Cancer of the testicles accounts for about 1% of all cancers in men, according to the National Cancer Institute. About 7,000 Americans were expected to get the disease in 1995, with an estimated 325 deaths. Compared with prostate cancer, estimated to kill 40,400 of its 244,000 victims in 1995, testicular cancer is relatively rare.
Testicular cancer is the most common cancer among young men (aged 15-40) in North America; the rates of testicular cancer have been steadily climbing since the 1950s. More recent data from 2003 suggested that some 7,500 Americans were being diagnosed annually with testicular cancer, of which some 500 were dying as a result.
Nearly all testicular tumors stem from germ cells, the special sperm-forming cells within the testicles. These tumors fall into one of two types, seminomas or nonseminomas. Other forms of testicular cancer, such as sarcomas or lymphomas, are extremely rare.
Seminomas account for about 40% of all testicular cancer cases and are made up of immature germ cells. Usually, seminomas are slow-growing and tend to stay localized in the testicle for long periods.
Nonseminomas are a group of cancers that sometimes occur in combination, including choriocarcinoma, embryonal carcinoma, and yolk sac tumors. Nonseminomas arise from more mature, specialized germ cells and tend to be more aggressive than seminomas. According to the American Cancer Society, some 60-70% of patients with nonseminomas have cancer that has spread to the lymph nodes.
Most testicular tumors are discovered by patients themselves – either by accident, or while performing a self-examination on each testicle. The usual presentation is of an enlarged, painless lump, and occasionally there can be pain. The lump is typically pea-sized, but sometimes may be as big as a marble or even an egg.
Besides lumps, if a man notices any other abnormality – an enlarged testicle, a feeling of heaviness or sudden collection of fluid in the scrotum, a dull ache in the lower abdomen or groin, or enlargement or tenderness of the breasts, this should be investigated. These symptoms can be caused by other conditions, but it is critical to seek attention promptly.
The only positive way to identify a tumor is for a pathologist to examine a tissue sample under a microscope. Doctors obtain the tissue by removing the entire affected testicle through the groin, a procedure called inguinal orchiectomy. Surgeons do not cut through the scrotum or remove just a part of the testicle, because if cancer is present, a cut through the outer layer of the testicle may cause the disease to spread locally. Besides enabling diagnosis, testicle removal also can prevent further growth of the primary tumor.
The process of staging will indicate which stage the cancer has reached:
Imaging techniques provide doctors with pictures of internal organs, giving visual clues to cancer staging. Chest X-rays can tell doctors if disease has spread to the lungs. Lymphangiography allows the lymph nodes to be visualized on an X-ray. CT scans can indicate possible tumors at various body sites.
No one treatment works for all testicular cancers. Seminomas and nonseminomas differ in their tendency to spread, their patterns of spread, and response to radiation therapy. Thus, they often require different treatment strategies, which doctors choose based on the type of tumor and the stage of disease.
Because they are slow-growing and tend to stay localized, seminomas generally are diagnosed in stage 1 or 2. Treatment might be a combination of testicle removal, radiation, or chemotherapy. Surgical removal of lymph nodes usually is not necessary for seminoma patients because this type of tumor is especially sensitive to radiation. Normally directed to the retroperitoneal lymph nodes but sometimes to other lymph nodes, radiation can effectively remove cancer cells there. Stage 3 seminomas are usually treated with multidrug chemotherapy.
Though most nonseminomas are not diagnosed at an early stage, cases confined to the testicle may need no further treatment other than testicle removal. These men must have careful follow-up for at least two years because about 10% of stage 1 patients have recurrences, which then are treated with chemotherapy. Stage 2 nonseminoma patients who have had testicle and lymph node removal may also need no further therapy. Some doctors opt for a short course of multidrug chemotherapy for stage 2 patients to reduce the risk of recurrence. Most stage 3 nonseminomas can be cured with drug combinations.
Surgery to remove the retroperitoneal lymph nodes, into which the testicles drain, often is necessary for testicular cancer patients. Doctors examine lymph tissue microscopically to help determine the stage of the disease. Also, removing the tissue helps control further cancer spread.
As recently as the 1980s, a diagnosis of testicular cancer was grim news. Ten times as many patients died then as at the end of the century. Dramatic advances in therapeutic drugs, along with improved diagnostics and better tests to gauge the extent of the disease, have boosted survival rates remarkably. Now, testicular cancer often is completely curable, especially if found and treated early.
Any kind of cancer treatment can cause undesirable side-effects, but one of the main concerns in this case is how treatment might affect sexual or reproductive capabilities.
Removing one testicle does not impair fertility or sexual function. The remaining testicle can produce sperm and hormones adequate for reproduction. Removal of the retroperitoneal lymph nodes usually does not affect the ability to have erections or orgasms. It can, however, disrupt the nerve pathways that control ejaculation, causing infertility.
Modern "nerve-sparing" surgical techniques have increased the odds of retaining fertility. Many surgeons are abandoning procedures involving the blanket removal of every single lymph node. Ejaculation can be preserved in as many as 80% of cases.
Some chemotherapy drugs may cause infertility, but studies have shown that many men recover fertility two to three years after therapy ends. Radiation treatment may also cause infertility, but usually this is temporary.
It must be emphasized that even though the cure rate is very high for all types and stages of testicular cancer, many of the drastic measures taken to cure later-stage disease can be avoided if the tumor is caught early enough. The best way to do this is through regular self-examination.
For unknown reasons, testicular cancer is about four times more common in white men than in black men.
In October of 2003, the largest study on diet and testicular cancer ever conducted was published, studying the diets of hundreds of cancer victims. Previously there was little data on dietary risk factors for this dreaded disease. This study found that by far the strongest dietary risk factor associated with testicular cancer was the consumption of cheese. Those men that ate the most cheese were almost 90% more likely to develop cancer of the testicles. The investigators guessed that it may be the hormones in milk and dairy that were to blame. [International Journal of Cancer 106 (2003): p.934]
In October of 2003, the largest study on diet and testicular cancer ever conducted was published, studying the diets of hundreds of cancer victims. After cheese consumption, the second strongest dietary risk factor for testicular cancer seemed to be the consumption of lunch meat. [International Journal of Cancer 106 (2003): p.934]
The October 10, 2003 issue of the International Journal of Cancer revealed that a high intake of cheese is associated with an elevated risk of testicular cancer in Canadian males. An analysis was made of the diets of 601 men who were diagnosed with testicular cancer, and of 744 controls. Food consumption data from seventeen food groups were analyzed from a 69-item food-frequency questionnaire. According to the researchers: "...high dairy product intake, in particular high intake of cheese (odds ratio [OR] = 1.87; 95% confidence interval [CI] 1.22-2.86; p-trend < 0.001), is associated with an elevated risk of testicular cancer."
In 2002, the International Journal of Cancer (Ganmaa, et. al. 98: pp.262-7) reported that diet has an important influence on testicular and prostate cancer risk. The authors of the study found: "Cheese was found to be most closely correlated with the incidence of testicular cancer."
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