The testicles are two glands that are part of the male reproductive system. They are located in the scrotum, a sack that sits behind the penis. The primary function of the testicles is to produce sperm and testosterone (a male hormone). Testicular cancer refers to the growth of abnormal (malignant or cancerous) cells in one or both testicles. The two primary types of testicular cancer (seminoma and nonseminoma) start in the testicular cells that make sperm.

• Seminomas are usually only found in the testicles and usually do not grow very fast. This type of cancer is often found in men in their 30 to 40s, but can occur in younger or older men as well. In some cases seminomas can spread to the lymph nodes near the testicles, but they are very sensitive to radiation.
• Nonseminomas are made up of different cells and tends to grow faster than seminomas. Nonseminomas are more common than seminomas and often occur in young men.

Your healthcare provider will look to see if your testicular cancer has spread to other areas of the body. This process is called “staging.”

• Metastatic testicular cancer is cancer that started in the testicles and has spread to other organs and tissues.
• In advanced cases, testicular cancer can spread to other organs in the abdomen, lungs and spine.

Your healthcare provider will need the following clinical information to decide what type of treatment is right for you.

• What does the cancer look like under the microscope?
• Does the cancer invade outside the testicles?
• How large is the primary cancer in the testicle?
• Has the cancer spread to pelvic lymph nodes or anywhere else in the body?
• Is the cancer associated with abnormal blood tests called tumor markers?

An orchiectomy is the removal of one or both of the testicles through an incision in the groin. It is the primary surgical treatment for testicular cancer. The nearby lymph nodes may also be removed at the same time as the testicle(s).

• Removal of the testicles is done for both seminomas and nonseminomas.
• If only one testicle is removed, there should be minimal impact to your sex drive. You will also still be able to father children if the other testicle is healthy.
• If both testicles are removed, you may need to take a testosterone supplement.
• You will not be able to father children after both testicles are removed. Having your sperm frozen and stored before surgery is an option if you hope to have children in the future. This is called “sperm banking”.

It is not known for sure what causes testicular cancer. Several factors may increase your chance of developing testicular cancer are:

• Age – Men between the ages of fifteen and thirty-four
• Abnormal testes development – Men who have a history of abnormal testes development or undescended testes
• Medical history – Men who have a previous history of testicular cancer
• Family history – Men who have a family history of testicular cancer
• Chemical exposure – Men who have a history of exposure to certain chemicals
• Klinefelter syndrome – Men who have an extra X chromosome (Klinefelter syndrome)
• Race – Caucasian men have a higher risk than African-American or Asian-American men do
• HIV Infection – Men who have HIV may have an increased risk of developing testicular cancer

There is no conclusive link between having a vasectomy and developing testicular cancer.

There may be no symptoms in the early stages of testicular cancer. Some of the symptoms that can develop include:

• Pain, discomfort or heaviness in the testicles or scrotum
• Lower back or abdominal pain
• A testicle that has become larger, has a lump or feels different than usual
• Enlarged breasts, which can also occur in teenage boys who do not have testicular cancer

As the cancer advances, other symptoms can develop. These symptoms can affect the:

• Lungs
• Abdomen and pelvis
• Back
• Brain

Contact your healthcare provider if you have any of the above symptoms. He or she will review your symptoms and perform a physical examination, which may include shining a flashlight through your scrotum. Your provider may also recommend one or more of the following:

• Blood tests
• X-rays
• Ultrasounds
• Removal of tissue for exam under a microscope (biopsy or surgery)

The treatment for testicular cancer is based on many factors, including:

• The type and stage of the cancer
• The size of the tumor
• How fast it is growing
• Whether the cancer has spread to other parts of the body
• Other tests that determine the specific characteristics of the cancer
• Your overall health
• Your age (though most people with testicular cancer are young)

Treatments are either local (only affects the area of the cancer) or systemic (affects all areas of the body). Local treatments include:

• Surgery to remove the testicle(s) (orchiectomy)
• Radiation to kill the cancer cells

The systemic treatment for testicular cancer is chemotherapy to kill the cancer cells.

Treatment for testicular cancer often involves a combination of local and systemic treatments.

• Radiation and chemotherapy are usually given in a doctor's clinic or hospital by specially trained medical people.
• In some cases, you may be able to receive chemo at home with the help of specially trained nurses.

To get a full range of opinions and perspectives, you may want to consider input from a variety of doctors. This group may include:

• Your primary care physician
• A urologist or surgeon with experience in testicular cancer
• A medical oncologist (a doctor who specializes in the treatment of cancer)
• A radiation oncologist (a doctor who specializes in treating cancer with radiation therapy)

If your healthcare provider recommends an orchiectomy, prior to the surgery you should tell them about any medications you are taking (including over-the-counter medications and supplements). You should also ask about specific instructions to follow before and after the surgery. These may include:

• Medications you should not take before the procedure, such as blood thinners
• Regular medications you should continue to take on the day of your procedure
• How many hours you should stop eating and drinking before the procedure

If you are a smoker, you should quit smoking. It can interfere with your recovery from surgical procedures.

During your surgery, you will receive anesthesia to keep you comfortable and pain free.

• General anesthesia is the most common type of anesthesia for an orchiectomy.
• With general anesthesia, you are put into a deep sleep and are unable to see, hear or feel anything.

You may need pain medication and help at home while you recover.

It is important to remember that the total cost of this care path does not include all possible medications, labwork or imaging studies. Those charges can add up. If your healthcare provider recommends any labwork or imaging studies you may need to search for their costs separately.

You should contact your healthcare provider if you have symptoms of testicular cancer. Be prepared to discuss any symptoms you have and how long you've had them.

• Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations).
• Make a list of your medications (including over-the-counter).
• Write down any questions, symptoms or concerns you want to talk about.
• If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).

What should I ask my healthcare provider before having an orchiectomy?

• What is my diagnosis? What type of cancer do I have?
• What is the reason for the surgery? Are there any alternatives to surgery?
• What tests are you recommending and why? Will the test results change my treatment plan? If not, then why do I need them?
• How will I feel after the surgery? Will I have to modify my activity?
• What are the possible complications for this surgery?
• What happens if I do not go through with the surgery?
• What is your experience in doing this type of surgery? What is your complication rate?
• Is there any special preparation for the surgery? (If so, get clear instructions on what you need to do.)
• Will I be receiving other treatments before or after my surgery?
• What other specialists will need to get involved?

Do not forget to arrange for transportation to and from the facility and for help at home.

Before you go home, make sure you understand all home care instructions (including medications and side effects), what symptoms you should report to your healthcare provider after discharge and follow-up plans. Your surgeon should also communicate with your primary care physician.

Source UHC.com

Also known as:

Testicle Removal

Removal of Testicle

Orchiectomy

Cancer of Testicle

Cancer - Testicle Removal

Cancer