Testicular Cancer

Anatomy of the Testicle

To understand testicular cancer, it helps to start with a description of the testicular anatomy. The male anatomy is shown in the picture below.

The scrotum or sac contains a testicle on each side. The testicle has two functions. It makes testosterone, the male hormone, which is carried from the testis through the blood stream. It also makes sperm, which travels from the testicle into a series of tubes which collectively form the epididymis.

The epididymis sits to the side and in back of the testis. Sperm leaves the epididymis by way of the vas deferens (this is the tube that is divided during a vasectomy), which then joints the seminal vesicles and prostate. The vas deferens travels through a structure known as the spermatic cord, which also includes the artery and vein that provide the blood supply to the testis and the lymphatic vessels that drain the testis. Sperm delivered from the vas deferens, mixes with fluid from the seminal vesicle and prostate to produce the semen, which is the fluid that comes out from the penis at the time of ejaculation.

What is a testicular tumor?

The term “testicular tumor” is used to describe a mass or growth within the testicle itself. Oftentimes this mass is noted by the patient, or it may be detected by a health care provider during a physical exam. There are a variety of other conditions which can cause a lump in the scrotal contents – not all lumps are testicular tumors. Some of these conditions include hydrocele (fluid around the testicle), spermatocele (a cyst in the epididymis), nodule or inflammatory change in the epididymis, and varicocele (a dilation of the veins around the testis).

How is testicular cancer diagnosed?

When there is a mass identified within the testis itself, further diagnostic studies include scrotal ultrasound, and blood tests to check the levels of the tumor markers: beta hCG, alpha-fetoprotein and LDH. A scrotal ultrasound (sonogram) can confirm that the mass is within the testis itself. The tumor markers can be useful to guide subsequent treatment decisions. They are not by themselves diagnostic – they may be normal even when cancer is present. CT scan of the abdomen and pelvis is carried out to assess for enlargement of the lymph nodes. If testicular cancer spreads beyond the testis, it often involves an area called the retroperitoneal lymph nodes, which are the lymph nodes in back of the abdominal cavity.

How is testicular cancer treated?

When a solid mass is present in the testicle, the next step is inguinal (radical orchiectomy). Over 95% of solid masses in the testis are malignant (cancerous), and less than 5% are benign (non-cancerous). A biopsy is not carried out for several reasons – the biopsy may not show cancer even if cancer is present, and if cancer is present, biopsy may introduce the possibility of cancer spread. Inguinal orchiectomy (through an incision in the groin) rather than scrotal orchiectomy (through an incision in the scrotum or sac) is carried out so the spermatic cord can be removed along with the testis. Surgery is typically carried out under general anesthesia in an outpatient setting.

Hazards of surgery include the general risks of infection or bleeding, and issues related to anesthesia. Some men notice some numbness in the scrotum or thigh following orchiectomy.

After surgery, the genital area looks the same. The scrotum is unchanged. The remaining testis is able to provide adequate testicular function. The testosterone level remains normal, and sexual function remains the same. In the past, some patients opted for insertion of a testicular prosthesis, which was made of silicone, to replace the removed testis, but current practice does not favor placement of a prosthesis. The removed testis is examined to determine the type of cancer.

What are the types of testicular cancer?

In broad terms, testicular cancers are divided into two categories – seminoma and nonseminoma (which includes choriocarcinoma, embryonal cell carcinoma, yolk sac tumor and teratocarcinoma).

There are a variety of different treatment options for subsequent treatment of testicular cancer, which depend on the stage of the cancer and the cell type.

Classification of Testicular Tumors

Germ cell tumors

Sex cord-stromal tumors

What additional treatment is needed after surgery?

Treatment options include active surveillance, chemotherapy, radiotherapy and further surgery with retroperitoneal lymph node dissection (RPLND).

Treatment for testicular cancer is typically carried out by a combination of doctors, including the urologist, a medical oncologist (a physician who specializes in the treatment of all types of cancer), and may include a radiation oncologist (a physician who specializes in the use of radiation to treat cancer).

Fortunately, most men with testicular cancer do extremely well with treatments. The overall survival rate is 98%. Although the initial diagnosis of testicular tumor and cancer can be daunting, men who have testicular cancer can be optimistic that with appropriate treatment, there is the prospect for a favorable long-term outcome.