Testicular Cancer

Testicular cancer is the most frequent type of cancer in men 15 to 35 years old.  It can generally be treated and can often also be cured; while about 8100 cases are diagnosed annually in the U.S., fewer than 400 will die of the disease each year (Bohnenkamp & Yoder, 2009).  Early diagnosis of testicular cancer results in a 99% cure rate, so it is important to examine male patients for this during regular physical exams (Shaw, 2008).  An average family physician may see very few  cases of testicular cancer in an entire career, but it is often missed in physical exams, with between 25% and 50% of testicular cancer patients receiving an incorrect initial diagnosis (Lin & Sharangpani, 2010).  Still, there is no evidence that wholesale screening of symptom-free men provides a significant healthcare benefit overall (Ilic & Misso, 2011).

While no one knows exactly why certain men develop this cancer, factors such as family history, age, being Caucasian, and having congenital abnormalities increase the risk; another large risk factor is an undescended testicle; this can increase the risk of developing testicular cancer by 10 to 40 times (Bohnenkamp &Yoder, 2009).
Testicular cancer may present only mild or no symptoms, including pain in one testicle, a dull ache in the scrotum or abdomen, a painless lump in the testicle along with a swelling of the testicle. There may also be swelling of the breast as well (Shaw, 2008). If the cancer has metastacized, it may also present with shortness of breath, lumps in the neck, or even back pain (Bohnenkamp & Yoder, 2009).  About 5% of patients with testicular cancer demonstrate metastacized cancer (Shaw, 2008).

Tests for testicular cancer include a physical exam, checking for tumor marker, and various radiological imaging.  The physical exam includes palpation of the testes, abdomen, and lymph nodes.  If a mass is detected, an ultrasound is indicated to evaluate the mass and distinguish between a simple fluid build-up and an actual testicular mass (Shaw, 2008).  Sonograms that determine the presence of a mass would result in a chest x-ray and CT-scan of the pelvis.  Serum tumor markers are very sensitive tests, and can be used, but a needle biopsy is generally not recommended lest it contribute to metastasizing any tumor (Shaw, 2008). 

The treatment plan for a patient with testicular cancer depends how advanced the cancer is at the time of diagnosis.  Stage I cancer patients would usually receive only chemotherapy or only radiation depending on type of cancer. Stage II cancer patients would receive more intense radiation or more intense chemotherapy and dissection of lymph nodes if appropriate.  Stage III cancer patients would receive intensive chemotherapy, possibly referral to a clinical trial and possibly testicle removal.  The survival rate for this cancer is excellent, with 10-year survival rates even with metastatic cancer as much as 67 to 94% (Shaw, 2008).
 

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