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Testicular cancer is a disease in which malignant (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 nonseminomas. These 2 types grow and spread differently
and are treated differently. Nonseminomas tend to grow and
spread more quickly than seminomas. Seminomas are more sensitive
to radiation. A testicular tumor that contains both seminoma
and nonseminoma cells is treated as a nonseminoma.
Testicular cancer is the most common cancer in men 20 to
35 years old.
Health history can affect the risk of developing testicular
cancer.
Anything that increases the chance of getting a disease
is called a risk factor.
Risk factors for testicular cancer include:
• Having had an undescended testicle.
• Having had abnormal development of the testicles.
• Having a personal or family history of testicular cancer.
• Having Klinefelter's syndrome.
• Being white.
Possible signs of testicular cancer include swelling or
discomfort in the scrotum.
These and other symptoms may be caused by testicular cancer.
Other conditions may cause the same symptoms. A doctor should
be consulted if any of the following problems occur:
• 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.
Tests that examine the testicles and blood are used to detect
(find) and diagnose testicular cancer.
The following tests and procedures may be used:
• Physical exam and history: An exam of the body to check
general signs of health, including checking for signs of
disease, such as lumps or anything else that seems unusual.
The testicles will be examined to check for lumps, swelling,
or pain. A history of the patient's health habits and past
illnesses and treatments will also be taken.
• Ultrasound exam: 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 3 tumor markers are used to detect testicular
cancer:
o Alpha-fetoprotein (AFP).
o Beta-human chorionic gonadotropin (ß-hCG).
o Lactate dehydrogenase (LDH).
Tumor marker levels are measured before radical inguinal
orchiectomy and biopsy, to help diagnose testicular cancer.
• Radical inguinal orchiectomy and biopsy: 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.) If cancer is found, the cell type (seminoma
or nonseminoma) is determined in order to help plan treatment.
Certain factors affect prognosis (chance of recovery) and
treatment options.
The prognosis (chance of recovery) and treatment options
depend on the following:
• 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, ß-hCG, and LDH).
• Type of cancer.
• Size of the tumor.
• Number and size of retroperitoneal lymph nodes.
Testicular cancer is often curable.
Treatment for testicular cancer can cause infertility.
Certain treatments 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.
Stages of Testicular Cancer
After testicular cancer has been diagnosed, tests are done
to find out if cancer cells have spread within the testicles
or to other parts of the body.
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. The following tests and procedures
may be used in the staging process:
• Chest x-ray: An x-ray of the organs and bones inside the
chest. An x-ray is a type of energy beam that can go through
the body and onto film, making a picture of areas inside
the body.
• CT scan (CAT scan): A procedure that
makes a series of detailed pictures of areas inside the
body, taken from different angles. The pictures are made
by a computer linked to an x-ray machine. A dye may be injected
into a vein or swallowed to help the organs or tissues show
up more clearly. This procedure is also called computed
tomography, computerized tomography, or computerized axial
tomography.
• Lymphangiography: A procedure used to
x-ray the lymph system. A dye is injected into the lymph
vessels 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 procedure
to examine lymph nodes in the abdomen. Lymph nodes are removed
and a pathologist checks them 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 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.)
• 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 or cancer when found in increased
levels in the blood. These are called tumor markers. The
following 3 tumor markers are used in staging testicular
cancer:
o Alpha-fetoprotein (AFP)
o Beta-human chorionic gonadotropin (ß-hCG).
o 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. Tumor marker
levels are also measured during follow-up as a way of checking
if the cancer has come back.
The following stages are used for testicular
cancer:
Stage 0
In stage 0, abnormal cells are found only in the tiny tubules
where the sperm cells begin to develop. The cells do not
invade normal tissues. This is sometimes called a "precancerous
condition." Stage 0 cancer is also called carcinoma
in situ. All tumor marker levels are normal.
Stage I
Stage I is divided into stage IA, stage IB, and stage IS
and is determined after a radical inguinal orchiectomy is
done.
• In stage IA, the cancer is in the testicle and epididymis
and may have spread to the inner layer of the membrane surrounding
the testicle. All tumor marker levels are normal.
• In stage IB, the cancer:
o is in the testicle and the epididymis and has spread to
the blood or lymph vessels in the testicle; or
o has spread to the outer layer of the membrane surrounding
the testicle; or
o is in the spermatic cord or the scrotum and may be in
the blood or lymph vessels of the testicle.
