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What is Testicular Cancer and Types of testicular Cancer?

 At the bottom of this page are pictures on how to do a testicular exam

Cancer starts when cells begin to grow out of control. Cells in nearly any part of the body can become cancerous and spread to other parts of the body.


What Is Cancer?


Cancer that starts in the testicles is called testicular cancer. To understand this cancer, it helps to know about the normal structure and function of the testicles.


The good news is that detecting Testicular Cancer can often be done through a simple Testicular Cancer Self Exam (TSE).  We recommend performing this “self-check” once a week.  By performing a regular Testicular Self Exam, you highly increase the likelihood of catching Testicular Cancer in its early stage, which has the best prognosis.   A staggering 62% of those most at risk don’t know how to check themselves. We lose one male every single day to Testicular Cancer.   Increase the chances that “one” male isn’t you. A simple self-exam takes less than one minute!  Learn how to perform a self-check, and get to know what is normal for you, so if anything changes you can act on it!


Male reproductive system

 The testicles are 2 organs that are contained in a pouch of loose skin below the penis called the scrotum. Testicles are part of the male reproductive system and produce sperm but also male hormones (testosterone). The spermatic cord is a structure that connects the testicles to the rest of the body. It contains veins and arteries (necessary for the testicles to receive oxygen through blood flow), nerves, and the vas deferens (that carry sperm from the testicles to the urethral opening in the prostate where it is expelled during ejaculation).


Sperm cells are made in long, thread-like tubes inside the testicles called seminiferous tubules. They're then stored in a small coiled tube behind each testicle called the epididymis. This is where they mature.


During ejaculation, sperm cells are carried from the epididymis through the vas deferens to the seminal vesicles. There, they mix with fluids made by the vesicles, prostate gland, and other glands to form semen. This fluid then enters the urethra, the tube in the center of the penis through which both urine and semen leave the body.


Compared with other types of cancer, testicular cancer is rare. But testicular cancer is the most common cancer in American males between the ages of 15 and 35.


Testicular cancer is highly treatable, even when cancer has spread beyond the testicle. Depending on the type and stage of testicular cancer, you may receive one of several treatments or a combination.


Usually, an enlarged testicle or a small lump or area of hardness are the first signs of testicular cancer. Any lump, enlargement, hardness, pain, or tenderness should be evaluated by a doctor as soon as possible.

Other symptoms of testicular cancer usually do not appear until after the cancer has spread to other parts of the body.


This year, an estimated 9,910 people in North America will be diagnosed with testicular cancer. About 1 out of every 250 men and boys will be diagnosed with the disease during their lifetime. Worldwide, an

estimated 74,458 people were diagnosed with testicular cancer in 2020.

Prostate cancer accounts for one-fifth (20%) of all new cancer cases in men.

That being said, 100% of people will die if they don’t get treatment. Statistics say that the longer some one waits to go to the hospital, the longer the list of treatments will be. Waiting to see the doctor can mean the difference between having to undergo chemotherapy or not.


Men who have been diagnosed with testicular cancer may have questions about prognosis and survival, both of which depend on numerous factors. Only a physician who is well-informed about the patient’s medical history, type of cancer diagnosed, stage, characteristics of the disease, treatments and reactions to these treatments can evaluate all the data and reach a prognosis.


8 warning signs and symptoms of testicular cancer:

 1. A painless lump or swelling on either testicle. If found early, a testicular tumour may be about the size of a pea or a marble, but it can grow much larger.

 2. Pain, discomfort, or numbness in a testicle or the scrotum, with or without swelling.

 3. Change in the way a testicle feels or a feeling of heaviness in the scrotum.

 4. Dull ache in the lower abdomen or groin

 5. Sudden buildup of fluid in the scrotum

 6. Breast tenderness or growth. Although rare, some testicular tumors make hormones that cause breast tenderness or growth of breast tissue.

 7. Lower back pain, shortness of breath, chest pain, and bloody sputum or phlegm can be symptoms of later-stage testicular cancer.

 8. Swelling of 1 or both legs or shortness of breath from a blood clot can be symptoms of testicular cancer. For some young or middle-aged men, developing a blood clot may be the first sign of*testicular     cancer



Types of testicular cancer

 The testicles are made up of many types of cells, each of which can develop into one or more types of cancer. It's important to know the type of cell cancer started in and what kind of cancer it is because

they differ in how they're treated and, in their prognosis, (outlook).


Doctors can tell what type of testicular cancer you have by looking at the cells under a microscope.

