Risk Factors

Doctors can’t always explain why one man gets testicular cancer and another doesn’t. However, certain risk factors may make a man more likely to develop testicular cancer. A risk factor is something that may increase the chance of getting a disease.

Having a risk factor does not mean that a man will get testicular cancer. Many men who get testicular cancer have none of these risk factors, and many men who have known risk factors never have cancer. A man with one or more of these risk factors should talk with his doctor about cancer risk.

Risk factors for testicular cancer include the following:

• Undescended testicle (cryptorchidism): Normally, the testicles descend from inside the abdomen into the scrotum before birth. The risk of testicular cancer increases in males who have a testicle that does not move down into the scrotum. This risk does not change even after surgery to move the testicle into the scrotum. The increased risk applies to both testicles.
• Congenital abnormalities: Men born with abnormalities of the testicles, penis, or kidneys, as well as those with inguinal hernia (hernia in the groin area, where the thigh meets the abdomen), may have a higher risk.
• Personal history of testicular cancer: Men who have had testicular cancer are at increased risk of developing cancer in the other testicle.
• Family history of testicular cancer: The risk for testicular cancer is greater in men whose brother or father has had the disease.
• Race: Testicular cancer is more common in white men.

Symptoms

Common symptoms of testicular cancer include the following:

• A change in how the testicle feels
• A dull ache in the lower abdomen or groin
• A painless lump or swelling in either testicle
• A sudden build-up of fluid in the scrotum
• Pain or discomfort in the testicle or scrotum

Most often, these symptoms are not due to cancer. Men with these symptoms should tell their doctor so any problems can be diagnosed and treated as early as possible.

Screening and Diagnosis

Men are encouraged to perform testicular self exams to help find abnormal changes in the testicles. To learn more about testicular self exams, men can talk with their urologist or call the Cancer Learning Center at 801-581-6365 or 1-888-424-2100 toll free.

If symptoms suggest testicular cancer, the doctor will try to find out what’s causing the problems. The doctor also may order one or more of the following tests:

• Physical exam: The doctor will check for signs of disease, such as lumps or anything else that seems unusual. The doctor will examine the testicles for lumps, swelling, or pain.
• Ultrasound: In this test, high-energy sound waves are bounced off internal organs and tissues and make echoes. A computer creates a picture from the echoes. An ultrasound of the scrotum can show the presence and size of a mass in the testicle. It is also helpful in ruling out other conditions, such as swelling due to infection or a collection of fluid unrelated to cancer.
• Blood tests: The doctor sends blood to the lab to measure tumor markers (substances often found in higher-than-normal amounts in the blood when cancer is present). Tumor markers such as alpha-fetoprotein (AFP), beta-human chorionic gonadotropin, and lactate dehydrogenase (LDH) may suggest the presence of a testicular tumor, even if it is too small to be detected by physical exams or tests.
• Radical inguinal orchiectomy and biopsy: A surgeon removes an entire testicle through an incision in the groin. It's important to choose a surgeon who has experience with this kind of surgery. A tissue sample from the testicle is sent to the lab where it is viewed under a microscope to check for cancer cells. The removal of tissue to look for cancer cells is called a biopsy. If cancer is found, the cell type (seminoma or nonseminoma) is determined in order to help plan treatment.

Staging

If testicular cancer is diagnosed, the doctor needs to learn the extent (stage) of the disease to help choose the best treatment. Staging is a careful attempt to find out if cancer has spread within the testicles or to other parts of the body.

The doctor may order one or more of these staging tests:

• X-ray: An x-ray of the organs and bones inside the chest can show whether cancer has spread to other locations
• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of the inside of the body. The patient may receive contrast material by mouth or by injection into a blood vessel. The contrast material makes abnormal areas easier to see.
• Lymphangiography: The doctor injects dye into the lymph vessel in the feet. The dye travels upward through the lymph nodes and lymph vessels, and x-rays are taken to see if there are any blockages. This test helps find out whether cancer has spread to the lymph nodes.
• Abdominal lymph node dissection: A surgeon removes lymph nodes in the abdomen. A tissue sample from the lymph nodes is sent to the lab where it is viewed under a microscope to check for cancer cells. For patients with nonseminoma, removing the lymph nodes may help stop the spread of disease. Cancer cells in the lymph nodes of seminoma patients can be treated with radiation therapy.
• Radical inguinal orchiectomy and biopsy: A surgeon removes an entire testicle through an incision in the groin. A tissue sample from the testicle is sent to the lab where it is viewed under a microscope to check for cancer cells. The removal of tissue to look for cancer cells is called a biopsy. If cancer is found, the cell type (seminoma or nonseminoma) is determined in order to help plan treatment.
• Blood tests: The doctor sends blood to the lab to measure tumor markers (substances often found in higher-than-normal amounts in the blood when cancer is present). Three tumor markers are used in staging testicular cancer: alpha-fetoprotein (AFP), beta-human chorionic gonadotropin, and lactate dehydrogenase (LDH). Tumor marker levels are measured again, after radical inguinal orchiectomy and biopsy, in order to determine the stage of the cancer. This helps to show if all of the cancer has been removed or if more treatment is needed.

