Genitourinary Cancers

Testicular Cancer

Background

The testicles are two 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, which produce testosterone and sperm. Germ cells within the testicles produce immature sperm that travel through a network of tiny tubes and larger tubes into the epididymis, a long and 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.

Surgery to remove the testicle (radical inguinal orchiectomy) and some of the lymph nodes may be done at diagnosis and staging.

Symptoms

Possible signs of testicular cancer include swelling or discomfort in the scrotum; other conditions may cause the same symptoms.

A doctor should be consulted if any of the following problems occur:

  • Painless lump or swelling in either testicle
  • Change in how the testicle feels
  • Dull ache in the lower abdomen or the groin
  • Sudden build-up of fluid in the scrotum
  • Pain or discomfort in a testicle or in the scrotum

Staging

Stage I: Stage I testicular cancer is determined after a radical inguinal orchiectomy. Stage I is divided into Stages IA, IB, and IS.

    • spread to the blood or lymph vessels in the testicle; or
    • has spread to the outer layer of the membrane surrounding the testicle; or
    • 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 slightly above normal; or
    • one or more tumor marker levels are moderately above normal or high.
  • Stage IA: 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.

    Stage IB: Cancer is in the testicle and the epididymis and has:

    All tumor marker levels are normal.

    Stage IC: Cancer is found anywhere within the testicle, spermatic cord, or the scrotum and either:

Stage II: Stage II is divided into Stage IIA, IIB, and IIC and is determined after a radical inguinal orchiectomy is done.

    • has spread to up to five 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
    • has spread to more than five lymph nodes; the lymph nodes are not larger than 5 centimeters.
  • Stage IIA: Cancer is anywhere within the testicle, spermatic cord, or scrotum; and has spread to up to five lymph nodes in the abdomen, none larger than 2 centimeters. All tumor marker levels are normal or slightly above normal.

    Stage IIB: Cancer is anywhere within the testicle, spermatic cord, or scrotum; and either:

    All tumor marker levels are normal or slightly above normal.

    Stage IIC: Cancer is anywhere within the testicle, spermatic cord, or scrotum; and 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 Stages IIIA, IIIB, and IIIC and is determined after a radical inguinal orchiectomy is done.

    • spread to one or more lymph nodes in the abdomen; and
    • has spread to distant lymph nodes or to the lungs.
  • Stage IIIA: Cancer is anywhere within the testicle, spermatic cord, or scrotum; and may have:

    The level of one or more tumor markers may range from normal to slightly above normal.

    Stage IIIB: Cancer is anywhere within the testicle, spermatic cord, or scrotum; and 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. Stage IIIC: Cancer is anywhere within the testicle, spermatic cord, or scrotum and 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.

Treatment

Surgery
Surgery to remove the testicle (radical inguinal orchiectomy) and some of the lymph nodes may be done at 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, some patients may be given chemotherapy or radiation therapy following surgery to kill any cancer cells that remain. Treatment given after the surgery, to lower the risk that the cancer will come back, 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.

References
Oregon Urology Institute