90% of seminomas and 56% of non-seminomas indicate a good prognosis. Approximately 16% of non-seminomas mean a sombre prognosis at advanced stages of the disease while seminomas react better to treatment even at an advanced stage.


Size of the tumour

A seminoma that is larger than 6 cm can be a sign of an advanced stage, the size of the non-seminoma is not an indicator of an advanced stage.

Distant metastasis

Cancer of the testicle that has spread to the lungs or other distant areas is a sign of a sombre prognosis.

Retroperitoneal lymph node

The presence of testicular cancer in the retroperitoneal lymph node is an advanced stage indicator.

For testicular cancer that has spread to the lymph nodes in the back of the abdomen, called the retroperitoneal lymph nodes, the survival rate is 96%. But this depends on the size of the lymph nodes with cancer.  About 18% of cases are diagnosed at this stage. For testicular cancer that has spread outside the testicles to areas beyond the retroperitoneal lymph nodes, such as to the lungs or other organs, the survival rate is 73%. About 12% of testicular cancer is diagnosed at this stage.


Germ cell tumors

More than 90% of cancers of the testicle start in cells known as germ cells. These are the cells that make sperm. The main types of germ cell tumors (GCTs) in the testicles are *seminomas *and *non-seminomas*.     These types occur about equally. Many testicular cancers contain both seminoma and non-seminoma cells. These *mixed germ cell tumors* *are treated as non-seminomas* because they grow and spread like non-seminomas.



Seminomas tend to grow and spread more slowly than non-seminomas. The 2 main sub-types of these tumors are//classical (or typical) seminomas and spermatocytic seminomas.


  * *Classical seminoma:* More than 95% of seminomas are classical.  These usually occur in men between 25 and 45.

  * *Spermatocytic seminoma:* This rare type of seminoma tends to occur  in older men. (The average age is about 65.) Spermatocytic tumors tend to grow more slowly and are less likely to spread to other

    parts of the body than classical seminomas.


Some seminomas can increase blood levels of a protein called human chorionic gonadotropin (HCG). HCG can be checked with a simple blood test and is considered a tumor marker for certain types of testicular cancer. It can be used for diagnosis and to check how the patient is responding to treatment.




These types of germ cell tumors usually occur in men between their late teens and early 30s. The 4 main types of non-seminoma tumors are embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and teratoma.  Most tumors are a mix of different types (sometimes with seminoma cells too), but this doesn’t change the treatment of most non-seminoma cancers.


*Embryonal carcinoma:* These cells are found in about 40% of testicular tumors, but pure embryonal carcinomas occur only 3% to 4% of the time.  When seen under a microscope, these tumors can look like tissues of very early embryos. This type of non-seminoma tends to grow rapidly and spread outside the testicle.     Embryonal carcinoma can increase blood levels of a tumor marker protein called *alpha-fetoprotein* (AFP), as well as *human chorionic gonadotropin* (HCG).


*Yolk sac carcinoma:* These tumors are so named because their cells look like the yolk sac of an early human embryo. Other names for this cancer include yolk sac tumor, endodermal sinus tumor, infantile embryonal carcinoma, or orchidoblastoma.


This is the most common form of testicular cancer in children (especially in infants), but pure yolk sac carcinomas (tumors that do not have other types of non-seminoma cells in them) are rare in adults.

When they occur in children, these tumors usually are treated successfully. But they're of more concern when they occur in adults, especially if they are pure. Yolk sac carcinomas respond very well to

chemotherapy , even if they have spread.

This type of tumor almost always increases blood levels of AFP (alpha-fetoprotein).


*Choriocarcinoma:* This 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. These mixed tumors tend to have a somewhat better outlook than pure choriocarcinomas, although the presence of choriocarcinoma is always a worrisome finding.

This type of tumor increases blood levels of HCG (human chorionic gonadotropin).


*Teratoma:* Teratomas are germ cell tumors with areas that, under a microscope, look like each of the 3 layers of a developing embryo: the endoderm (innermost layer), mesoderm (middle layer), and ectoderm (outer layer). Pure teratomas of the testicles are rare and do not increase AFP

(alpha-fetoprotein) or HCG (human chorionic gonadotropin) levels. Most often, teratomas are seen as parts of mixed germ cell tumors.


There are 3 main types of teratomas:

   * *Mature teratomas* are tumors formed by cells a lot like the cells of adult tissues. They rarely spread. They can usually be cured with surgery, but some come back recur) after treatment.

  * *Immature teratomas* are less well-developed cancers with cells that  look like those of an early embryo. This type is more likely than a mature teratoma to grow into (invade) nearby tissues, spread

    (metastasize) outside the testicle, and come back (recur) years after treatment.

