Testis Cancer

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Testicular Cancer

The testicles are the male sex organs located in the scrotum. Testis cancer is a malignant disease of the testicles, and is seen when abnormal cells in the testes start to grow in an uncontrolled fashion. This disease occurs most often in young men, between the ages of 20 and 40. Testis cancer is also seen more often in white males, but can affect men of any race. The cause of testicular cancer is not well known. However, we are aware that men with a family history of testis cancer, a history of cryptorchidism (undescended testicle), and a history of infertility problems are at higher risk for developing the disease.

The majority of men with testis cancer present to the urologist with either a mass in the testicle, or a change in the size of their testes. The mass can be associated with pain, but most often the mass is completely asymptomatic, and is only noticed on a testicular examination. If a man notices a mass on his testicle, he should seek an evaluation by their primary care physician or a urologist as soon as possible. Once the mass has been evaluated, the physician will order several of the following tests:

1. Testicular ultrasound
2. Blood tests to evaluate the levels of tumor markers. Tumor markers are proteins that are sometimes produced by the cancer and released into the blood stream.
3. CT or MRI scan

If there is a strong suspicion that a man has testis cancer the urologist will recommend a surgical procedure to remove the abnormal testicle (this surgery is called an orchiectomy). After the orchiectomy, the testicle will be processed by a pathologist, who will evaluate the tumor under the microscope. The biopsy will determine the types of cells present in the tumor. Between 90-95% of the time the cells are found to be cancerous. Typically the pathology is divided in seminoma, or nonseminomatous germ cell tumors. This information will help the urologist plan the course of treatment. Depending on the cell type, the urologist may need to consult with a specialist in Hematology/Oncology, or Radiation Oncology.

The stage of the cancer is determined from the findings of the tests noted above. There are 3 parts to the staging, and the staging system is referred to the TNM cancer staging system.

1. T = Tumor size and extend
2. N = Nodal involvement
3. M = Metastasis outside the nodal system, involving other parts of the body.

Additional therapy will depend on the type of cells seen by the pathologists, the results of the tumor markers, and the CT scan (or MRI). All of these tests will help determine the final TNM stage. Follow up therapy could include:

1. Nerve Sparing Retroperitoneal Lymph Node Dissection (RPLND) - this may be required to check for cancer that has spread to the lymph nodes in the back of the abdomen.
2. Chemotherapy - is used to destroy cancer cells that may be seen on RPLND, or CT scan, or by virtue of the fact that the tumor markers remain elevated after the orchiectomy.
3. Radiation therapy - used in some patients with a very specific cell type (seminoma) to treat cancer that may have spread to the back of the abdomen
4. Active monitoring (observation) - used in a very highly selected patient population.

Most men will have one remaining testicle, and should still have normal sexual function after their therapy has been completed. A Nerve Sparing RPLND enhances the chances of normal sexual function following therapy. Fertility, or the ability to have children, is variable, and depends on which therapy is required to treat the patient. Many men have found that fertility is still possible once all of their therapy has been completed. If you have questions regarding infertility or sexual function, talk with your urologist.

Once the tumor has been treated, it is important for the man to receive follow up care, in order to detect recurrent cancer. The follow up will include:

1. Physical examinations
2. Chest X-rays
3. CT scans
4. Tumor markers

Men with the diagnosis of testicular cancer will need to continue follow up with the urologist for many years,

Testicular cancer is considered to be a highly curable cancer. However, it is still a serious disease that has the potential to kill young men in the prime of their life. It is important that the man seeks care promptly, and then follows up on a regular basis once treatment has been completed.