What is Testicular Cancer?

Cancer begins when the body's cells grow out of control and form lumps known as tumors. Tumors may either be benign (noncancerous) or malignant (cancerous). Testicular cancer starts in the testicles, the 2 organs in the scrotum that make androgens and sperm.

The testicles are normally no larger than golf balls and are found in a sac called the scrotum, which hangs at the base of the penis. They make sperm cells in the long, thread-like tubes called the seminiferous tubules and store them in the small coiled tube behind the testicles called the epididymis, where they mature. When men ejaculate, the sperm goes through the vas deferens to the seminal vesicles, where they are mixed with fluids made by the vesicles and prostate gland to form the semen. The semen then leaves the body through the urethra.

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Types of Testicular Cancer

The testicles are made of different cells, and the type of testicular cancer can be determined by which cells the cancer started from. Different types of cancer have different outlooks and may vary in treatment methods.

Germ Cell Tumors (GCT)

More than 90% of testicular cancers are germ cell tumors that make up the sperm. GCTs may either be seminomas or non-seminomas. These occur at about the same rate as each other but may also be mixed. Mixed GCTs are treated like non-seminomas because they grow and spread like non-seminomas.

Seminomas

These types of testicular cancer tend to grow and spread slower than non-seminomas. Classical seminomas make up more than 95% of seminomas and usually occur in men ages 25-45. Spermatocytic seminomas on the other hand are usually found in older males at an average age of 65 and tend to grow more slowly and spread less rapidly compared to classical seminomas.

Some seminomas increase blood levels of the protein called human chorionic gonadotropin (HCG). These can be found during blood tests and are considered tumor markers, which are useful for diagnosis.

Non-Seminomas

Non-seminomas usually occur in the late teens to early 30s. There are 4 main types of non-seminomas:

Embryonal Carcinoma

Embryonal carcinoma cells are found in approximately 40% of testicular tumors, but pure embryonal carcinomas are rare, occurring only 3% to 4% of the time. These tumors look like tissues of very early embryos under a microscope and tend to grow fast and spread outside the testicle. Embryonal carcinoma can increase blood levels of tumor marker proteins such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG).

Yolk Sac Carcinoma

Yolk sac carcinomas, also known as yolk sac tumors, endodermal sinus tumors, infantile embryonal carcinomas, orchidoblastomas, have cells that look like the yolk sac of an early human embryo. These tumors are the most common form of testicular cancer in children, especially infants, but pure yolk sac carcinomas are rare in adults. They are usually treated successfully in children, but treatment is more difficult in adults. Yolk sac carcinomas respond very well to chemotherapy, even if they have spread, and almost always increase blood levels of AFP.

Choriocarcinoma

Choriocarcinoma is a very rare and fast-growing type of testicular cancer in adults. Pure choriocarcinoma is likely to spread rapidly to other parts of the body, including the lungs, bones, and brain. More often, choriocarcinoma cells are seen with other types of non-seminoma cells in a mixed germ cell tumor, which tends to have a somewhat better outlook than pure choriocarcinomas. However, the presence of choriocarcinoma is always a worrisome finding. This type of tumor increases blood levels of HCG.

Teratoma

Teratomas are germ cell tumors with areas that resemble each of the three layers of a developing embryo: endoderm, mesoderm, and ectoderm. Pure teratomas of the testicles are rare and do not increase AFP or HCG levels. They are most often seen as parts of mixed germ cell tumors. There are three main types of teratomas: mature teratomas, which are formed by cells similar to adult tissues and rarely spread; immature teratomas, which are less well-developed cancers with cells resembling those of an early embryo and are more likely to invade nearby tissues, metastasize, and recur; and teratomas with somatic type malignancy, which are very rare and have areas that look like mature teratomas alongside areas where the cells have become a type of cancer normally developing outside the testicle.

Testicular Carcinoma in situ (CIS)

Testicular germ cell cancers can begin as a non-invasive form called carcinoma in situ (CIS) or intratubular germ cell neoplasia. In testicular CIS, the cells appear abnormal under the microscope but have not yet spread outside the walls of the seminiferous tubules, where sperm cells are formed. CIS doesn't always progress to invasive cancer and is difficult to detect before it becomes invasive, as it generally doesn't cause symptoms or form an obvious lump. The only way to diagnose testicular CIS is through a biopsy, which is sometimes found incidentally when performed for another reason, such as infertility.

Experts disagree about the best treatment for CIS. Since CIS doesn't always develop into an invasive cancer, many doctors in the United States consider observation (watchful waiting) to be the best treatment option.

When the CIS of the testicle becomes invasive, the cancer cells are no longer confined to the seminiferous tubules and have grown into other structures of the testicle. These cancer cells can then spread either to the lymph nodes through lymphatic vessels or to other parts of the body through the bloodstream.

Stromal Tumors

Gonadal Stromal Tumors

Gonadal stromal tumors are tumors that originate in the supportive and hormone-producing tissues, or stroma, of the testicles. These tumors account for less than 5% of adult testicular tumors but up to 20% of childhood testicular tumors. The main types of gonadal stromal tumors are Leydig cell tumors and Sertoli cell tumors.

