Testicular cancer


Overview

Tuesday 8 September, 2020

About testicular cancer

Cancer that develops in a testicle is called testicular cancer or cancer of the testis (plural form: testes). Usually only one testicle is affected, but in some cases both are affected. About 90 to 95 per cent of testicular cancers start in the cells that develop into sperm - these are known as germ cells.

Sometimes testicular cancer can develop outside the testicle. It can also  spread to lymph nodes in the abdomen, or to other parts of the body.

The testicles

The testicles are two oval glands that sit behind the penis in a pouch of skin called the scrotum. They are part of the male reproductive system and are also called testes (or a testis, if referring to one).

Role of the testicles

The testicles produce and store sperm. They also produce the sex hormone testosterone, which is responsible, among other functions, for the development of facial hair, a deeper voice and increased muscle mass, as well as sexual drive (libido).

Epididymis, spermatic cord and vas deferens

A tightly coiled tube at the back of each testicle called the epididymis stores immature sperm. The epididymis connects the testicle to the spermatic cord. The spermatic cord runs through the groin region into the pelvis and contains blood vessels, nerves, lymph vessels and a tube called the vas deferens. The vas deferens carries sperm from the epididymis to the prostate gland.

Seminal vesicles and prostate gland

Two small glands called seminal vesicles sit above the prostate gland. The seminal vesicles and prostate gland produce fluids that make up a large part of semen. Semen also contains sperm from the testicles and is ejaculated from the penis during sexual climax.

Lymph nodes and vessels

There are many lymph nodes (also called lymph glands) and lymph vessels around the testicles and in the abdomen. These are part of the lymphatic system and are important for resisting and fighting disease (immunity). The nodes and vessels also drain lymphatic fluid (lymph) from the tissues back into the bloodstream.

Types

The most common testicular cancers are called germ cell tumours. There are two main types: seminoma and non-seminoma.

Seminoma tumours

Seminoma tumours have these two main characteristics:

  • tend to develop more slowly than non-seminoma tumours
  • usually occur between the ages of 25 and 45, but can also occur in older people.

Non-seminoma tumours

These are the characteristics of non-seminoma tumours:

  • tend to develop more quickly than seminoma cancers
  • more common in people in their late teens and early 20s
  • there are four main subtypes: teratoma, choriocarcinoma, yolk sac tumour and embryonal carcinoma

Other tumours

Mixed tumours

Sometimes a testicular cancer can include a mix of seminoma cells and non-seminoma cells, or a combination of the different subtypes of non-seminoma cells (mixed tumours). When there are seminoma and non-seminoma cells mixed together, doctors treat the cancer as if it were a non-seminoma cancer.

Stromal tumours

A small number of testicular tumours start in cells that make up the supportive (structural) and hormone-producing tissue of the testicles. These are called stromal tumours. The two main types are Sertoli cell tumours and Leydig cell tumours. They are usually benign and are removed by surgery.

Other types of cancer, such as lymphoma, can also involve the testicles. For information about lymphoma, call Cancer Council 13 11 20 or visit your local Cancer Council website.

Intratubular germ cell neoplasia (ITGCN)

Some testicular cancers begin as a condition called intratubular germ cell neoplasia (ITGCN or IGCN). In this condition, the cells are abnormal, but they haven’t spread outside the area where the sperm cells develop.
ITGCN is not cancer but it has about a 50 per cent risk of turning into testicular cancer within five years. About 5 to 10 per cent of people diagnosed with testicular cancer have ITGCN.
ITGCN has similar risk factors to testicular cancer. It is hard to diagnose because there are no symptoms and it can only be found by testing a tissue sample.
Once diagnosed, some cases of ITGCN will be carefully monitored (see the information on surveillance). Other cases will be treated with radiation therapy or with surgery to remove the testicle.

 

Risk factors

The causes of testicular cancer are unknown, but certain factors may increase the risk of developing it:

Personal history

If you have previously had cancer in one testicle, you are more likely to develop cancer in the other
testicle. Intratubular germ cell neoplasia is also a risk factor.

Undescended testicles

Before birth, testicles develop inside the abdomen. By birth, or within the first six months of life, the testicles should move down into the scrotum.

If the testicles don‘t descend by themselves, doctors perform an operation to bring them down. Although this reduces the risk of developing testicular cancer, people born with undescended testicles are still more likely to develop testicular cancer than those born with descended testicles.

