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Testicular cancer is a type of cancer that develops in the testicles, a part of the male reproductive system. In the United States, about 8,000 to 9,000 men are diagnosed with this disease each year. Over a lifetime, the chance of getting testicular cancer is roughly 1 in 250 (4/10th of one percent). It is most common among males ages 15 through 40. Thankfully, testicular cancer has one of the highest cure rates of all cancers, in excess of 90%, and essentially 100% if it has not spread. Even for the relatively few cases where it is has spread widely, chemotherapy offers at least a fifty percent chance of a cure.

Symptoms and early detection

As testicular cancer is curable when detected early, experts recommend regular monthly testicular self-examination after a hot shower when the scrotum is looser. Men should examine each testicle first feeling for lumps then, compare them together to see if one is bigger than the other.

Symptoms include a lump in one testicle, pain and tenderness in testicles, blood in sperm during ejaculation, build up of fluid in the scrotum, enlargement or tenderness of breasts, a dull ache in the lower abdomen or groin, and an increase, or significant decrease, in the size of one testicle. Men should report any of these to a doctor as soon as possible.

Whether testicular cancer exists or not (and its extent) is evaluated by ultrasound (of the testicles) and X-rays, including CT-scans, looking for tumors. For nonseminomas (see b, a blood test is used to test for (and measure) tumor markers that are specific to that type of testicular cancer.

Pathology

Testicular cancer can be caused by any type of cell found in the testes, but more than 95% of all cancers are from germ cells. (Germ cells produce sperm; they are not pathogenic.) In general, the remainder of this article discusses germ cell testicular cancer.

Germ cell tumors are classified as either seminomas or nonseminomas. Seminomas are slow-growing, immature germ cells. Seminomas, when found, tend to be only in the testicles (that is, to be localized), simply because they spread relatively slowly. Nonseminomas, on the other hand, are more mature germ cells which spread more quickly. (Nonseminomas are classified as one of three or four subtypes; their rate of spread varies somewhat but they are treated similarly.) When seminomas and nonseminomas are both present (which is not unusual), the cancer is classified as nonseminoma.

A case of testicular cancer is categorized as being in one of three stages (which have subclassifications). Stage one is where the cancer remains in the testicle. In stage two, the cancer has spread to the nearest lymph nodes, small bean shaped structures that produce and store infection fighting cells, in the abdomen. In stage three, the cancer has spread further to locations including the kidneys, liver, bones, lungs or brain. The majority of cases are stage 1, when first identified; stage 3 is relatively rare.

Treatment

There are three basic types of treatment: surgery, radiation therapy, and chemotherapy.

While it is possible, in many cases, to remove testicular cancer tumors from a testicle while leaving it functional, this is rarely done. Since only one testicle is sufficient for fertility, hormone production, and other male functions, surgery to remove the afflicted testicle is virtually always done (an appropriate exception would be in the case of the second testicle later developing cancer as well).

In the case of nonseminomas that appear to be stage 1, surgery is often done on the lower lymph nodes (in a separate operation) to better determine whether the cancer is in stage 1 or 2. However, this approach, while standard in many places, is also omitted at many cancer centers because of the significant possibility of nerve damage.

Surgery can be done in other parts of the body where (in rare cases) there are tumors for which is this appropriate; this may occur before or after chemotherapy or radiation.

Radiation therapy is not effective on nonseminomas. It can be given to treat stage 2 seminoma cancers, or as preventive (adjuvant or primary) therapy, in the case of stage 1 cancers, to minimize the likelihood that miniscule (non-detectable) tumors exist and will spread. Chemotherapy as an alternative to radiation therapy is increasing, because radiation therapy has more significant long-term side affects (internal scarring, for example).

Chemotherapy is the standard treatment, with or without radiation, when the cancer has spread to other parts of the body (that is, stage 2 or 3). It is also an option for stage 1 nonseminomas, as preventive (adjuvant) therapy, particularly for higher-risk cases.

While treatment success depends on the stage, the average survival rate (five year) is around 95%, and stage 1 cancers cases (if monitored properly) have essentially a 100 percent survival rate (which is why prompt action, when testicular cancer is a possibility, is so important).

Surgery (testicle removal) is done by a urologist; radiation therapy is done by a radiation oncologist; and chemotherapy is done by a general oncologist.

Actions after treatment

For stage 1 cancers which have not had any adjuvant (preventive) therapy, close monitoring for at least a year is important (blood tests, if a nonseminoma; CT-scans in all cases) to evaluate if the cancer has spread to other parts of the body (metastasized). For other stages, and where radiation therapy or chemotherapy was used, the extent of monitoring (tests) will vary depending on circumstances, but normally should be done for a five-year period (with decreasing intensity).

A man with one remaining testicle can have a perfectly normal life, as the other testicle takes up the load, and will generally have adequate fertility. However, it is worth the (minor) expense of measuring hormone levels before surgery (removal of a testicle), and sperm banking may be appropriate for younger men who still plan to have children, since fertility will certainly be lessened by removal of one testicle, and can be severely affected if extensive chemotherapy is done.

A man who loses both testicles will normally have to take hormone supplements (in particular, testosterone, which is created in the testicles), and is obviously infertile, but can lead a normal life. Less than five percent of those who have testicular cancer will have it again in the second testicle.

Famous survivors

Decorated cyclist Lance Armstrong is a testicular cancer survivor. He once said, "It's ironic, I used to ride my bike to make a living. Now I just want to live so that I can ride."

Canadian comedian Tom Green was diagnosed with testicular cancer in 2000 and made a widely acclaimed documentary about his treatment. In 1997, figure skater Scott Hamilton survived a bout with testicular cancer. Two English footballers - Jason Cundy and Neil Harris - also survived the condition.

Famous victims

Brian Piccolo, an American football player in the late 1960s with the Chicago Bears, died of testicular cancer that was not detected until it had metastasized into his lungs. Piccolo would be a major subject of teammate and friend Gale Sayers' autobiography I Am Third; Sayers' story of their friendship, and Piccolo's struggle with cancer, was adapted into the legendary made-for-TV movie Brian's Song.

See also

• Testicular self-examination
• Germ cell ovarian cancer

External links

• Testicular Cancer Resource Center
• National Institute of Health information and links
• http://www.malecare.com/ nonprofit patient and doctor authored source of testicular cancer information, updated with new articles or citations every week.

• Oncology
• Andrology