Dr. M.J. Bazos, MD.
About Your Diagnosis
Testicular cancer or germ cell tumors
are cancers that begin in the testes (testicles). The testes are the male sex
glands that produce and store sperm and the male hormone testosterone.
Approximately 7500 new cases of testicular cancer are diagnosed each year in the
United States. Most patients are men between the ages of 20 and 40 years. The
cause is not known. Some patients, however, are at higher risk for testicular
cancer than are others. Men who were born with an undescended testicle
(cryptorchidism; the testicle remains in the abdomen instead of descending into
the scrotum) are more likely to have testicular cancer than are other men.
Testicular cancer is not contagious. The best way to detect testicular cancer is
by performing a self-examination of the testicles (Fig 1). This is important
because the first sign of testicular cancer usually is a lump in the testicle.
If you feel a lump in your testicle, you should notify your primary care
physician, who proceeds with further evaluation. The next step usually is
testicular ultrasonography. If this examination shows a solid testicular mass
(lump), the primary care physician refers you to a urologist, who removes the
testicle (orchiectomy) and makes a definitive diagnosis. Nearly 90% of newly
diagnosed testicular cancers are curable. Even cancers that have spread have a
very good cure rate of 70% to
Living With Your
The first sign of testicular
cancer usually is a lump in the testicle. Other signs and symptoms are pain,
swelling, and enlargement of the testis. Cancer that spreads to the back and
lungs produces low back pain and shortness of
cancers are divided into two types, seminomatous and nonseminomatous. This is
important to know because the tumors spread differently and are managed
differently. Once the diagnosis is made during an operation, staging is
performed to find out the extent of spread of the disease. Staging is commonly
performed with special blood tests, computed tomography (CT) of the abdomen and
pelvis to look for spread to lymph nodes, and possibly an operation to remove
lymph nodes (retroperitoneal lymph node dissection; RPLND). Stage I disease is
confined to the testis. Stage II is disease that has spread to local lymph
nodes. Stage III disease has distant spread. Depending on the type of tumor
(seminomatous or nonseminomatous) and the stage of disease (I, II, III),
specific treatment with surgical, radiation, or chemotherapy is recommended.
Seminomatous tumors are sensitive to radiation. If there is no distant spread,
irradiation is the recommended treatment. If there is distant spread,
chemotherapy is advised. Typical side effects of radiation are dry, red, itchy
skin in the area of radiation. Because radiation is in the abdominal area,
diarrhea, bloody stools, urinary frequency and discomfort, and nausea may occur.
Chemotherapy can cause easy bruising and bleeding, hair loss, nausea, vomiting,
and fevers. Nonseminomatous tumors in the early stage are managed with a
surgical procedure (RPLND) and observation. For more advanced disease,
chemotherapy is added to surgical
• Learn and perform
testicular self examinations.
for second opinions. You must feel comfortable with the decisions about
treatment, and learning about the disease helps relieve
• Understand the importance
of nutrition after surgical treatment and
• Ask about emotional
• Do not miss
follow-up appointments with your physicians. Special blood tests usually are
ordered to help detect whether the cancer has recurred. Radiographs (x-rays) and
scans are obtained regularly to make sure there is no
• Do not forget to
perform testicular self-examinations on the remaining testicle; there is a 1%
chance that cancer will develop in that
• Do not be afraid to ask
about sex. An operation to remove one testicle does not make you infertile,
sterile, or impotent (inability to have an erection). An operation to remove the
lymph nodes has no affect on your ability to have an erection but can cause
• Do not wait if you feel
a lump on your
When to Call
• If you feel a lump
on your testicle.
• If you have
swelling or pain in your testicle.
If you have a fever after
• If you have back pain
or shortness of breath.
• If you have
excess drainage from the surgical site.