Testicular Cancer

The exact causes of testicular cancer are unknown, but the American Cancer Society notes that most testicular cancer cells have extra copies of a part of chromosome 12. Some cancers have abnormal changes in other chromosomes, or abnormal numbers of chromosomes. Studies are underway to determine how this might affect the development of testicular cancer.

Researchers have identified a few risk factors that may increase the likelihood of developing testicular cancer, but they don’t know how much each risk factor actually contributes to the disease. Most men who have testicular cancer do not have any of the known risk factors.

Testicular cancer risk factors include:

Age

Testicular cancer usually affects men ages 15 to 40.

Race

White men are five to 10 times more likely to develop the disease than other races.

Undescended testicle (cryptorchidism)

Men whose testicles did not descend into the scrotum before birth have a higher risk, even if they have had surgery to correct the condition. Abnormal testicular development also raises the risk.

Klinefelter's syndrome

Men who have this chromosome disorder — characterized by low levels of male hormones, sterility, breast enlargement and small testes — have an increased risk.

Human immunodeficiency virus (HIV) or AIDS

Men who have HIV or AIDS seem to have an increased testicular cancer risk.

Carcinoma in situ (CIS)

This non-invasive form of testicular germ cell cancer causes cells to look abnormal. In some cases, CIS progresses to invasive cancer.

Family or personal history

If your father or brother has had testicular cancer, or you have previously had it, your risk is higher. But most men with testicular cancer do not have a family history of the disease, and no genetic link is known.

Having any of these risk factors does not mean you will develop testicular cancer. If you’re concerned about your risk, talk with your doctor.

Many testicular cancers can be detected at an early stage, when treatment is most likely to be successful. While there are no screening tests, a lump or a swollen testicle is often the first sign. The American Cancer Society recommends that men have their testicles examined by a physician as part of a routine checkup.

Between exams, practice awareness — know the signs and symptoms of testicular cancer and call your doctor if you notice anything unusual.

If you do have symptoms or a physical exam finds anything unusual, your doctor may recommend further testing. Scripps physicians use advanced imaging and lab tests to diagnose testicular cancer. These may include:

Blood tests

Blood tests may be used to detect certain protein "markers" in the blood that may indicate testicular cancer. These tests include:

• Alpha-fetoprotein (AFP) to check for elevated levels of this protein, which may indicate the presence of a germ cell tumor
• Beta human chorionic gonadotropin (b-HCG) to check for increased levels that may indicate testicular cancer
• Lactate dehydrogenase (LDH) to check for this enzyme linked to increased activity in the body's cells and tissues, which may indicate cancer

Ultrasound

Diagnostic ultrasound is an imaging procedure that uses sound waves to create pictures of the tissue. During ultrasound, a wand-like instrument is moved over the testicles, and the images are recorded and displayed for review.

Biopsy

During a biopsy, the doctor removes a small tissue sample from the testicle to be examined under a microscope for cancer. Biopsy may be used in some cases to confirm testicular cancer, but it’s more likely that the doctor will remove the entire tumor if possible.

Scripps oncologists use testicular cancer stages to determine whether cancer has spread from the testicles to other areas of the body. Staging is important for developing a testicular cancer prognosis and treatment plan. 

Stage 0 (carcinoma in situ)

Abnormal cells are found in the tiny tubules where sperm cells develop. In some cases, these abnormal cells may become cancer. All blood tumor marker levels are normal. Stage 0 testicular cancer is also called carcinoma in situ.

Stage IA

In stage IA testicular cancer, cancer is in the testicle and epididymis (the tube that connects ducts in the testicle to vas deferens) and may have spread to the inner layer of the membrane around the testicle. All tumor marker levels are normal.

Stage IB

In stage IB testicular cancer, all tumor marker levels are normal, and cancer is found in one of the following:

• In the testicle and epididymis and has spread to the blood or lymph vessels in the testicle
• In the outer layer of the membrane surrounding the testicle
• In the spermatic cord or the scrotum and may be in the blood or lymph vessels of the testicle

Stage IS

In stage IS testicular cancer, cancer is found anywhere within the testicle, spermatic cord or the scrotum and either:

• All tumor marker levels are slightly above normal
• One or more tumor marker levels are moderately above normal or high

Stage IIA

In stage IIA testicular cancer, all tumor marker levels are normal or slightly above normal, and cancer is found in one of the following:

• Anywhere within the testicle, spermatic cord or scrotum
• In up to five lymph nodes in the abdomen, none larger than 2 cm

Stage IIB

In stage IIB testicular cancer, all tumor marker levels are normal or slightly above normal, and cancer is anywhere within the testicle, spermatic cord or scrotum and has spread to either:

• Up to five lymph nodes in the abdomen, with at least one of the lymph nodes that is larger than 2 cm, but none is larger than 5 cm
• More than five lymph nodes that are not larger than 5 cm

Stage IIC

In stage IIC testicular cancer, all tumor marker levels are normal or slightly above normal, and the cancer:

• Is anywhere within the testicle, spermatic cord or scrotum, and
• Has spread to a lymph node in the abdomen and the tumor is larger than 5 cm

Stage IIIA

In stage IIIA testicular cancer, the level of one or more tumor markers may range from normal to slightly above normal, and cancer is found in all of the following:

• Anywhere within the testicle, spermatic cord or scrotum
• One or more lymph nodes in the abdomen
• Distant lymph nodes or in the lungs

Stage IIIB

In stage IIIB testicular cancer, the level of one or more tumor markers may range from normal to high, and the cancer:

• Is anywhere within the testicle, spermatic cord or scrotum
• May have spread to one or more nearby or distant lymph nodes or to the lungs

Stage IIIC

In stage IIIC testicular cancer, the level of one or more tumor markers may range from normal to very high, and the cancer:

• Is anywhere within the testicle, spermatic cord or scrotum
• May have spread to one or more nearby or distant lymph nodes or to the lungs or anywhere else in the body

No one wants to hear that they have cancer. It’s completely normal to feel anxious, scared, depressed or overwhelmed. Learning all you can about your diagnosis and your options can help you make informed, confident decisions about the next steps to take.