All tumor marker levels are normal.
• In stage IS, the cancer is found anywhere
within the testicle, spermatic cord, or the scrotum and
either:
o all tumor marker levels are slightly above normal; or
o one or more tumor marker levels are moderately above normal
or high.
Stage II
Stage II is divided into stage IIA, stage IIB, and stage
IIC and is determined after a radical inguinal orchiectomy
is done.
• In stage IIA, the cancer:
o is anywhere within the testicle, spermatic cord, or scrotum;
and
o has spread to up to 5 lymph nodes in the abdomen, none
larger than 2 centimeters.
All tumor marker levels are normal or slightly above normal.
• In stage IIB, the cancer is anywhere within the testicle,
spermatic cord, or scrotum; and either:
o has spread to up to 5 lymph nodes in the abdomen; at least
one of the lymph nodes is larger than 2 centimeters, but
none are larger than 5 centimeters; or
o has spread to more than 5 lymph nodes; the lymph nodes
are not larger than 5 centimeters.
All tumor markers levels are normal or slightly above normal.
• In stage IIC, the cancer:
o is anywhere within the testicle, spermatic cord, or scrotum;
and
o has spread to a lymph node in the abdomen that is larger
than 5 centimeters.
All tumor marker levels are normal or slightly above normal.
Stage III
Stage III is divided into stage IIIA, stage IIIB, and stage
IIIC and is determined after a radical inguinal orchiectomy
is done.
• In stage IIIA, the cancer:
o is anywhere within the testicle, spermatic cord, or scrotum;
and
o may have spread to one or more lymph nodes in the abdomen;
and
o has spread to distant lymph nodes or to the lungs.
The level of one or more tumor markers may range from normal
to slightly above normal.
• In stage IIIB, the cancer:
o is anywhere within the testicle, spermatic cord, or scrotum;
and
o may have spread to one or more nearby
or distant lymph nodes or to the lungs.
The level of one or more tumor markers may range from normal
to high.
• In stage IIIC, the cancer:
o is anywhere within the testicle, spermatic cord, or scrotum;
and
o may have spread to one or more nearby or distant lymph
nodes or to the lungs or anywhere else in the body.
The level of one or more tumor markers may range from normal
to very high.
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 Option Overview
There are different types of treatment for patients with
testicular cancer.
Different types of treatments are available for patients
with testicular cancer. Some treatments are standard (the
currently used treatment), and some are being tested in
clinical trials. Before starting treatment, patients may
want to think about taking part in a clinical trial. A treatment
clinical trial is a research study meant to help improve
current treatments or obtain information on new treatments
for patients with cancer. When clinical trials show that
a new treatment is better than the standard treatment, the
new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country.
Information about ongoing clinical trials is available from
the NCI Web site. Choosing the most appropriate cancer treatment
is a decision that ideally involves the patient, family,
and health care team.
Testicular tumors are divided into 3 groups, based on how
well the tumors are expected to respond to treatment.
Good Prognosis
For nonseminoma, all of the following must be true:
• The tumor is found only in the testicle or in the retroperitoneum
(area outside or behind the abdominal wall); and
• The tumor has not spread to organs other than the lungs;
and
• The levels of all the tumor markers are slightly above
normal.
For seminoma, all of the following must be true:
• The tumor has not spread to organs other than the lungs;
and
• The level of alpha-fetoprotein (AFP) is normal. Beta-human
chorionic gonadotropin (ß-hCG) and lactate dehydrogenase
(LDH) may be at any level.
Intermediate Prognosis
For nonseminoma, all of the following must be true:
• The tumor is found in one testicle only or in the retroperitoneum
(area outside or behind the abdominal wall); and
• The tumor has not spread to organs other
than the lungs; and
• The level of any one of the tumor markers is more than
slightly above normal.
For seminoma, all of the following must be true:
• The tumor has spread to organs other than the lungs; and
• The level of AFP is normal. ß-hCG and LDH may be
at any level.
Poor Prognosis
For nonseminoma, at least one of the following must be true:
• The tumor is in the center of the chest between the lungs;
or
• The tumor has spread to organs other than the lungs; or
• The level of any one of the tumor markers is high.
There is no poor prognosis grouping for seminoma testicular
tumors.
