Testicular cancer Health Article

Definition

Testicular cancer is an abnormal, rapid, and invasive growth of cancerous (malignant) cells in the testicles (male sex glands adjacent to the penis).

Alternative Names

Cancer - testes; Germ cell tumor; Seminoma

Causes, incidence, and risk factors

Although the exact cause of testicular cancer is unknown, several factors seem to increase risk. These include a past medical history of undescended testicle(s), abnormal testicular development, Klinefelter's syndrome (a sex chromosome disorder that may be characterized by low levels of male hormones, sterility, development of breasts, and small testes), or previous testicular cancer.

Other factors are under investigation as possible causes. They include exposure to certain chemicals and infection with the human immunodeficiency virus (HIV). A family history of testicular cancer may increase risk. There is no link between vasectomy (an operation to cause sterility) and elevated risk of testicular cancer.

Between 6,000 and 8,000 men will be diagnosed with testicular cancers each year. Although testicular cancer accounts for 1% of all cancers in men, it is the most common form of cancer in young men 15 to 40 years old. It may also occur in young boys, but only about 3% of all testicular cancer is found in this group.

White American men have about five times the risk of African-American men and more than twice the risk of Asian-American men. The risk for testicular cancer has doubled among white Americans in the past 40 years but has remained the same for African-Americans. The reasons for these differences are not known.

Testicular cancers may be classified as follows:

• Seminomas account for about 30-40% of all testicular tumors. These are usually is found in men in their 30s and 40s. The condition is usually localized to the testes, although in about 25% of cases it has spread to lymph nodes.
• Non-seminomas account for 60% of all testicular tumors; subcategories of these tumors are listed below. Non-seminoma tumors often contain more than one of the following cell types:
  • Embryonal carcinoma (about 20% of testicular cancers) occurs in 20-30 year olds and is highly malignant. It grows rapidly and spreads to the lung and liver.
  • Yolk sac tumor (about 60% of all testicular cancers in young boys).
  • Teratomata (about 7% of testicular cancers in adult men and 40% in young boys).
  • Choriocarcinoma (rare).

Stromal cell tumors are a kind of tumor that is made of Leydig cells (testosterone-secreting cells), Sertoli cells (cells where sperm matures), and granulose cells. These tumors account for only 3-4% of all testicular tumors. However, they do make up nearly 20% of all childhood testicular tumors. These tumors may secrete a hormone -- estradiol -- that can cause one of the symptoms of testicular cancer, gynecomastia (excessive development of breast tissue).

Symptoms

• Enlargement of a testicle or a change in the way it feels
• Lump or swelling in either testicle
• Dull ache in the back or lower abdomen
• Gynecomastia (excessive development of male breast tissue), this can also occur normally in adolescent males, in whom it is not a symptom of testicular cancer
• Testicular discomfort/pain or a feeling of heaviness in the scrotum
• Occasionally, the initial symptoms are related to the spread of the cancer to other parts of the body, such as the lungs, abdomen, pelvis, or brain

Note: There may be no symptoms.

Signs and tests

A physical examination typically reveals a firm, non-tender testicular mass that does not "trans-illuminate" (light from a flashlight held to the scrotum does not pass through the mass).

Other tests include:

• Scrotal ultrasound is used to confirm solid mass.
• Blood tests for tumor markers: alpha-fetoprotein (AFP), human chorionic gonadotrophin (beta HCG), and lactic dehydrogenase (LDH). Approximately 85% of non-seminomas will have elevations of either AFP or beta HCG. Seminomas will have elevations only in beta HCG or LDH. These tests can also be used to monitor the response to treatment.
• A chest X-ray is done to look for potential metastasis (spreading of cancer) to the lungs.
• An abdominal CT scan may be done to look for potential metastasis.

Tissue biopsy is usually by surgical removal of the testicle. After the testicle is removed, the tissue is examined.