Stages of Testicular Cancer

Stage 0: Abnormal cells are found only in the tiny tubules where the sperm cells begin to develop. These abnormal cells may become cancer and spread into nearby normal tissue. The doctor may call this carcinoma in situ.

Stage I: Cancer is found in the testicle and epididymis (a tightly coiled tube for sperm storage attached to the testicle). Cancer may have spread to the membrane around the testicle, blood vessels in the testicle, lymph vessels, the spermatic cord, or the scrotum.

Stage II: Cancer is in the testicle, spermatic cord, or scrotum and has spread to lymph nodes in the abdomen.

Stage III: Cancer is in the testicle, spermatic cord, or scrotum and has spread to lymph nodes, the lungs, or other parts of the body.

Treatment

At Huntsman Cancer Institute, testicular cancer is treated by a team of specialists, including urologists (doctors who specialize in diseases of the urinary and sex organs in males), surgeons, medical oncologists (doctors who treat cancer with medicine), radiation oncologists (doctors who treat cancer with radiation), nurses, dietitians, and social workers.

Common treatment options for testicular cancer include the following:

• Surgery
• Chemotherapy
• High-dose chemotherapy with stem cell transplant
• Radiation therapy
• Watchful waiting
• Clinical trials

A patient may have a combination of treatments. The treatment that’s right for each patient depends on many factors:

• The stage of the cancer
• The patient’s tumor marker levels
• The size of the tumor
• Whether the cancer has spread to lymph nodes (and the number and size of lymph nodes with cancer in them)
• Whether the cancer has spread to other parts of the body
• The patient’s age and general health

The health care team can describe all of the treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, patients should discuss fertility preservation and possible side effects.

Surgery

Surgery to remove the testicle (radical inguinal orchiectomy and some of the lymph nodes may be done for diagnosis and staging. Tumors that have spread to other places in the body may be partly or entirely removed by surgery.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, the patient may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after surgery (called adjuvant therapy) lowers the risk that the cancer will come back.

Before surgery, patients should discuss fertility preservation and possible side effects with their doctor.

Chemotherapy

Chemotherapy uses drugs to kill and control cancer cells. Learn more about this treatment in our introduction to chemotherapy video.

High-dose chemotherapy with stem cell transplant

Using this treatment, doctors are able to give the patient high doses of chemotherapy and then replace the blood-forming cells that can be destroyed by the chemotherapy.

Stem cell transplants take place in the hospital. Before high-dose treatment, stem cells (immature blood cells) are taken from the patient’s blood or bone marrow and then frozen and stored. After chemotherapy is finished, the patient’s stored stem cells are thawed and given back to him through an infusion. New blood cells develop from the transplanted stem cells.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. Radiation therapy only affects cells in the treated area.

External radiation comes from a large machine outside the body. The machine aims beams of radiation at the lymph nodes in the abdomen. Patients go to a hospital or clinic for treatment. This type of treatment uses computers to closely target the cancer, which protects healthy tissue near the lymph nodes.

External radiation may be used after surgery to treat seminomas. Because nonseminomas are less sensitive to radiation, men with this type of cancer usually do not undergo radiation therapy.

Watchful waiting

Watchful waiting means doctors closely monitors the patient’s condition without giving any treatment until symptoms appear or change. This is also called expectant management or observation. Watchful waiting may be an option for men with stage 0 (also called carcinoma in situ).

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or any questions regarding research studies. For more information, visit HCI’s clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, work, or normal daily life.

There are several places you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services offer emotional support and resources for coping with cancer and its impact on daily life to HCI patients and their families.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers many programs to increase the quality of life and well-being of HCI patients and their families.