Family history

Sometimes gene mutations are passed on in families. If your father or brother has had testicular cancer, you are slightly more at risk of cancer. Family history is only a factor in a small number (about 2 per cent) of people who are diagnosed with testicular cancer. If you are concerned about your family history of testicular cancer, you can ask your doctor for a referral to a urologist.

Infertility

Having difficulty conceiving a baby (infertility) can be associated with testicular cancer. Testicular cancer can cause changes in your testosterone levels as well as genetic damage to sperm cells. As a result, infertility is considered a risk factor for testicular cancer.

HIV and AIDS

There is some evidence that people with HIV (human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome) have an increased risk of testicular cancer.

Some congenital defects

Some people are born with an abnormality of the penis called hypospadias. This causes the urethra to open on the underside of the penis, rather than at the end. People with this condition are at increased risk of developing testicular cancer. Likewise, there may be an increased risk for people born with a lump in the groin known as an inguinal hernia, even when it has been repaired.

How common is it?

Testicular cancer is not a common cancer but, according to information published in 2012 by the Australian Institute of Health and Welfare, it is the most commonly diagnosed cancer after skin cancer in men aged 20–39. In Australia, about 850 men are diagnosed with testicular cancer each year, accounting for about 1 per cent of all cancers in men. The Australian Institute of Health and Welfare found in 2018 that it occurs most often in men aged 25 to 40. 

Symptoms

In some people, testicular cancer does not cause any noticeable symptoms, and it may be found during tests for other conditions. When there are symptoms, the most common ones are a swelling or a lump in the testicle (usually painless) or a change in a testicle’s size or shape (such as hardness or swelling). These symptoms don’t necessarily mean you have testicular cancer. They can be caused by other conditions, such as cysts, which are harmless lumps in the scrotum. If you find any lump, it is important to see your doctor for a check-up.

Occasionally, testicular cancer may cause other symptoms such as a feeling of heaviness in the scrotum; a feeling of unevenness between the testicles; pain or ache in the lower belly (lower abdomen), testicle or scrotum; enlargement or tenderness of the breast tissue; back pain; or stomach-aches. If you are concerned about any of these symptoms, make an appointment to see your doctor If you are concerned about any of these symptoms, make an appointment to see your doctor.

Health professionals you may see

Your general practitioner (GP) will arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will usually be referred to a specialist called a urologist. The urologist will arrange  further tests.  If testicular cancer is diagnosed, the specialist will consider treatment options. Often these will be discussed with other health professionals at a multidisciplinary team (MDT) meeting. During and after treatment, you will see various health professionals who specialise in different aspects of your care.

Health professionals you may see
Role
urologist* treats diseases of the male and female urinary systems and the male reproductive system, including testicular cancer; performs surgery
fertility specialist* diagnoses, treats and manages infertility and reproductive hormonal disorders; may be a reproductive endocrinologist or urologist
medical oncologist* treats cancer with drug therapies such as chemotherapy; supports you through regular check-ups and reviews (surveillance)
radiation oncologist* treats cancer by prescribing and overseeing a course of radiation therapy
nurses administers drugs and provides care, information and support throughout treatment
cancer care coordinator coordinates your care, liaises with other members of the multidisciplinary team and supports you and your family throughout treatment; care may also be coordinated by a clinical nurse consultant (CNC) or clinical nurse specialist (CNS)
anaesthetist* administers anaesthetic before surgery and monitors you during the operation
psychologist, counsellor help you manage your emotional response to diagnosis and treatment
physiotherapist, occupational therapist assist with physical and practical problems, including restoring movement and mobility after treatment and recommending aids and equipment

*Specialist doctor

Expert content reviewers:

Professor Declan Murphy, Urologist and Director of Genitourinary Oncology, Peter MacCallum Cancer Centre, Vic.; Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer and Palliative Care Network, North Metropolitan Health Service, WA; Associate Professor Nicholas Brook, Senior Consultant Urological Surgeon, Royal Adelaide Hospital and the University of Adelaide, SA; Clinical Associate Professor Peter Grimison, Medical Oncologist, Chris O’Brien Lifehouse and the University of Sydney, NSW; Dr Tanya Holt, Senior Radiation Oncologist, Radiation Oncology Princess Alexandra Hospital Raymond Terrace (ROPART), Qld; Brodie Kitson, vonsumer; Elizabeth Medhurst, Genitourinary and Stereotactic Ablative Body Radiotherapy (SABR) Nurse Consultant, Peter MacCallum Cancer Centre, Vic; Rosemary Watson, 13 11 20 Consultant, Cancer Council Victoria

 

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