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National Cancer Institute

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Testicular cancer


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is cancer of the testicle?
STAGE EXPLANATION
Stages of cancer of the testicle
Stage I
Stage II
Stage III
Recurrent
TREATMENT OPTION OVERVIEW
How cancer of the testicle is treated
Treatment by stage
STAGE I TESTICULAR CANCER
STAGE II TESTICULAR CANCER
STAGE III TESTICULAR CANCER
RECURRENT TESTICULAR CANCER
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is cancer of the testicle?

Cancer of the testicle (also called the testis), a rare kind of cancer in men, is a disease in which cancer (malignant) cells are found in the tissues of one or both testicles. Sperm (the male germ cells that can join with a female egg to develop into a baby) and male hormones are made in the testicles. There are two testicles located inside of the scrotum (a sac of loose skin that lies directly under the penis). The testicles are similar to the ovaries in women (the small sacs that hold the female egg cells).

Cancer of the testicle is the most common cancer in men 15 to 35 years old. Men who have an undescended testicle (a testicle that has never moved down into the scrotum) are at higher risk of developing cancer of the testicle than other men whose testicles have moved down into the scrotum. This is true even if surgery has been done to place the testicle in the appropriate place in the scrotum.

A doctor should be seen if there is any swelling in the scrotum. The doctor will examine the testicles and feel for any lumps. If the scrotum doesn't feel normal, the doctor may need to do an ultrasound examination, which uses sound waves to make a picture of the inside of the testes. The doctor may need to cut out the testicle and look at it under a microscope to see if there are any cancer cells. It is very important that this be done correctly.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the testicle or has spread to other places) and the patient's general state of health.


STAGE EXPLANATION


Stages of cancer of the testicle

Once cancer of the testicle has been found, more tests will be done to find out if the cancer has spread from the testicle to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the testicle:


Stage I

Cancer is found only in the testicle.


Stage II

Cancer has spread to the lymph nodes in the abdomen (lymph nodes are small, bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).


Stage III

Cancer has spread beyond the lymph nodes in the abdomen. There may be cancer in parts of the body far away from the testicles, such as the lungs and liver.


Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the same place or in another part of the body. A patient should regularly examine the opposite testicle for possible recurrence for many years after treatment. Patients will probably have check-ups once per month during the first year after surgery, every other month during the next year, and less frequently after that.


TREATMENT OPTION OVERVIEW


How cancer of the testicle is treated

There are treatments for all patients with cancer of the testicle, and most patients can be cured with available treatments. Four kinds of treatment are used:

Surgery is a common treatment of most stages of cancer of the testicle. A doctor may take out the cancer by removing one or both testicles through an incision (cut) in the groin. This is called a radical inguinal orchiectomy. Some of the lymph nodes in the abdomen may also be removed (lymph node dissection).

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation therapy for testicular cancer usually comes from a machine outside the body (external-beam radiation).

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the testicle.

Bone marrow transplantation is a newer type of treatment. For autologous bone marrow transplant, bone marrow is taken from the patient and treated with drugs to kill any cancer cells. The marrow is then frozen and the patient is then given high-dose chemotherapy with or without radiation therapy to destroy all of the remaining marrow. The marrow that was taken out is then thawed and given back to the patient through a needle in a vein to replace the marrow that was destroyed.


Treatment by stage

Treatment of cancer of the testicle depends on the stage and cell type of the disease, and the patient's age and overall condition.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in many parts of the country for all stages of cancer of the testicle. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


STAGE I TESTICULAR CANCER

Treatment depends on what the cancer cells look like under a microscope (cell type). If a tumor called a seminoma is found, treatment will probably be surgery to remove the testis (radical inguinal orchiectomy), followed by external-beam radiation to the lymph nodes in the abdomen. Clinical trials are also being performed on radical inguinal orchiectomy alone followed by careful testing to see if the cancer comes back.

If a tumor called a nonseminoma is found, treatment may be one of the following:

1. Radical inguinal orchiectomy and removal of some of the lymph nodes in the abdomen (lymph node dissection). Patients may undergo surgery that will preserve fertility. Blood tests and chest x-rays must be done once each month for the first year following the operation and at least every 2 months during the second year. A CT scan, a special kind of x-ray, may also be done. If results of the tests don't look normal and the cancer has recurred (come back), the doctor will give the patient systemic chemotherapy as soon as possible.

2. Radical inguinal orchiectomy alone followed by careful testing to see if the cancer comes back. The doctor must check the patient and do blood tests and x-rays every month for 2 years. This option is chosen only if the tumor has certain special features.


STAGE II TESTICULAR CANCER

Treatment depends on what the cancer cells look like under a microscope (cell type). If a tumor called a seminoma is found and the tumor is nonbulky (no lymph nodes can be felt in the abdomen, and no lymph nodes block the ureters [the tubes that carry urine from the kidney to the bladder]), treatment will probably be surgery to remove the testis (radical inguinal orchiectomy). External-beam radiation is then given to the lymph nodes in the abdomen.

If a tumor called a seminoma is found and the tumor is bulky (lymph nodes can be felt in the abdomen and/or the lymph nodes block the ureters, or if a CT scan shows them to be large), treatment will probably be a radical inguinal orchiectomy followed by systemic chemotherapy or external-beam radiation therapy.

If a tumor called a nonseminoma is found, treatment will probably be one of the following:

1. Radical inguinal orchiectomy and removal of the lymph nodes in the abdomen (lymph node dissection). The doctor will check the patient each month and do blood tests, chest x-rays, and CT scans. If the test results are not normal, patients will probably receive systemic chemotherapy.

2. Radical inguinal orchiectomy and lymph node dissection, followed by systemic chemotherapy. Blood tests and chest x-rays must be done once each month for the first year after the operation. CT scans are also done regularly.

3. Radical inguinal orchiectomy followed by systemic chemotherapy. If x-rays following chemotherapy show that cancer remains, surgery may be done to remove the cancer. After the operation, the doctor will check the patient each month and do blood tests, chest x-rays, and CT scans. In some cases, chemotherapy may be given before the radical inguinal orchiectomy.

4. Clinical trials of systemic chemotherapy instead of lymph node dissection (in selected patients).


STAGE III TESTICULAR CANCER

Treatment depends on what the cancer cells look like under a microscope (cell type). If a tumor called a seminoma is found, treatment will probably be surgery to remove the testis (radical inguinal orchiectomy), followed by systemic chemotherapy. Clinical trials are testing radical inguinal orchiectomy followed by systemic chemotherapy. If a tumor called a nonseminoma is found, treatment will probably be one of the following:

1. Systemic chemotherapy. Clinical trials are testing new chemotherapy drugs.

2. Systemic chemotherapy, followed by surgery to take out any masses that remain to see if there are any cancer cells left. If cancer cells remain, patients will probably receive more systemic chemotherapy.

3. Clinical trials of systemic chemotherapy.

4. Clinical trials of high-dose systemic chemotherapy with autologous bone marrow transplantation (in some patients).


RECURRENT TESTICULAR CANCER

Treatment depends on what the cancer cells look like under a microscope, where the cancer recurred (came back), and other factors. Treatment options include systemic chemotherapy, high-dose systemic chemotherapy with autologous bone marrow transplantation, surgery, and clinical trials testing new chemotherapy drugs.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about cancer of the testicle, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, you can speak with a trained information specialist who can answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public and can be sent on request. The following booklets on questions related to cancer may be helpful:

What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again

There are many other places where people can get material and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 09/1999


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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