Three types of standard treatment are used:
Surgery
Surgery to remove the testicle (radical inguinal orchiectomy)
and some of the lymph nodes may be done at diagnosis and
staging. (Refer to the General Information and Stages sections
of this summary.) 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, some patients may be given chemotherapy
or radiation therapy after surgery to kill any cancer cells
that are left. Treatment given after the surgery, to increase
the chances of a cure, 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.
There are two types of radiation therapy. External radiation
therapy uses a machine outside the body to send radiation
toward the cancer. Internal radiation therapy uses a radioactive
substance sealed in needles, seeds, wires, or catheters
that are placed directly into or near the cancer. The way
the radiation therapy is given depends on the type and stage
of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop
the growth of cancer cells, either by killing the cells
or by stopping the cells from dividing. When chemotherapy
is taken by mouth or injected into a vein or muscle, the
drugs enter the bloodstream and can reach cancer cells throughout
the body (systemic chemotherapy). When chemotherapy is placed
directly into the spinal column, an organ, or a body cavity
such as the abdomen, the drugs mainly affect cancer cells
in those areas (regional chemotherapy). The way the chemotherapy
is given depends on the type and stage of the cancer being
treated.
New types of treatment are being tested in clinical trials.
These include the following:
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.
This summary section refers to specific treatments under
study in clinical trials, but it may not mention every new
treatment being studied. Information about ongoing clinical
trials is available from the NCI Web site.
Lifelong follow-up exams are very important for men who
have had testicular cancer.
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.
Lifelong clinical exams are very important. The patient
will probably have checkups once per month during the first
year after surgery, every other month during the next year,
and less often after that.
Treatment Options by Stage
Stage I Testicular Cancer
Treatment of stage I testicular cancer depends on whether
the cancer is a seminoma or a nonseminoma.
Treatment of seminoma is usually surgery to remove the testicle,
with or without radiation therapy to lymph nodes in the
abdomen after the surgery, with lifelong follow-up.
Treatment of nonseminoma may include the following:
• Surgery to remove the testicle and lymph nodes in the
abdomen, with lifelong follow-up.
• Surgery to remove the testicle, followed by chemotherapy
and lifelong follow-up.
• Surgery to remove the testicle, with lifelong follow-up.
Stage II Testicular Cancer
Treatment of stage II testicular cancer depends on whether
the cancer is a seminoma or a nonseminoma.
Treatment of seminoma may include the following:
• When the tumor is 5 centimeters or smaller, treatment
is usually surgery to remove the testicle followed by radiation
therapy to lymph nodes in the abdomen and pelvis, with lifelong
follow-up.
• When the tumor is larger than 5 centimeters, treatment
is usually surgery to remove the testicle followed by combination
chemotherapy or radiation therapy to lymph nodes in the
abdomen and pelvis, with lifelong follow-up.
Treatment of nonseminoma may include the following:
• Surgery to remove the testicle and lymph nodes, with lifelong
follow-up.
• Surgery to remove the testicle and lymph nodes, followed
by combination chemotherapy and lifelong follow-up.
• Surgery to remove the testicle followed by combination
chemotherapy and a second surgery if cancer remains, with
lifelong follow-up.
• Combination chemotherapy before surgery to remove the
testicle, for cancer that has spread and is thought to be
life-threatening.
• A clinical trial of combination chemotherapy instead of
removing the lymph nodes.
This summary section refers to specific treatments under
study in clinical trials, but it may not mention every new
treatment being studied. Information about ongoing clinical
trials is available from the NCI Web site.
Stage III Testicular Cancer
Treatment of stage III testicular cancer depends on whether
the cancer is a seminoma or a nonseminoma.
Treatment of seminoma may include the following:
• Surgery to remove the testicle followed by combination
chemotherapy. Any tumor remaining after treatment will need
lifelong follow-up.
• A clinical trial of a new therapy.
• A clinical trial of high-dose chemotherapy with bone marrow
transplant.
Treatment of nonseminoma may include the following:
• Surgery to remove the testicle, followed by combination
chemotherapy.
• Combination chemotherapy followed by surgery to remove
any remaining tumor.
Additional chemotherapy may be given if the tumor tissue
removed contains cancer cells that are growing.
• Combination chemotherapy combined with radiation therapy
to the brain for cancer that has spread to the brain.
• Combination chemotherapy before surgery to remove the
testicle, for cancer that has spread and is thought to be
life-threatening.
• A clinical trial of a new therapy.
