Testicular Cancer: Patient Education

Cancer Facts

According to the National Cancer Institute:

  • Testicular cancer is the most common cancer in men ages 20 to 35.

According to the American Cancer Society:

  • The rate of testicular cancer has been increasing in the United States and many other countries. The increase is mostly in seminomas. Experts have not been able to find reasons for this increase. Lately, the rate of increase has slowed.
  • The five-year relative survival rate for all men with this cancer is 95 percent. More than 190,000 men in the United States have survived testicular cancer.

Overview

Testicular cancer is a malignant growth that begins in one or both testicles. The outlook for treatment and cure for testicular cancer is very good.

The Testicles

The testicles are two ping pong-sized glands hanging below the penis in a skin sac called the scrotum. The spermatic cord holds the testicles within the scrotum. Also within the scrotum are:

  • Vas deferens (a coiled tube that carries sperm out of the testicles)
  • Nerves
  • Blood vessels

Your testicles are also called testes (one testis) or gonads. The testicles are part of the male reproductive system. They produce sperm and the male hormone testosterone.

As part of the male reproductive system, your sperm cells pass from the testes through the vas deferens to the seminal vesicles for ejaculation. There, they’re mixed with fluid from your prostate gland.

Next, sperm cells, seminal vesicle fluid and prostatic fluid pass to your urethra (the tube through which both urine and semen flow) to exit your body in ejaculation.

How Does Testicular Cancer Grow?

Germ cells within your testicles produce immature sperm, the source of most testicular cancer cells. Within your testicles also are a number of other different kinds of cells.

Different types of cancers develop from these diverse cells. These different cancers are treated differently and their prognosis for cure is often distinct as well.

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Types of Germ Cell Tumors

There are two main types of germ cell tumors (GCTs):

  • Seminomas
  • Non-seminomas

Seminomas and non-seminomas appear different under a microscope. They occur with equal frequency.

Many men with testicular cancer may have more than one kind of testicular tumor.

Seminomas

There are two kinds of seminomas. They both arise from testicular germ cells.

Classical Seminoma

  • About 95 percent of seminoma cases
  • Occurs most often in men ages 35 to 50
  • Grows more rapidly and spreads more quickly than spermatocytic semimona

Spermatocytic Seminoma

  • Rare
  • Occurs most often in men ages 55 and older
  • Grows more slowly and is less likely to spread than classical seminoma

In some cases, seminomas cause elevated blood levels of human chorionic gonadotropin (HCG). Your physician may order a tumor marker test to check for elevated levels of this protein.

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Non-Seminomas

Non-seminomas in many cases occur in men as young as their late teens through their early 40s.

There are four main types of non-seminomas:

Embryonal Carcinoma

  • Occurs in about 40 percent of testicular cancer patients, but presents singly in only about 3 to 4 percent of cases
  • Has the appearance of a very early embryo
  • Grows more rapidly and often spreads outside the testicle
  • May cause elevated levels of the tumor marker alpha feto-protein (AFP) and HCG

Yolk Sac Carcinoma

  • Most common testicular cancer in children
  • Has the appearance of the yolk sac of an early embryo
  • Responds well to chemotherapy
  • In most cases causes elevated levels of AFP

Choriocarcinoma

  • Very rare and aggressive
  • Spreads rapidly to distant organs, including bones, brain and lungs
  • In most cases doesn’t occur in “pure” form in testicles; usually mixed with other testicular tumor types
  • In most cases causes elevated levels of HCG

Teratomas

Teratomas have the appearance of three different layers of a developing embryo.

Mature teratoma

  • Appears similar to adult tissue cells
  • Usually benign and rarely spreads
  • Generally treated successfully with surgery

Immature teratoma

  • Appears similar to an early embryo
  • May spread to surrounding tissues
  • May return (recur) after treatment

Teratoma with malignant transformation

  • Very rare
  • Has mixed appearance—some appear similar to mature teratomas, while others develop as cancer outside the testicle in your:
    • Muscle
    • Lung
    • Intestinal tissue
    • Brain

Other less common types of testicular tumors include:

  • Gonadal stromal tumors
  • Leydig cell tumors
  • Sertoli cell tumors
  • Carcinomas of the rete testis

The term testicular cancer here refers to seminomas and non-seminomas.

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