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Johns Hopkins Medicine

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Testicular Cancer

What is it?

Testicular cancer is the growth of malignant cells in the testicles. In almost all cases only one testicle is involved.While relatively rare, testicular cancer is the most common cancer among young men; incidence is highest between the ages of 15 and 34, and quite rare beyond age 40. The disease disproportionately affects white men. Prognosis is often good, though it depends heavily on whether the cancer has spread to other organs. The cure rate is very high when testicular cancer is detected and treated early.

What Causes It?

  • The cause is unknown, but the incidence is significantly higher among men in whom one or both testicles failed to descend from the abdominal cavity into the scrotum before birth (cryptorchidism).
  • Other predisposing factors include a history of testicular trauma or testicular inflammation that occurs in conjunction with mumps (see Orchitis).

Prevention

  • There is no way to prevent testicular cancer, but vigilant monthly self-examination can aid in early detection, which promises a very favorable prognosis. The best time to perform self-examination is after a warm shower, when the scrotum is soft and pliable.

Diagnosis

  • Patient history and physical examination are needed. A special bright light can be shined through the scrotum to aid in diagnosis; tumors will appear opaque, while most other abnormalities (such as a hydrocele or a spermatocele) will appear translucent.
  • Blood tests for specific biochemical markers of testicular cancer can be used to track the response to treatment and detect the recurrence of cancer.
  • An ultrasound scan can confirm the presence of a solid mass.
  • Chest x-rays and CT (computed tomography) scans of the abdomen and pelvis are used to evaluate the stage of any tumors and to determine whether cancer has spread beyond the testicle. Treatment strategy depends heavily upon results of these tests and the type of cell causing the cancer, determined by microscopic examination of testicular tissue.

How to Treat It

  • Once a tumor is detected by diagnostic procedures, the affected testicle must be removed. (A biopsy to confirm diagnosis is not done since it may promote the spread of the cancer.)
  • The course of further treatment depends on the cell type of the tumor. Seminomas are treated with radiation to pelvic and abdominal lymph nodes. Other types of cancer (nonseminomas) require surgical removal of these lymph nodes or chemotherapy.
  • Chemotherapy is used if either type of cancer has spread to other sites in the body. These treatments may result in infertility.
  • Men who discover they have testicular cancer and wish to have children in the future may consider preserving sperm in a sperm bank prior to treatment. The approximate two-week delay in therapy appears to have little effect on outcome.
  • The removed testicle may be replaced with a prosthesis; fertility is maintained if the other testicle is unaffected. If need be, regular hormone injections can be given to preserve normal sexual functioning.

When to Call a Doctor

  • Make an appointment with your doctor right away if you discover a lump on one of your testicles. While any testicular abnormality is cause for concern, an actual lump is frequently a sign of cancer, and the sooner treatment is sought, the greater the likelihood of a complete cure.