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Testicular cancer

Alternative Names:
Cancer - testes; Germ cell tumor; Seminoma

Treatment:
Treatment depends on the type of tumor, the stage of the tumor, and the extent of the disease. Most patients can be cured.

Once cancer is found, the first step is to determine the type of cancer cell. This determination is done by a microscopic exam. The cells can be seminoma or non-seminoma. If both types of seminoma and non-seminoma cells are found in a single tumor, the tumor is treated as a non-seminoma.

The next step is to determine how far it has spread to other parts of the body. This is called "staging."
  • In Stage I, the cancer has not spread beyond the testicle.
  • In Stage II, the cancer has spread to lymph nodes in the abdomen.
  • In Stage III, the cancer has spread beyond the lymph nodes; it could be as far as the liver or lungs.

There are three types of treatment that can be used.

  1. Surgical treatment includes removing the testicle (orchiectomy) and removal of associated lymph nodes (lymphadenectomy). This is usually performed in the case of both seminoma and non-seminoma testicular cancers
  2. Radiation therapy using high dose X-rays or other high-energy rays may be used after surgery for patients with seminomas to prevent the tumor from returning. The use of radiation therapy is usually limited to the treatment of seminomas.
  3. Chemotherapy -- using drugs such as cisplatin, bleomycin, and etoposide to kill cancer cells -- has greatly enhanced the survival rate of both seminomas and non-seminomatous testicular tumors.

The cure rate for Stage I seminoma tumor is over 95%. The treatment is usually surgery to remove the testis and radiation to the lymph nodes in the abdomen.

Stage II seminoma tumors are divided into bulky and non-bulky disease. Bulky disease is generally defined as tumors greater than 5 centimeters.

The treatment of Stage II seminomas includes surgery to remove the testis followed by either radiation to the lymph nodes in the case of non-bulky disease or chemotherapy with cisplatin for patients with bulky disease. The cure rate is between 85-95%.

Stage III seminoma tumors have a 90% cure rate. The treatment is surgery to remove the testis and multi-drug chemotherapy.

The cure rate for a Stage I nonseminoma tumor is over 95%. The treatment is removal of the testis and, possibly, removal of lymph nodes in the abdomen.

Stage II nonseminoma tumors have a cure rate of over 95%. The treatment is usually surgery to remove the testis and lymph nodes in the abdomen, possibly followed by chemotherapy.

Stage III nonseminoma has a 70% cure rate. The treatment will probably be chemotherapy and surgical removal of the testis.

If the cancer is a recurrence of a previous testicular cancer, the treatment usually consists of chemotherapy using combinations of different medications, such as ifosfamide, cisplatin, etoposide, or vinblastine.



Support Groups:
Joining a support group where members share common experiences and problems can often help the stress of illness. Your local branch of the American Cancer Society may have a support group.

Lance Armstrong, a famous cyclist, is a survivor of testicular cancer. He has a web site that offers support and information. A Federal Government web site from the National Cancer Institute offers information and services for cancer patients and their families.

Expectations (prognosis):
The survival rate for men with early stage seminoma (the least aggressive type of testicular cancer) is greater than 95%. The disease-free survival rate for Stage I non-seminomatous cancer is nearly 95%; for Stage II seminomas it is 70-90%, depending on the size of the tumor when treatment is begun; for Stage II non-seminomas it is greater than 95%; and for Stage III for both is usually about 70% curable.

This response to treatment means that testicular cancer is one of the most treatable cancers.

Complications:
Metastasis (spreading) to other parts of the body may occur with testicular cancer. The most common sites include the retroperitoneal area, the abdomen, the spine, and the lungs.

If both testicles are removed the man becomes infertile (unable to have children) because no sperm cells will be produced. If surgery is done to remove lymph nodes, there can be damage to nerves that control ejaculation. This can also cause infertility as well as impotence. There is a newer type of surgery that has a better chance of preserving the nerves that main erection and still removes the lymph nodes. Since testicular cancer affects men at the ages they may want to father children, nerve-sparing surgery and sperm banking (to save sperm and freeze it for use in artificial insemination) before any treatment should be discussed with the doctor.

Calling your health care provider:
Call your health care provider if symptoms of testicular cancer occur.

Also call if you are a male over 15 years old who has not been taught testicular self-examination (TSE), or who has not had testicular screenings performed by your health care provider during routine physical examinations.

Review Date: 5/13/2002
Reviewed By: William Matsui, M.D., Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network.

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