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Conditions

Testicular Cancer

The testicles are 2 egg-shaped glands located inside the scrotum (a sac of loose skin that lies directly below the penis). The testicles are held within the scrotum by the spermatic cord, which also contains the vas deferens and vessels and nerves of the testicles.

The testicles are the male sex glands and produce testosterone and sperm. Germ cells within the testicles produce immature sperm that travel through a network of tubules (tiny tubes) and larger tubes into the epididymis (a long coiled tube next to the testicles) where the sperm mature and are stored. Almost all testicular cancers start in the germ cells. The two main types of testicular germ cell tumors are seminomas and nonseminomas. These 2 types grow and spread differently and are treated differently. Nonseminomas tend to grow and spread more quickly than seminomas. Seminomas are more sensitive to radiation. A testicular tumor that contains both seminoma and nonseminoma cells is treated as a nonseminoma.

Symptoms

Possible signs of testicular cancer include swelling or discomfort in the scrotum.

These and other symptoms may be caused by testicular cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

  1. A painless lump or swelling in either testicle.
  2. A change in how the testicle feels.
  3. A dull ache in the lower abdomen or the groin.
  4. A sudden build-up of fluid in the scrotum.
  5. Pain or discomfort in a testicle or in the scrotum.

Testicular Cancer

The testicles are 2 egg-shaped glands located inside the scrotum (a sac of loose skin that lies directly below the penis). The testicles are held within the scrotum by the spermatic cord, which also contains the vas deferens and vessels and nerves of the testicles.

The testicles are the male sex glands and produce testosterone and sperm. Germ cells within the testicles produce immature sperm that travel through a network of tubules (tiny tubes) and larger tubes into the epididymis (a long coiled tube next to the testicles) where the sperm mature and are stored. Almost all testicular cancers start in the germ cells. The two main types of testicular germ cell tumors are seminomas and nonseminomas. These 2 types grow and spread differently and are treated differently. Nonseminomas tend to grow and spread more quickly than seminomas. Seminomas are more sensitive to radiation. A testicular tumor that contains both seminoma and nonseminoma cells is treated as a nonseminoma.

Stages of Testicular Cancer

Stage I

In stage I, cancer has formed. Stage I is divided into stage IA, stage IB, and stage IS and is determined after a radical inguinal orchiectomy is done.

  1. In stage IA, cancer is in the testicle and epididymis and may have spread to the inner layer of the membrane surrounding the testicle. All tumor marker levels are normal.
  2. In stage IB, cancer:
    1. is in the testicle and the epididymis and has spread to the blood or lymph vessels in the testicle; or
    2. has spread to the outer layer of the membrane surrounding the testicle; or
    3. is in the spermatic cord or the scrotum and may be in the blood or lymph vessels of the testicle.
    All tumor marker levels are normal.
  3. In stage IS, cancer is found anywhere within the testicle, spermatic cord, or the scrotum and either:
    1. all tumor marker levels are slightly above normal; or
    2. one or more tumor marker levels are moderately above normal or high.


Stage II
Stage II is divided into stage IIA, stage IIB, and stage IIC and is determined after a radical inguinal orchiectomy is done.

  1. In stage IIA, cancer:
    1. is anywhere within the testicle, spermatic cord, or scrotum; and
    2. has spread to up to 5 lymph nodes in the abdomen, none larger than 2 centimeters.
    All tumor marker levels are normal or slightly above normal.

  2. In stage IIB, cancer is anywhere within the testicle, spermatic cord, or scrotum; and either:
    1. has spread to up to 5 lymph nodes in the abdomen; at least one of the lymph nodes is larger than 2 centimeters, but none are larger than 5 centimeters; or
    2. has spread to more than 5 lymph nodes; the lymph nodes are not larger than 5 centimeters.
    All tumor markers levels are normal or slightly above normal.

  3. In stage IIC, cancer:
    1. is anywhere within the testicle, spermatic cord, or scrotum; and
    2. has spread to a lymph node in the abdomen that is larger than 5 centimeters.
    All tumor marker levels are normal or slightly above normal.

    Stage III
    Stage III is divided into stage IIIA, stage IIIB, and stage IIIC and is determined after a radical inguinal orchiectomy is done.

    1. In stage IIIA, cancer:
      1. is anywhere within the testicle, spermatic cord, or scrotum; and
      2. may have spread to one or more lymph nodes in the abdomen; and
      3. has spread to distant lymph nodes or to the lungs.
      The level of one or more tumor markers may range from normal to slightly above normal.

    2. In stage IIIB, cancer:
      1. is anywhere within the testicle, spermatic cord, or scrotum; and
      2. may have spread to one or more nearby or distant lymph nodes or to the lungs.
      The level of one or more tumor markers may range from normal to high.

    3. In stage IIIC, cancer:
      1. is anywhere within the testicle, spermatic cord, or scrotum; and
      2. may have spread to one or more nearby or distant lymph nodes or to the lungs or anywhere else in the body.
      The level of one or more tumor markers may range from normal to very high.

    Treatment Options

    Surgery

    Surgery to remove the testicle (radical inguinal orchiectomy) and some of the lymph nodes may be done at diagnosis and staging. (See the General Information and Stages sections of this summary.) Tumors that have spread to other places in the body may be partly or entirely removed by surgery.

    Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

    Radiation therapy

    Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.