What it is:
Testicular cancer is a common cancer among young American men. This year, there are estimated to be nearly 5,000 new cases. There are several subtypes of testis cancer. Most are germ cell neoplasms and consist of either a seminoma or a non-seminoma (or both). Several other types of rare tumors can be found in the testes.
These cancers are usually diagnosed after a man feels a mass in his scrotum or has sensations of “heaviness” in his testis. A select group of men will have a tumor present elsewhere in their bodies (such as a neck mass or an abdominal mass) that is removed and then determined to be testicular cancer. Many men with testis cancer have a history of trauma to the scrotum or an undescended testes.
How we find it:
When a man discovers a testicular mass, he should see his doctor immediately. In addition to a testicular exam (feeling the testis), an ultrasound X-ray study of the testes may be performed. Several blood tests (called tumor markers or biomarkers), including an alpha-fetoprotein [AFP], a beta-hCG, and an LDH will be obtained. Surgery will then be performed to remove the testis and make the diagnosis of cancer. This is called a radical orchiectomy and is required for any suspicious testicular lesion or mass and is almost always the first step in making the diagnosis of testis cancer.
Prior to the orchiectomy, blood should be collected to monitor the following biomarkers: alpha-fetoprotein [AFP], beta-hCG and LDH. The presence or absence of these tumor biomarkers before and/or after orchiectomy may indicate the type of testis cancer present and the presence of residual disease and may impact upon the type (if any) of treatment after the orchiectomy.
- This involves removal of the testes, the surrounding capsule, and the spermatic cord – the structure that connects the testes to the abdomen.
- The radical orchiectomy is performed through an incision in the lower part of the abdomen: the scrotum is left untouched. This is to prevent spread of testes cancer cells.
- After surgery, the patient is advised to be sedentary for several days and is given and ice pack and athletic supporter to help prevent untoward bleeding.
Once the diagnosis is made, additional treatments can consist of further surgery, radiotherapy, chemotherapy, a combination of these approaches, or close observation with blood tests and radiologic studies.
How we treat it:
Fortunately, most patients with testicular cancer will be cured of their disease. In addition, most will return to normal activities in an expeditious timeframe. Treatment for testicular cancer depends upon several factors, including the type of testis cancer and the extent of disease. First, surgery is performed to remove the testis (radical orchiectomy) and make the diagnosis of testis cancer.
The type of tumor will dictate in part the kind of treatment used after orchiectomy. Likewise, the presence or absence of biomarkers (alpha-fetoprotein [AFP], beta-hCG, and LDH) before and/or after orchiectomy may impact upon the type of treatment as this can indicate the presence of residual disease. Finally, the presence or absence of metastatic lesions on CT scans and/or chest X-rays will determine in part the type, if any, of additional treatment that may be necessary. These treatments can consist of further surgery, radiotherapy, chemotherapy, a combination of these approaches, or close observation with blood tests and radiologic studies.
Although most men maintain normal fertility, at some point in treatment the role of sperm-banking, to preserve the ability to father children after treatment for the testicular cancer is completed, may occur.