Questions and considerations

Here are some questions you may want to ask your doctor or health insurance provider regarding your diagnosis:

• Should I get a second opinion?
• How do I find a specialist?
• What is my cancer treatment plan?
• Will I have to miss work/school?
• What are the side effects of testicular cancer treatment?
• How successful is my treatment likely to be?
• What costs will be covered by insurance?
• Which costs will I be responsible for?

Your Scripps cancer team is here to help you find the answers you need to take an active role in your care. In addition, there are a number of community resources that provide education, information and helpful resources — often at no cost.

Learn more about the many cancer patient resources available to you and your loved ones via Scripps.

Treatment for testicular cancer typically involves surgery, and may involve radiation therapy and/or chemotherapy if the cancer has spread. Your Scripps cancer care team will customize your treatment plan based on several factors, including:

• The type and stage of your cancer
• Whether your cancer has spread
• Your age and overall health

Surgery

Surgery for testicular cancer may involve the following procedures. Whenever possible, Scripps surgeons use minimally invasive procedures, such as laparoscopic surgery or robotic-assisted surgery. Minimally invasive surgery can offer benefits such as fewer incisions, a shorter hospital stay and a faster recovery.

• Orchiectomy is when surgeons remove the testicle through an incision in the groin. The procedure can also be part of the approach to diagnosing testicular cancer. Tissue removed from the testicle is examined to determine the stage of the cancer, and typically involves removal of some of the nearby lymph nodes.
• Retroperitoneal lymph node dissection (RPLND) is when the surgeon removes and tests lymph nodes in the abdominal area. RPLND is typically done at the same time as the orchiectomy.

Radiation therapy

Radiation therapy is often effective in treating seminomas, the most common type of testicular cancer. Radiation therapy is generally performed after orchiectomy surgery.

• Intensity-modulated radiation therapy (IMRT) is an advanced form of radiation therapy. IMRT allows the radiation oncologist to specify the dose of radiation for the tumor while restricting the dose to surrounding healthy tissues.

Chemotherapy

Several chemotherapy drugs may be used following surgery to treat cancer that has spread, or to help prevent cancer from returning. High-dose chemotherapy in combination with stem cell transplant can also be part of treatment.

Active surveillance

Following surgery to remove testicular cancers that have not spread beyond their starting point, your physician may recommend monitoring and testing to see if the cancer returns instead of radiation and chemotherapy to prevent recurrence. Follow-up visits and tests may be needed for up to 10 years.

Some testicular cancer treatment plans may involve clinical trials. Talk with your physician about whether a clinical trial is right for you.

For a list of clinical trials that are currently enrolling patients, see our current list of clinical trials.

Your Scripps cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.

Your testicular cancer treatment plan generally includes:

• Family and medical history
• A summary of your cancer diagnosis and staging information
• Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
• Plans for surgery, radiation, chemotherapy and/or other treatments
• Potential side effects of treatments
• Contact information for your cancer care team members

Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.

Your testicular cancer care team includes health and medical professionals from a wide range of specialties. Scripps will customize your team to ensure you have the expertise and support you need.

Your team may include:

• Physicians
• Surgeons and surgical oncologists
• Radiation oncologists
• Medical oncologists
• Registered nurses
• Nurse navigators
• Dietitians
• Oncology social workers

Visit your cancer care team for more on Scripps' multidisciplinary approach to treatment.

We are here for you — not only as your oncologists, but as a robust multidisciplinary team of experts who understands that your cancer journey is about much more than your medical treatment. Specifically, Scripps Cancer Center offers a variety of patient support services to ensure your physical, psychological and emotional well-being as well as resources for dealing with the logistical and financial aspects of cancer care. Our services and resources include:

• Oncology nurses and nurse navigators with extensive clinical expertise in cancer care to help guide you and your caregivers to make informed decisions and ensure your optimal care.
• Palliative care to provide an extra layer of supportive care to manage pain and relieve symptoms, offer emotional and spiritual support, and improve your quality of life. 
• Oncology social workers specially trained to provide counseling, connect you with community and medical resources, assist with transportation and housing and coordinate care after discharge.
• Our registered dietitian nutritionists offer individualized nutrition support for patients whose efforts to optimize their nutrition may be affected by cancer symptoms or treatment side effects.
• Referrals and professional care from experts in psychology, psychiatry and emotional health, including individual and family counseling to help with the emotional challenges of cancer.
• Physical rehabilitation and occupational therapy services, including wound care, voice therapy and swallowing therapy, lymphedema therapy, balance and vestibular rehabilitation, yoga and more.
• Scripps Center for Integrative Medicine for patients interested in mind-body healing through acupuncture, biofeedback, herbal nutrition, massage therapy, integrative cancer care and more.
• Nondenominational spiritual care offered by our chaplains to help coordinate spiritual care with your own clergy, rabbi or spiritual advisor.
• Visiting patient services if you reside beyond San Diego and want help arranging appointments or learning more about short-term lodging.

For the full spectrum of offerings, please visit our cancer patient support services section.