  * *Teratomas with somatic type malignancy* are very rare. These cancers have some areas that look like mature teratomas but have other areas where the cells have become a type of cancer that

    normally develops outside the testicle (such as a sarcoma, adenocarcinoma, or even leukemia).



      Carcinoma in situ of the testicle

Testicular germ cell cancers can start as a non-invasive form of the disease called *carcinoma in situ* (CIS) or *intratubular germ cell neoplasia*. In testicular CIS, the cells look abnormal under the

microscope, but they have not yet spread outside the walls of the seminiferous tubules (where sperm cells are formed). Carcinoma in situ doesn’t always progress to invasive cancer.


It's hard to find CIS before it becomes an invasive cancer because it generally doesn't cause symptoms or form a lump that you or the doctor can feel. The only way to diagnose testicular CIS is to have a biopsy . (This is a procedure to take out a tiny bit of tissue so it can be checked under a microscope.) Sometimes CIS is found incidentally (by accident) when a testicular biopsy is done for another reason, such as infertility.


When CIS of the testicle becomes invasive, its cells are no longer just in the seminiferous tubules, they've grown into other structures of the testicle. These cancer cells can then spread either to the lymph nodes (small, bean-shaped collections of white blood cells) through lymphatic vessels (tiny fluid-filled tubes that connect the lymph nodes), or through the blood to other parts of the body.


      Stromal tumors

Tumors can also start in the supportive and hormone-producing tissues, or stroma, of the testicles. These tumors are known as *gonadal stromal tumors*. They make up less than 5% of adult testicular tumors, but up to 20% of childhood testicular tumors. The main types are *Leydig cell tumors* and *Sertoli cell tumors*.



        Leydig cell tumors

These tumors start in the Leydig cells in the testicle that normally make male sex hormones (androgens like testosterone). Leydig cell tumors can develop in both adults and children. These tumors often make

androgens (male hormones), but sometimes they make estrogens (female sex hormones).


Most Leydig cell tumors are not cancer (benign). They seldom spread beyond the testicle and can often be cured with surgery. Still, a small number of Leydig cell tumors do spread to other parts of the body. These tend to have a poor outlook because they usually don't respond well to chemo or radiation therapy.


        Sertoli cell tumours

These tumors start in normal Sertoli cells, which support and nourish the sperm-making germ cells. Like the Leydig cell tumors, these tumors are usually benign. But if they spread, they usually don’t respond well to chemo or radiation therapy.


Testicular cancer relative survival after 5 years stands at 97%, which means that a man who is diagnosed with testicular cancer would have, on average, a 97% likelihood of surviving 5 years (or more) following die However, survival varies depending on each stage and the prognostic classification of testicular cancer. As a general rule, the earlier testicular cancer is diagnosed and treated the better the prognosis. That is why it is important to quickly consult a doctor. It is important to note that most testicular cancers are diagnosed at an early stage.


    Secondary testicular cancers

Cancers that start in another organ and then spread (metastasize) to the testicle are called secondary testicular cancers. These are not true testicular cancers – they don't start in the testicles. They're named

and treated based on where they started.


Lymphoma is the most common secondary testicular cancer. Testicular lymphoma is more common

in men older than 50 than primary testicular tumors. The outlook depends on the type and stage of lymphoma. The usual treatment is surgical removal, followed by radiation and/or chemotherapy.


leukemia, the leukemia cells can sometimes form a tumor in the testicle. Along with chemotherapy to treat leukemia, this might require treatment with radiation or surgery to remove the testicle.


Cancers of the prostate, lung, skin (melanoma), kidney, and other organs also can spread to the testicles. The prognosis for these cancers tends to be poor because these cancers have usually spread widely to other organs as well. Treatment depends on the specific type of cancer.


Testicular cancer or its treatment can make you infertile (unable to father a child). Before treatment starts, men who might want to father children may consider storing sperm in a sperm bank for later use. But testicular cancer also can cause low sperm counts, which could make it hard to get a good sample


How is Testicular Cancer Treated?

Treatment options for testicular cancer include surgery, which often can include removing the testicle. Testicular biopsy of the mass is rarely done unless the patient only has one testicle. Patients can have a good quality of life and normal fertility with only one testicle. For more advanced cancers, that have spread to the lymph nodes, some patients may need further surgery, radiation therapy or chemotherapy. You may end up receiving more than one type of *treatment for your testicular cancer* Depending on several factors, such as the grade of the tumour, where it is located, and whether it has spread to other parts of your body Your doctors will decide which type or types of treatment is best for your personal condition.

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