• A clinical trial of high-dose chemotherapy with bone marrow
transplant.
This summary section refers to specific treatments under
study in clinical trials, but it may not mention every new
treatment being studied. Information about ongoing clinical
trials is available from the NCI Web site.
Treatment Options for Recurrent Testicular
Cancer
Treatment of recurrent testicular cancer may include the
following:
• Combination chemotherapy.
• High-dose chemotherapy with bone marrow transplant.
• Surgery to remove cancer that has either:
o come back more than 2 years after complete remission;
or
o come back in only one place and does not respond to chemotherapy.
• A clinical trial of a new therapy.
This summary section refers to specific treatments under
study in clinical trials, but it may not mention every new
treatment being studied. Information about ongoing clinical
trials is available from the NCI Web site.
The PDQ cancer information summaries are reviewed regularly
and updated as new information becomes available. This section
describes the latest changes made to this summary as of
the date above.
Changes were made to this summary to match those made to
the health professional version.
To Learn More
Call
For more information, U.S. residents may call the National
Cancer Institute's (NCI's) Cancer Information Service toll-free
at 1-800-4-CANCER (1-800-422-6237) Monday through Friday
from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers
with TTY equipment may call 1-800-332-8615. The call is
free and a trained Cancer Information Specialist is available
to answer your questions.
Web sites and Organizations
The NCI Web site provides online access to information on
cancer, clinical trials, and other Web sites and organizations
that offer support and resources for cancer patients and
their families. There are also many other places where people
can get materials and information about cancer treatment
and services. Local hospitals may have information on local
and regional agencies that offer information about finances,
getting to and from treatment, receiving care at home, and
dealing with problems associated with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health
professionals, and the public. These publications discuss
types of cancer, methods of cancer treatment, coping with
cancer, and clinical trials. Some publications provide information
on tests for cancer, cancer causes and prevention, cancer
statistics, and NCI research activities. NCI materials on
these and other topics may be ordered online or printed
directly from the NCI Publications Locator. These materials
can also be ordered by telephone from the Cancer Information
Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY
at 1-800-332-8615.
LiveHelp
The NCI's LiveHelp service, a program available on several
of the Institute's Web sites, provides Internet users with
the ability to chat online with an Information Specialist.
The service is available from 9:00 a.m. to 11:00 p.m. Eastern
time, Monday through Friday. Information Specialists can
help Internet users find information on NCI Web sites and
answer questions about cancer.
Write
For more information from the NCI, please write to this
address:
• NCI Public Inquiries Office
• Suite 3036A
• 6116 Executive Boulevard, MSC8322
• Bethesda, MD 20892-8322
About PDQ
PDQ is a comprehensive cancer database available on NCI's
Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive
cancer information database. Most of the information contained
in PDQ is available online at NCI's Web site. PDQ is provided
as a service of the NCI. The NCI is part of the National
Institutes of Health, the federal government's focal point
for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published
information on cancer prevention, detection, genetics, treatment,
supportive care, and complementary and alternative medicine.
Most summaries are available in two versions. The health
professional versions provide detailed information written
in technical language. The patient versions are written
in easy-to-understand, nontechnical language. Both versions
provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer
experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related
specialties are responsible for writing and maintaining
the cancer information summaries. The summaries are reviewed
regularly and changes are made as new information becomes
available. The date on each summary ("Date Last Modified")
indicates the time of the most recent change.
PDQ also contains information on clinical trials.
Before starting treatment, patients may want to think about
taking part in a clinical trial. A clinical trial is a study
to answer a scientific question, such as whether one treatment
is better than another. Trials are based on past studies
and what has been learned in the laboratory. Each trial
answers certain scientific questions in order to find new
and better ways to help cancer patients. During treatment
clinical trials, information is collected about new treatments,
the risks involved, and how well they do or do not work.
If a clinical trial shows that a new treatment is better
than one currently being used, the new treatment may become
"standard."
Listings of clinical trials are included in PDQ and are
available online at NCI's Web site. Descriptions of the
trials are available in health professional and patient
versions. Many cancer doctors who take part in clinical
trials are also listed in PDQ. For more information, call
the Cancer Information Service 1-800-4-CANCER (1-800-422-6237);
TTY at 1-800-332-8615.
Physicians version: CDR0000062899
Date last modified: 2006-01-20
http://www.meb.uni-bonn.de/
cancer.gov/ CDR0000257530.html
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