The testicles are two glands that are part of the male reproductive system. They are located in the scrotum, a sack that sits behind the penis. The main function of the testicles is to produce sperm and testosterone (a male hormone). Testicular cancer refers to the growth of abnormal (malignant or cancerous) cells in one or both testicles. The two main types of testicular cancer (seminoma and nonseminoma) start in the cells that make sperm.
- Seminomas are usually found only in the testicles and usually do not grow very fast. This type of cancer is often found in men in their 30 to 40s, but can occur in younger or older men as well. In some cases, seminomas can spread to the lymph nodes near the testicles, but they are very sensitive to radiation.
- Nonseminoma testicular cancers are made up of cells and tend to grow faster than seminomas. Nonseminomas are more common than seminomas and often occur in young men.
Your healthcare provider will look to see if your testicular cancer has spread to other areas of the body. This process is called “staging.”
- Metastatic testicular cancer is cancer that started in the testicles and has spread to other organs and tissues.
- In advanced cases, testicular cancer can spread to other organs in the abdomen, lungs and spine.
Your healthcare provider will need the following clinical information to decide what type of treatment is right for you.
- What does the cancer look like under the microscope?
- Does the cancer invade outside the testicles?
- How large is the primary cancer in the testicle?
- Has the cancer spread to pelvic lymph nodes or anywhere else in the body?
- Is the cancer associated with abnormal blood tests or tumor markers?
Radiation therapy may be used in certain patients with seminoma. It is usually done after surgery to remove the testicle.
- In these patients, radiation is mainly used to kill cancer cells that may have escaped to the lymph nodes located in the pelvis.
- It may also be used when imaging studies, such as CT and PET scans, have detected cancer cells in the lymph nodes.
Radiation therapy involves the use of various forms of radiation, or high-energy x-ray beams, to kill cancer cells in a specific area of the body. The x-ray beams must pass through normal tissue on their way to the cancer and out of the body.
- The radiation that passes through normal organs can cause damage.
- Radiation oncologists plan treatments to minimize exposure to normal organs.
- The treatments must be given daily over several weeks because normal tissues do not tolerate a large dosage given at one time.
Some types of radiation therapy include:
- Three-dimensional (3D) conformal radiation uses a beam that goes straight through the body. The patient's position is changed so this beam comes through from two or three different angles. The approach is planned to allow the maximum exposure of radiation to the tumor.
- Intensity-modulated radiation therapy (IMRT) uses hundreds of angles to accomplish the same task. It is far more expensive and is used when many angles are necessary. This approach helps to spare an important organ that is not affected by the cancer. In IMRT, the intensity of the beam is varied to conform to the shape of the tumor. The aim is to limit damage to surrounding healthy tissues, while effectively treating the cancer. IMRT is a valuable technique for treating a small percentage of cancerous tumors, but adds little value in the treatment of others. IMRT may not be covered by your health plan unless certain criteria are met.
- Brachytherapy applies the radiation source internally immediately next to the area being treated.
- The decision to administer radiation therapy will depend on the individual circumstances.
It is not known for sure what causes testicular cancer. Several factors may increase your chance of developing testicular cancer are:
- Age – Men between the ages of fifteen and thirty-four
- Abnormal testes development – Men who have a history of abnormal testes development or undescended testes
- Medical history – Men who have a previous history of testicular cancer
- Family history – Men who have a family history of testicular cancer
- Chemical exposure – Men who have a history of exposure to certain chemicals
- Klinefelter syndrome – Men who have an extra X chromosome (Klinefelter syndrome)
- Race – Caucasian men have a higher risk than African-American or Asian-American men do
- HIV Infection – Men who have HIV may have an increased risk of developing testicular cancer
There is no conclusive link between having a vasectomy and developing testicular cancer.
There may be no symptoms in the early stages of testicular cancer. Some of the symptoms that can develop include:
- Pain, discomfort or heaviness in the testicles or scrotum
- Lower back or abdominal pain
- A testicle that has become larger, has a lump or feels different than usual
- Enlarged breasts, which can also occur in teenage boys who do not have testicular cancer
As the cancer advances, other symptoms can develop. These symptoms can affect the:
- Abdomen and pelvis
Contact your healthcare provider if you have any of the above symptoms. He or she will review your symptoms and perform a physical examination, which may include shining a flashlight through your scrotum. Your provider may also recommend one or more of the following:
- Blood tests
- Removal of tissue for exam under a microscope (biopsy or surgery)
A biopsy may be needed to determine if an abnormality is cancer. If a biopsy or initial testing indicates you have cancer, more testing (CT scan or MRI) may be needed to see if the cancer has spread to other organs.
The treatment for testicular cancer is based on many factors. These factors include:
- The type and stage of the cancer
- The size of the tumor
- How fast it is growing
- Whether the cancer has spread to other parts of the body
- Other tests that determine the specific characteristics of the cancer
- Your overall health
- Your age (though most people with testicular cancer are young)
Treatments for testicular cancer are either local (only affects the area of the cancer) or systemic (affects all areas of the body). Local treatments include:
- Surgery to remove the cancer
- Radiation to kill the cancer cells
The systemic treatment for testicular cancer is chemotherapy to kill the cancer cells.
Treatment for testicular cancer often involves a combination of local and systemic treatments.
- Radiation and chemotherapy are usually given in a doctor's clinic or hospital by specially trained medical people.
- In some cases, you may be able to receive chemo at home with the help of specially trained nurses.
To get a full range of opinions and perspectives, you may want to consider input from a variety of doctors. This group may include:
- Your primary care physician
- A urologist or surgeon with experience in testicular cancer
- A medical oncologist (a doctor who specializes in the treatment of cancer)
- A radiation oncologist (a doctor who specializes in treating cancer with radiation therapy)
It is important to remember that the total cost of this care path does not include all possible medications, labwork, or imaging studies. Those charges can add up. If your healthcare provider recommends any labwork or imaging studies you may need to search for their costs separately.
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You should contact your healthcare provider if you have symptoms of testicular cancer. Be prepared to discuss your symptoms and how long you've had them.
- Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations).
- Make a list of your medications (including over-the-counter).
- Write down any questions, symptoms or concerns you want to talk about.
- If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).
What should I ask my healthcare provider before having radiation therapy?
- How will radiation improve my prognosis?
- What specific precautions do I need to take after receiving radiation therapy?
- What are the possible complications?
- How will I feel after radiation therapy? Will I have to modify my activity?
- What type of radiation will I receive? What symptoms should I report to my healthcare provider before my next appointment?
- Is there a reason you are recommending one form of radiation therapy over another?
- Will I be receiving other treatments along with the radiation therapy?
- What other specialists will need to get involved?
It is important you understand all home care instructions (including medications and side effects) and follow-up plans. Don't forget to make arrangements for help at home.