What is Testicular Cancer?

 

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).

Content is courtesy of CCS.

Content is courtesy of CCS.

Testicular cancer starts in the DNA of the cells of the testicle. DNA contains the instructions providing all information that cells need to grow and divide. If these instructions are changed in any way that is not repaired by the body’s own safety checks, cancer cells may develop. Cancer cells are cells that grow out of control and are not turned off by the usual instructions in the cell. If cancer cells grow and divide many millions of times, a tumor can develop.

The cells of the testicle are often referred to as germ cells. Therefore if a tumor develops in the testicles, they are called germ cell tumors. There are two broad categories of germ cell tumors are: seminomas and non-seminomas. Both can be treated successfully but sometimes the treatments are different.

 

Survival Statistics

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.

The following elements are prognosis factors for testicular cancer.

 

Type of cancer

90% of seminomas and 56% of non-seminomas indicate a good prognosis. Approximately 16% of non-seminomas mean a somber 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.

Analysis of serum markers

A high level of serum tumoral markers is usually associated with an advanced stage of testicular cancer.

 
 

Testicular tumours are classified based on the quality of therapeutic response expected:

Testicular cancer survival statistics are very general and should be interpreted prudently. As they are based on the experience of groups of people among the general population, they cannot predict the survival of any one specific individual. 

Observed survival corresponds to the percentage of those diagnosed with testicular cancer and who are still alive 5 years post diagnosis (see below).

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 diagnosis versus men in the general population who do not have cancer (which explains the difference in percentages with the table below).

However, survival varies depending on each stage and the prognostic classification of the 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.

 

Questions about survival?

We recommend that cancer patients discuss their prognosis with their doctor. The prognosis is based on numerous factors and only a physician who is well aware of the patient’s medical history, the type of cancer diagnosed, its stage, specific characteristics, treatments and response to treatment can examine all this data and relevant survival statistics to determine the prognosis.

 

Understanding your Diagnostic

What causes testis cancer?

We do not know what causes testicular cancer. Some men are at higher risk of developing testicular cancer (if they have had an undescended testicle, family history), but even in men with risk factors, very few will develop cancer.

Are there different types of testis cancer?

There are several varieties of testis cancers which originate from the cells of the testis. Germ cell tumours are the most common type. There are two main types of germ cell tumours: 

(1) Seminoma

(2) Nonseminoma (with 4 different subtypes)

  • embryonal cell carcinoma
  • teratoma
  • yolk sac tumours
  • choriocarcinoma

Often, within a germ cell tumour, there is a mixture or combination of these different cell types. After removal of the testicle, your doctor will decide on the best treatment for you based on the type of germ cell tumour and the extent of the cancer. Non-germ cell tumours are much less common and include Leydig cell tumours, Sertoli cell tumours. 

Certain cancers start from another organ and spread to the testis. These are called “secondary cancers” or “metastatic cancers.” Cancer of blood cells (called “leukemia”) and cancer of the lymph system (called “lymphoma”) are the more common cancers which can involve the testis.

 

Testicular Cancer Progression

How does testis cancer usually grow and spread?
hat other areas of the body does it affect?

Explanatory videos

A germ cell tumour starts inside the testicle and grows outwards. It then reaches and “invades” the layers covering of the testis – the “capsule” or “tunica.” It may also invade neighboring structures connected to the testis, called the “epididymis.” Eventually, the cancer reaches the layers of the loose skin sac, the scrotum. Most testicle tumours are diagnosed and treatment before cells spread to other parts of the body.

In some patients, the cancer cells can escape from the testicle and spread to other parts of the body. The cells can travel through the lymph channels or through blood vessels. The lymph channels (or “lymphatics”)are a lace¬like network of many small tubes interconnecting with “stations” called lymph nodes. As the tumour cells reach the small tubes with fluid flowing through them (lymph fluid inside lymph channels and blood inside blood vessels), they may be carried away by the fluid into places outside of the testicle and may eventually “land” or take root somewhere else and start growing there. This process is called “metastasis.”

Most commonly, if testicular cancer spreads, the cells travel through the lymph channels and deposit in lymph nodes. The first lymph nodes they “land” in are the ones higher up deep inside the abdomen, near the kidneys, close to the biggest artery in the body (the aorta) and the biggest vein (vena cava). If the lymph glands become affected by cancer cells, they will start growing and those lymph glands enlarge and the enlarged glands can be seen on CT scans. The cancer cells then may travel further along the lymph channels and land in lymph glands lower down in the pelvis or higher up in the chest, behind the heart and in the left neck area.

Less commonly, germ cell cancers travel through the blood vessels. When the cells travel through the blood vessels they can land almost anywhere in the body, but most commonly are found in the lungs, where they start growing as “lung nodules.” The lung nodules may be seen on chest x-rays or CT scans.

Source : Content is courtesy of CCS.

 

Blood Tumor Markers

What are blood tumour markers? And how are they used?

Some, but not all, germ cell cancers produce substances that can be detected with blood tests (AFP and βHCG) They are known as “tumour markers.” Some germ cell tumors, (almost all seminomas and some non¬seminomas) do not produce these tumour markers. So, if the blood tests do not find these markers, it does not necessarily mean there is no cancer. However, if the blood tests detect these markers, it strongly suggests the presence of cancer cells in the body.

The tumour markers should be measured after removing the testicle. With the germ cell cancers which produce the markers, they will still be detectable if there is still cancer left in the body (they will produce the markers whether the cancer is in the testicle itself or in locations where it has spread to). If there are high levels of tumour markers after the testicle is removed, the markers can be monitored with repeated measurements to see if the cancer is responding to treatment. 

If the markers start rising again after having come down to a normal level, that usually means the cancer is becoming active again or has returned (“relapsed”) and further treatment is needed. 

Why do I need treatment if the results are normal?

If your tumour markers become normal after your testicle is removed, you may or may not need additional treatment.

If the CT scans show that the cancer is advanced (if it has spread to the lymph nodes or other parts of the body), treatment with surgery, chemotherapy, or radiation will be recommended.

Staging

The “stage” of the cancer means how far along the cancer has grown or spread. The information comes from examining you, from the outcomes of your surgery, from the CT scans and X¬rays, and from tumor markers. See Table 2.

  • Stage 1: This means the cancer is limited to the testis.
  • Stage 2: This means the cancer has spread to the lymph glands in the abdomen.
  • Stage 3: This means the cancer has spread to lymph glands further away from the abdomen or it has spread to other organs such as the lungs.

Questions to ask about pathology and staging

The following are questions that you can ask the healthcare team to learn more about a type of cancer. Choose the questions that fit your situation and add questions of your own. You may find it helpful to take the list to the next appointment and to write down the answers.

  • What type of cancer is it? What is the correct spelling for the type of cancer?
  • What is the stage or extent of the cancer?
  • If the cancer has spread, where has it spread to?
  • Are more tests needed before treatment can start?If so, what are they? Why do they need to be done?
  • What is the prognosis for this stage and type of cancer?
  • What are the treatment options and what are the pros and cons of each option?