph nodes and lungs; tumors are relatively small (less than 2 cm).
    
    
  • Bulky Stage III - Cancer has spread extensively to other organs; tumors are relatively big (greater than 2 cm).
    

Who gets it?

In 1999, about 7,400 men in the U.S. were newly diagnosed with Testicular Cancer. About 30 men each year in Rhode Island are diagnosed with Testicular Cancer. The majority of these cases are in men between the ages of 15 and 40. While older men and younger boys can develop Testicular Cancer, it is rather uncommon. Race also seems to be a factor in determining who is at a higher risk of developing the disease. Caucasians develop Testicular Cancer at a rate double that of Asians and five times that of African-Americans.

There are certain other risk factors that have been associated with a higher chance of developing Testicular Cancer. Some of these include:

• Cryptorchidism - This is a condition at birth known as an "undescended testicle" that affects about 3% of newborn males. Males who are born with this condition are at a higher risk of developing Testicular Cancer later in life, even if the condition has been corrected.
  
  
• Family History - Men with a brother or father who has had Testicular Cancer are at a higher risk of developing the disease.
  
  
• Personal History - Men who have had Testicular Cancer in one testicle are more likely to develop the cancer in the other testicle.
  
  
• Occupational Risk - There has been some evidence that exposure to certain chemicals can slightly increase a man's risk of developing Testicular Cancer. Miners, oil and gas workers, janitors, and utility workers are some of the occupations at higher risk.
  
  
• Carcinoma in situ - This symptom-less condition almost always progresses to cancer. It is sometimes detected in men being tested for other testicular conditions.
  

How is it detected?

Testicular Cancer is normally associated with symptoms that can be observed by the patient himself. In 9 out of 10 cases, a small mass can be felt on the testicle that may or may not be painful. If the patient or doctor suspects Testicular Cancer, a number of tests can be done to determine if cancer is present. Some of the tests that are used include:

• SELF-EXAMS - The majority of Testicular Cancer cases are first discovered by the patient himself. Periodic self-exams of the testicles are an important way to detect any changes or abnormalities. Beginning in adolescence, males should learn how to perform a self-exam and what to look for. Any abnormalities, lumps, or painful areas should be reported to a doctor immediately. The vast majority of swelling, lumps, or tenderness are something other than Cancer. However, these conditions also need to be taken care of. REMEMBER, TESTICULAR CANCER IS A VERY TREATABLE DISEASE IF IT IS DISCOVERED EARLY!!!
  
  
• Ultrasound - Sound waves are used to create an image of the testicle and surrounding tissue. This test is normally used to rule out non-cancerous causes of the symptoms.
  
  
• MRI - This is an imaging test that allows the physician to see the structure of the testicle and identify any abnormal regions.
  
  
• Blood Test - An increased level of certain proteins can be a sign of Testicular Cancer.
  
  
• Biopsy - If there is a very strong suspicion of cancer, then a biopsy is often performed. In this surgical procedure, a tissue sample is removed so it can be examined for the presence of cancer cells. Sometimes this can be done without removing the testicle, but other times the testicle does need to be removed.
  
  
• Lymphangiography - A special dye is injected into the lymph vessels and travels to the lymph nodes. The dye allows an image to be created which the doctor uses to determine if the cancer has spread.
  
  
• CT Scan - X-ray beams are used from a variety of angles to create an image of the affected area.
  

Symptoms:

Certain symptoms have been associated with a diagnosis of Testicular Cancer; however, these symptoms may be caused by any number of conditions and, in fact, are normally not cancer. Also, many men with Testicular Cancer experience no symptoms at all. If you experience any of the following symptoms then consult your physician immediately so that the actual cause can be determined. Even if cancer is not the cause, there are other possible conditions that need to be taken care of immediately.

• Painless or uncomfortable lump
  
• Heaviness or aching in lower back or scrotum
  
• Breast tenderness or growth
  
• Fluid accumulation in the scrotum
  

Is it curable?

Testicular Cancer is one of the most curable forms of cancer. Early and intermediate stages of Testicular Cancer have a 5-year survival rate of over 95%. More advanced stages have a survival rate that is still over 75%. While there is a high level of success in treating Testicular Cancer, early detection is still key. The earlier the cancer is found, the less invasive the treatment and the higher the chances of survival.

It's easier to prevent cancer than to treat it....

Most of the known risk factors for Testicular Cancer cannot be avoided (race, age, etc.). Therefore, little can be done to actually prevent the disease. However, early detection and treatment can prevent the disease from progressing too far. In general, certain lifestyle habits can help prevent many different types of cancer. Some of these include:

• Not smoking
  
• Regular exercise
  
• Moderate, if any, consumption of alcohol
  
• Low fat, high fiber diet
  

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