In the United States, testicular cancer is a common cancer in men aged 15-40. About 8,400 new cases are diagnosed each year. These cancers are usually diagnosed after a man feels a mass in his scrotum or has sensations of heaviness in a testicle. A few men have a tumors in other areas of their bodies, such as the neck or stomach area, that are diagnosed as testicular cancer after a doctor removes them. Many men with testicular cancer have a history of trauma to the scrotum or an undescended testicle.
There are several types of testicular cancer. Most are germ cell neoplasms. A germ cell neoplasm can be a a seminoma or a nonseminoma or both. Some other rare tumors can be found in the testicles but these are uncommon.
Fortunately, most men with testicular cancer will be cured of their disease. In addition, most will return to normal activities in a relatively short time.
What to expect
If you feel a lump in your testicle, you should see your doctor immediately. Your doctor can do some or all of the following tests:
- Testicular exam (feeling the testicle)
- Ultrasound X-ray study
- Blood tests
- Determine the need for surgery.
If you have testicular cancer, the best treatment for you depends on several factors. These include the type of testis cancer and whether the disease has spread.
First, your doctor will do surgery to remove the testicle. This is called a radical orchiectomy. Once the testicle is removed and your doctor knows more about the cancer, you may have:
- Additional surgery
- Radiation therapy
- A combination of these approaches, or
- Close observation with blood tests and imaging studies
Although most men maintain normal fertility, you may be asked to consider banking your sperm. This can help make sure you are able to have children after your treatment is complete.
Surgery to remove a testicle is called orchiectomy. This is almost always the first step in diagnosing testicular cancer. Before surgery, your doctor will take blood samples to check for the presence of proteins and hormones that could indicate cancer. Results of your blood tests can also tell your doctor what type of testicular cancer you have and whether it has been removed with treatment. Depending on your blood tests results, you may need more treatment, such as chemotherapy, after surgery.
In an orchiectomy, your doctor will remove the testicle and the structures that connect it to abdomen. The surgery is done through the lower abdomen, leaving the scrotum untouched to prevent the spread of cancer cells. After the cancerous testicle is removed, we will do a chest X-ray and CT scan of the abdomen and pelvis to determine if the cancer has spread to these areas.
After surgery, you should rest for several days. We will give you an ice pack and athletic supporter to help prevent bleeding or discomfort.
Treatment After Surgery
Once the testicle is removed, several options are available to you. They depend on the type of cancer you have, the results of your blood tests and whether they become normal after surgery and whether the X-ray and CT scan show cancer has spread or is left behind.
The treatment you have after surgery will depend on what type of tumor you haveand the results of your blood tests before and after surgery. It also depends on whether the testicular cancer has spread to other parts of your body. Additional treatment could include further surgery, radiation, chemotherapy, a combination of these or close observation with blood tests and imaging studies (CT scans, X-rays or other studies). Because treating testicular cancer can be complicated, we recommend seeing a testicular cancer specialist who treats many men with this disease.
Lymph Node Surgery
Some men with testicular cancer benefit from surgery to remove lymph nodes in the abdomen (stomach area). Your doctor will remove lymph nodes from the part of the abdomen behind the intestines. Most doctors do this surgery through a traditional incision. Laparoscopic surgery to remove these lymph nodes is controversial, and most testicular cancer specialists do not recommend it.
The lymph nodes your doctor will take out are close to the kidneys, intestines and nerves that help you ejaculate semen. Your doctor willplan the surgery so that all these organs work normally after surgery. Sometimes, your doctor will recommend that you bank your own sperm to improve your chances of having children after surgery.
You might need chemotherapy after lymph node surgery. Your doctor will talk with you after the results of your lymph node surgery are available.
Some men have chemotherapy for testicular cancer and then need lymph node surgery. This surgery is more complicated than having lymph node surgery first. You might have more side effects or need more time to recover or both. Because this operation is more complicated, most men do better if they are treated by a surgeon who specializes in this kind of testicular cancer surgery.