Testicular Cancer Support Group

Testicular cancer is a type of cancer that develops in the testicles, a part of the male reproductive system. In the United States, about 8,000 to 9,000 diagnoses of testicular cancer are made each year. Over his lifetime, a man's chance of getting testicular cancer is roughly 1 in 250 (four tenths of one percent, or 0.4%). It is most common among males aged 15�40 years. Testicular cancer has one of the highest cure rates of all cancers: in excess of ninety percent; essentially one hundred percent if it has not spread. Even for the relatively few cases in which the cancer has spread widely, chemotherapy offers a cure rate of at least fifty percent.

Because testicular cancer is curable when detected early, experts recommend regular monthly testicular self-examination after a hot shower, when the scrotum is looser. Men should examine each testicle, first feeling for lumps and then compare the testicles to each other together to see whether one is larger than the other.

Symptoms may include one or more of the following:

• a lump in one testicle
• pain and tenderness in the testicles
• blood in semen during ejaculation
• build-up of fluid in the scrotum
• a dull ache in the lower abdomen or groin
• an increase, or significant decrease, in the size of one testicle

  Men should report any of these to a doctor as soon as possible.

  The extent of testicular cancer and whether the cancer is present are ascertained by ultrasound (of the testicles), X-rays, and/or CT-scans, which are used to locate tumors. For nonseminomas (see below), a blood test is used to identify and measure tumor indicators that are specific to that type of testicular cancer.

  The three basic types of treatment are surgery, radiation therapy, and chemotherapy. Surgery (inguinal orchiectomy) is performed by urologists; radiation therapy is administered by radiation oncologists; and chemotherapy is the work of medical oncologists.

  While it is possible, in some cases, to remove testicular cancer tumors from a testicle while leaving the testicle functional, this is rarely done. Since only one testicle is typically required to maintain fertility, hormone production, and other male functions, the afflicted testicle is almost always removed completely. More importantly, since removing the tumor alone does not eliminate the precancerous cells that exist in the testicle, it is usually better in the long run to remove the entire testicle to prevent another cancer form. An appropriate exception would be in the case of the second testicle's later developing cancer as well.

  In the case of nonseminomas that appear to be stage 1, surgery may be done on the lower lymph nodes (in a separate operation) to accurately determine whether the cancer is in stage 1 or 2. However, this approach, while standard in many places, especially the United States, is falling out of favor due to costs and the high level of expertise required to perform the surgery.

  Many patients are instead choosing surveillance, where no further surgery is performed unless tests indicate that the cancer has returned. This approach maintains a high cure rate.

  Lymph node surgery may also be performed after chemotherapy to remove masses left behind, particularly in the cases of advanced initial cancer or large nonseminomas.

  Radiation may be used to treat stage-2 seminoma cancers, or as preventive (adjuvant) therapy in the case of stage 1 seminomas, to minimize the likelihood that tiny, non-detectable tumors exist and will spread (in the inguinal and para-aortic lymph nodes). Chemotherapy as an alternative to radiation therapy is increasing, because radiation therapy has more significant long-term side effects (internal scarring, for example). Radiation is never used as a primary therapy for nonseminoma because a much higher dose is required and chemotherapy is far more effective in that setting.

  Chemotherapy is the standard treatment, with or without radiation, when the cancer has spread to other parts of the body (that is, stage 2 or 3). It is also an option for stage-1 nonseminomas, as preventive (adjuvant) therapy, particularly for higher-risk cases. The standard chemotherapy protocol is 3 to 4 rounds of Bleomycin-Etoposide-Cisplatin (BEP). This treatment was developed by Dr. Lawrence Einhorn.

  While treatment success depends on the stage, the average survival rate after five years is around 95 %, and stage-1 cancers cases (if monitored properly) have essentially a 100-percent survival rate (which is why prompt action, when testicular cancer is a possibility, is so important).

  For stage-1 cancers that have not had any adjuvant (preventive) therapy, close monitoring for at least a year is important, and should include blood tests (in cases of nonseminomas) and CT-scans (in all cases), to ascertain whether the cancer has metastasized (spread to other parts of the body). For other stages, and for those cases in which radiation therapy or chemotherapy was administered, the extent of monitoring (tests) will vary on the basis of the circumstances, but normally should be done for five years (with decreasing intensity).

  A man with one remaining testicle can lead a normal life, because the other testicle takes up the load, and will generally have adequate fertility. However, it is worth the (minor) expense of measuring hormone levels before removal of a testicle, and sperm banking may be appropriate for younger men who still plan to have children, since fertility will certainly be lessened by removal of one testicle, and can be severely affected if extensive chemotherapy is done.

  A man who loses both testicles will normally have to take hormone supplements (in particular, testosterone, which is created in the testicles), and is infertile, but can lead an otherwise normal life. Less than five percent of those who have testicular cancer will have it again in the second testicle.