April is Testicular Cancer Awareness Month



 

What is testicular cancer?

Testicular cancer typically develops in one or both testicles in young men. It is a highly treatable and usually curable type of cancer.Testicular cancer typically develops in one or both testicles in young men. It is a highly treatable and usually curable type of cancer. 

More than 90% of cancers of the testicle develop in special cells known as germ cells. These are the cells that produce sperm. There are 2 main types of germ cell tumors (GCTs) in men: seminomas and non-seminomas. These 2 types occur about equally. Seminoma and non-seminoma cells look very different when seen under a microscope.

Some cancers contain both non-seminoma and seminoma cells. These are treated as non-seminomas because they grow and spread like non-seminomas.

The American Cancer Society's most recent estimates for the United States are for 2012:

  • About 8,590 new cases of testicular cancer will be diagnosed.
  • About 360 men will die of testicular cancer.

The rate of testicular cancer has been increasing in the United States and many other countries. The increase is mostly in seminomas. Experts have not been able to find reasons for this increase. Lately, the rate of increase has slowed.

Testicular cancer is not common; a man's lifetime chance of developing testicular cancer is about 1 in 270. Because treatment is so successful, the risk of dying from this cancer is very low: about 1 in 5,000.


What are the symptoms of testicular cancer?

In most testicular cancer cases, men have a lump on a testicle or they may notice the testicle is swollen or larger. Sometimes the lump causes pain, but most of the time it is not painful. Men with testicular cancer may mention a feeling of heaviness or aching in the lower abdomen or scrotum.

Some men with testicular cancer have no symptoms at all, and their cancer is found during medical testing for other conditions. Sometimes imaging tests done to find the cause of infertility can uncover a small testicular cancer.

A number of non-cancerous conditions, such as testicle injury or inflammation, can produce symptoms similar to those of testicular cancer. Inflammation of the testicle, known as orchitis, can cause painful swelling. Epididymitis (inflammation of the epididymis) can also cause swelling and pain. Both of these can be caused by viral or bacterial infections. The mumps virus causes orchitis in about 1 man in 5 who contracts mumps as an adult.


What are the risk factors of testicular cancer?

Undescended testicle

One of the main risk factors for testicular cancer is a condition called cryptorchidism, or undescended testicle(s). This means that one or both testicles fail to move into the scrotum before birth. Males with cryptorchidism are several times more likely to get testicular cancer than those with normally descended testicles.

Family history

A family history of testicular cancer increases the risk. If a man has the disease, there is an increased risk that one or more of his brothers or sons will also develop it. But only about 3% of testicular cancer cases are actually found to occur in families. Most men with testicular cancer do not have a family history of the disease.

HIV infection

Some evidence has shown that men infected with the human immunodeficiency virus (HIV), particularly those with AIDS, are at increased risk. No other infections have been shown to increase testicular cancer risk.

Carcinoma in situ

It isn't clear how often carcinoma in situ (CIS) in the testicles progresses to cancer. In some cases, CIS is found in men who have a testicular biopsy to evaluate infertility or have a testicle removed because of cryptorchidism.

Cancer of the other testicle

A personal history of testicular cancer is another risk factor. About 3% or 4% of men who have been cured of cancer in one testicle will eventually develop cancer in the other testicle.

Age

About 9 out of 10 testicular cancers occur in men between the ages of 20 and 54. But this cancer can affect males of any age, including infants and elderly men.

Race and ethnicity

The risk of testicular cancer among white men is about 5 times that of black men and more than 3 times that of Asian-American and American Indian men. The risk for Hispanics/Latinos falls between that of Asians and non-Hispanic/Latino whites. The reason for these differences is not known. Worldwide, the risk of developing this disease is highest among men living in the United States and Europe and lowest among men living in Africa or Asia.

Body size

Some studies have found that the risk of testicular cancer is somewhat higher in tall men, but other studies have not.


How is testicular cancer diagnosed?

Signs and symptoms of testicular cancer

In most testicular cancer cases, men have a lump on a testicle or they may notice the testicle is swollen or larger. Sometimes the lump causes pain, but most of the time it is not painful. Men with testicular cancer may mention a feeling of heaviness or aching in the lower abdomen or scrotum.

In rare cases, men with germ cell cancer notice their breasts are sore or have grown. This symptom occurs because certain types of germ cell tumors secrete high levels of a hormone called human chorionic gonadotropin (HCG), which stimulates breast development. Blood tests can measure HCG levels. These tests are important in diagnosis, staging, and follow-up of some testicular cancers.

Medical history and physical exam

If you have signs or symptoms that may suggest testicular cancer, your doctor will want to take a complete medical history to check for risk factors and symptoms.

Most doctors agree that examining a man's testicles should be part of a general physical exam The American Cancer Society (ACS) recommends a testicular exam as part of a routine cancer-related checkup.

The ACS advises men to be aware of testicular cancer and to see a doctor right away if they find a lump in a testicle. Because regular testicular self-exams have not been studied enough to show they reduce the death rate from this cancer, the ACS does not have a recommendation on regular testicular self-exams for all men. However, some doctors recommend that all men do monthly testicular self-exams after puberty.

Testicular self-exam

The best time for you to examine your testicles is during or after a bath or shower, when the skin of the scrotum is relaxed.

You should be aware that each normal testis has an epididymis, which can feel like a small bump on the upper or middle outer side of the testis. Normal testicles also contain blood vessels, supporting tissues, and tubes that conduct sperm. Some men may confuse these with cancer at first. If you have any concerns, ask your doctor.


What's new in testicular cancer research?

Important research into testicular cancer is being done in many university hospitals, medical centers, and other institutions around the country. Each year, scientists find out more about what causes the disease, how to prevent it, and how to improve treatment.

Recently, researchers have found inherited variations in two genes called c-KIT ligand (KITLG) and sprouty 4 (SPRY4) that appear to increase a man's risk of developing testicular cancer. Another study found that variants of 3 other genes, DMRT1, TERT, and ATF71P, may also increase the risk of testicular cancer. These findings may help identify men at higher risk, but they need to be studied much more.

Scientists are also studying the changes in DNA of testicular cancer cells to learn more about the causes of this disease. Their hope is that improved understanding will lead to even more effective treatment. Certain gene mutations found in the testicular cancer cells have been linked to resistance to chemotherapy and predict poor outcomes. These findings may help individualize treatment better and help find new drugs to treat testicular cancer that can target these gene mutations. A better understanding of the genetic changes will help doctors decide which patients need further treatment and which can be safely treated with surgery alone.


Source:  Visit the American Cancer Society for treatment options and additional information on testicular cancer.


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