Dr. M.J. Bazos, MD. Patient Handout

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 80%.

Living With Your Diagnosis
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 breath.

Testicular 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 treatment.

The DOs
• Learn and perform testicular self examinations.
• Ask for second opinions. You must feel comfortable with the decisions about treatment, and learning about the disease helps relieve anxiety.
• Understand the importance of nutrition after surgical treatment and chemotherapy.
• Ask about emotional support groups.

The DON’Ts
• 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 recurrence.
• Do not forget to perform testicular self-examinations on the remaining testicle; there is a 1% chance that cancer will develop in that testis.
• 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 sterility.
• Do not wait if you feel a lump on your testicle.

When to Call Your Doctor
• If you feel a lump on your testicle.
• If you have swelling or pain in your testicle.
• If you have a fever after chemotherapy.
• If you have back pain or shortness of breath.
• If you have excess drainage from the surgical site.