Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system.

In the United States, between 7,500 and 8,000 diagnoses of testicular cancer are made each year. It is the most common cancer in males aged 20–39 years, the period of peak incidence, and is rarely seen before the age of 15 years.

Testicular cancer has one of the highest cure rates of all cancers: If the cancer hasn’t spread outside the testicle, the 5-year relative survival rate is 99%. Even if the cancer has grown into nearby structures or has spread to nearby lymph nodes, the rate is 96%.

If it has spread to organs or lymph nodes away from the tumor, the 5-year relative survival rate is around 74%. (metastasized). Even for the relatively few cases in which malignant cancer has spread widely, modern chemotherapy offers a cure rate of at least 80%.

Not all lumps on the testicles are tumors, and not all tumors are malignant (cancerous).

Signs and symptoms

One of the first signs of testicular cancer is often a lump or swelling in the testes.

However, the American Cancer Society suggests that some men should examine their testicles monthly, especially if they have a family history of cancer, and the American Urological Association recommends monthly testicular self examinations for all young men.

Symptoms may also include one or more of the following:

– a lump in one testis which may or may not be painful
– sharp pain or a dull ache in the lower abdomen or scrotum
– a feeling often described as “heaviness” in the scrotum
– breast enlargement (gynecomastia) from hormonal effects of ß-hCG
– low back pain (lumbago) tumor spread to the lymph nodes along the back

It is not very common for testicular cancer to spread to other organs, apart from the lungs. However, if it has, the following symptoms may be present:

– shortness of breath (dyspnea)
– a cough or coughing up blood (hemoptysis) from metastatic spread to the lungs
– a lump in the neck due to metastases to the lymph nodes

The main way testicular cancer is diagnosed is via a lump or mass inside the testis. More generally, if a young adult or adolescent has a single enlarged testicle, which may or may not be painful, this should give doctors a reason to suspect testicular cancer.

The differential diagnosis of testicular cancer requires examining the histology of tissue obtained from an inguinal orchiectomy – that is, surgical excision of the entire testis along with attached structures (epididymis and spermatic cord).

A biopsy should not be performed, as it raises the risk of spreading cancer cells into the scrotum.

Testicular cancer is categorized as being in one of three stages (which have subclassifications). The size of the tumor in the testis is irrelevant to staging. In broad terms, testicular cancer is staged as follows:

Stage I: the cancer remains localized to the testis.
Stage II: the cancer involves the testis and metastasis to retroperitoneal and/or Paraaortic lymph nodes (lymph nodes below the diaphragm).
Stage III: the cancer involves the testis and metastasis beyond the retroperitoneal and Paraaortic lymph nodes.

Further information on the detailed staging system is available on the website of the American Cancer Society.

Classification

Although testicular cancer can be derived from any cell type found in the testicles, more than 95% of testicular cancers are germ cell tumors. Most of the remaining 5% are sex cord-gonadal stromal tumors derived from Leydig cells or Sertoli cells.

Correct diagnosis is necessary to ensure the most effective and appropriate treatment.

To some extent, this can be done via blood tests for tumor markers, but definitive diagnosis requires examination of the histology of a specimen by a pathologist.

The three basic types of treatment are surgery, radiation therapy, and chemotherapy.

Surgery is performed by urologists; radiation therapy is administered by radiation oncologists, and chemotherapy is the work of medical oncologists.

In most patients with testicular cancer, the disease is cured readily with minimal long-term morbidity.

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% survival rate (which is why prompt action, when testicular cancer is a possibility, is extremely important).



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