Testicular cancer is an abnormal growth of cells in the testicles. The testicles are the male reproductive organs (gonads) where sperm are produced.
- The two small testicular glands lie in a pouch of skin behind the penis called the scrotal sac, or scrotum.
- They are attached to the ejaculatory duct in the lower pelvis by cords called spermatic cords, which contain the vas deferens, the narrow tube through which the sperm moves out of the testis.
- Besides producing and storing sperm, the testicles (or testes) are the main source of male hormones such as testosterone, which control reproduction and sex drive (libido) and impart male physical traits such as deep voice and body and facial hair.
- Cancer usually occurs in only one testicle. Less than 5% of the time, it occurs in both testicles. (Usually, the
two tumors are found at different times, the second perhaps years later.)
Cancer occurs when normal cells transform and begin to grow and multiply without normal controls.
- This uncontrolled growth results in a mass of abnormal cells called a tumor.
- Some tumors grow quickly, others more slowly.
- Tumors are dangerous because they overwhelm surrounding healthy tissue, taking not only its space but also the oxygen and nutrients it needs to carry out its normal functions.
Not all tumors are cancer. A tumor is considered cancer if it is malignant. This means that, if the tumor is not treated and stopped, it will spread to other parts of the body. Other tumors are termed benign because their cells do not spread to other organs. However, almost all tumors start to cause symptoms when they get large enough.
- Malignant tumors can spread to neighboring structures, usually lymph nodes.
They encroach on and invade these healthy tissues, impairing their function and
eventually destroy them.
- Tumor cells sometimes enter the bloodstream and spread to distant organs. There, they can grow as similar but separate tumors. This process is called metastasis.
- The most common places for testicular cancer to spread are the lymph nodes in the area near the kidneys (located in the retroperitoneum area), called the retroperitoneal lymph nodes. It also can spread to the lungs, liver, and rarely to the brain.
- Metastatic cancers are more difficult to cure than benign tumors, but still have very high cure rates.
Testicular cancers can be comprised of one or several different types of tumor cells. The types are based on the cell type from which the tumor arises.
- By far the most common type is germ cell carcinoma. These tumors arise from the sperm forming cells within the testes.
- Other rarer types of testicular tumors include Leydig cell tumors, Sertoli cell tumors, primitive neuroectodermal tumors (PNET), leiomyosarcomas, rhabdomyosarcomas, and mesotheliomas. None of these tumors is very common.
- Most of the information presented here concerns germ cell tumors.
There are two types of germ cells tumors, seminomas and nonseminomas.
- Seminomas arise from only one type of cell: immature germ cells that have not yet differentiated. These constitute about 40% of all testicular cancers.
- Nonseminomas are composed of mature cells that have already specialized. Thus, these tumors often are "mixed," that is, they are made up of more than one tumor type. Typical components include choriocarcinoma, embryonal carcinoma, immature teratoma, and yolk sac tumors. These tumors tend to be faster growing and to spread more aggressively than seminomas.
Testicular cancer is the most common type of cancer in young men 15-35 years
of age, but it can occur at any age.
- It is not a common cancer, accounting for only 1%-2% of cancers in men.
- The American Cancer Society estimated that about 8,400 new cases of testicular cancer would be diagnosed in the United States and about 350 men would die of the disease in 2010.
- Testicular cancer is most common in whites and least common in blacks and Asians.
Testicular cancer is one of the most curable of all cancers.
- The cure rate is greater than 90% for all stages. In men whose cancer is diagnosed in an early stage, the cure rate is nearly 100%. Even those with
metastatic disease have a cure rate of greater than 80%.
- These figures apply only to men who receive appropriate treatment for their cancer. Prompt diagnosis and treatment are essential.
- Because of its high cure rate, testicular cancer is considered the model of successful treatment for cancer originating in a solid organ. In 1970, 90% of men with metastatic testicular cancer died of the disease. By 1990, that figure had almost reversed
-- nearly 90% of men with metastatic testicular cancer were cured.
Steven C Campbell, MD, PhD
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
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