• Leydig Cell Tumors

Leydig cell tumors develop from the Leydig cells in the testicle, which are responsible for producing male sex hormones (androgens) such as testosterone. These tumors can occur in both adults and children and often produce androgens, although they sometimes produce estrogens (female sex hormones). Most Leydig cell tumors are benign and rarely spread beyond the testicle, making them curable with surgery. However, a small number of Leydig cell tumors can metastasize to other parts of the body and have a poor prognosis due to their poor response to chemotherapy or radiation therapy.

• Sertoli Cell Tumors

Sertoli cell tumors originate from normal Sertoli cells, which support and nourish the sperm-producing germ cells. Similar to Leydig cell tumors, Sertoli cell tumors are usually benign. However, if they spread, they generally do not respond well to chemotherapy or radiation therapy.

Testicular Cancer Symptoms

Most testicular cancers are found by the patients themselves, during self-examination. The following are the common symptoms of testicular cancer:

Testicular Swelling or Lumps

A lump in the testicle which causes pain and swelling is a common sign of testicular cancer. It is normal for one testicle to hang lower than the other, but these types of lumps are irregular, tender, and even painful in some cases. They are usually accompanied by a feeling of heaviness in the lower abdomen or the scrotum.

Gynecomastia or Breast Pain in Men

In some cases, germ cell tumors can cause gynecomastia or 'man-boobs' due to an irregularly high secretion of HCG which stimulates breast development. Some Leydig cell tumors can also manufacture estrogen which leads not only to gynecomastia but loss of libido in men.

Early Male Puberty

Early puberty in boys, such as deepening of the voice and abnormal facial and body hair growth at such a young age could be an indication of Leydig cell tumors.

Advanced testicular cancer symptoms:

• Lower back pain if the cancer has spread to the lymph nodes
• Difficulty breathing if the cancer has spread to the lungs
• Abdominal pain if the cancer has spread to the liver
• Headaches and brain fog if the cancer has spread to the brain

Testicular Cancer Risk Factors

Risk factors are things that can affect your chances of getting testicular cancer. As in all cancers, some risk factors may be immutable, such as your age and race, but some can also be from lifestyle and environment.

The most significant ones, however, are those genetic conditions or disorders from birth that may make you more vulnerable to contracting different types of cancer.

Having any of these does not automatically mean that you will have testicular cancer, but their presence is something that you should reveal to your doctor so that you can be evaluated and subjected to testing earlier.

Undescended Testicle

One of the main risk factors for testicular cancer is a condition called cryptorchidism, or undescended testicle(s), where one or both testicles fail to move from the abdomen into the scrotum before birth. Males with cryptorchidism are several times more likely to develop testicular cancer compared to those with normally descended testicles.

Testicles typically develop inside the abdomen of the fetus and descend into the scrotum before birth. However, in about 3% of boys, one or both testicles do not complete this descent, either remaining in the abdomen or staying in the groin area. In most cases, undescended testicles continue moving down into the scrotum during the child's first year of life. If the testicle hasn't descended by the age of one, it is unlikely to do so on its own, and a surgical procedure called orchiopexy may be necessary to move the testicle into the scrotum.

The risk of testicular cancer may be slightly higher for men whose testicles remained in the abdomen compared to those whose testicles descended at least partway. When cancer does develop, it usually occurs in the undescended testicle, but about 25% of cases occur in the normally descended testicle. This observation has led some doctors to conclude that cryptorchidism itself does not cause testicular cancer, but rather that there may be an underlying factor that leads to both testicular cancer and abnormal positioning of one or both testicles. Orchiopexy may reduce the risk of testicular cancer if performed when a child is younger, but its effectiveness in older children is less clear. In the United States, experts recommend that orchiopexy be done soon after the child's first birthday for reasons unrelated to cancer, such as fertility.

Immutable Risk Factors

There are risk factors involving cancer that you cannot change. Being a certain age, race, or sex may make you more susceptible to different types of cancer. For testicular cancer, ages 20-34 are when the incidents most commonly occur. Some studies also show that taller men can be more prone to testicular cancer, although this is still debated. For reasons not yet known, White, Alaskan, and American Indian men have higher rates of testicular cancer than Black, Asian American, and Pacific Islander men.

Family History

A family history or having a brother or father with testicular cancer also increases the likelihood of one getting the disease as well. Klinefelter’s syndrome, an inherited disease, is also linked to increased rates of testicular cancer.

HIV Infection

Men with HIV infections are also more likely to get testicular cancer, specifically seminomas.

If you or a loved one have suffered from a misdiagnosis or delayed diagnosis for your testicular cancer, contact us at 833-PORTER9, or e-mail us at info@porterlawteam.com to discuss the details of our experience representing other clients and the results we were able to obtain in the past for clients who are suffering as you are. In many ways, our results speak for themselves, and we will stand ready to help you and your family in your time of greatest need.