Testicular Cancer

Signs & symptoms

Most men can detect their own testicular cancers. Doctors generally examine the testicles during routine physical exams. Between regular checkups, if you notice anything unusual about your testicles, you should talk with your doctor.

Common symptoms include:

• A painless lump or swelling in either testicle
• Any enlargement of a testicle or change in the way it feels
• A feeling of heaviness in the scrotum
• A dull ache in the lower abdomen or the groin
• A sudden collection of fluid in the scrotum
• Pain or discomfort in a testicle or in the scrotum

Diagnosis

To help find the cause of symptoms, the doctor will evaluate your general health. Your doctor will perform a physical exam and may order laboratory and diagnostic tests. If a tumor is suspected, your doctor will probably recommend an ultrasound. If a tumor is detected, the testicle is removed.

• Blood tests. Measures the levels of tumor markers. Tumor markers are substances often found in higher-than-normal amounts when cancer is present. Tumor markers for testicular cancer involve beta human chorionic gonadotropin hormone (B-hCG); alpha-fetoprotein, a blood protein that's present in adults with some forms of cancer; and lactate dehydrogenase (LDH), a protein that can be elevated by cancer.
• Ultrasound. A diagnostic test in which high-frequency sound waves are bounced off tissues and internal organs. Their echoes produce a picture called a sonogram. Ultrasound of the scrotum can show the presence and size of a mass in the testicle. It is also helpful in ruling out other conditions, such as swelling due to infection.
• Biopsy. If a testicular tumor is suspected based on physical examination, blood tests and ultrasound, the testicle is removed. In nearly all cases of suspected cancer, the entire affected testicle is removed through an incision in the groin. This procedure is called inguinal orchiectomy. In rare cases, for example, when a man has only one testicle, the surgeon performs an inguinal biopsy, removing a sample of tissue from the testicle through an incision in the groin and proceeding with orchiectomy only if the pathologist finds cancer cells. (The surgeon does not cut through the scrotum to remove tissue, because if the problem is cancer, this procedure could cause the disease to spread.)

Treatments

Four treatments commonly used for testicular cancer are surgery, radiation therapy, chemotherapy and bone marrow transplant.

Surgery

Surgery is a common treatment for most stages of cancer of the testicle. A doctor may take out the cancer by removing one or both testicles through an incision (cut) in the groin. This is called a radical inguinal orchiectomy. Some of the lymph nodes in the abdomen may also be removed in a procedure called a lymph node dissection.

Radiation therapy

Radiation therapy uses X-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation usually is emitted by a machine and is called external-beam radiation, rather than radiation emitted by a substance consumed by the patient.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It may be taken by pill, or injected into a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body and can kill cancer cells outside the testicle.

Bone marrow transplantation

Bone marrow transplantation is a newer type of treatment. In an autologous bone marrow transplant, bone marrow is taken from the patient and treated with drugs to kill cancer cells. The marrow is then frozen. The patient is given high-dose chemotherapy — with or without radiation therapy — to destroy the remaining marrow. The marrow removed from the patient is then thawed and returned to the patient by injection in a vein to replace the marrow that was destroyed.