LAST EDITED ON 22-Jul-10 AT 06:54 AM (PST)
After the cancer is found and staged, your doctor will talk to you about treatment choices. You should take time and think about all of the choices. In choosing a treatment plan, things to consider include the type and stage of the cancer, as well as your overall physical health. You might also want to check with another doctor for a second opinion. This can give you more information and help you feel good about the choice you make. Some insurance companies even require a second opinion before they will agree to pay for treatments.Where you are treated is important. There is no substitute for experience; you will have the best chance for a good outcome if you go to a hospital that treats many testicular cancer patients.
The 3 main methods of treatment for testicular cancer are surgery, radiation therapy, and chemotherapy.
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What is testicular cancer?
Testicular cancer is cancer in one or both testicles. It is most often found in young men. This type of cancer can be treated and very often cured.
The testicles
The testicles (or testes) are part of the male reproductive system. In adult men, each one is normally a little smaller than a golf ball. They are held in a sac of skin called the scrotum. The scrotum hangs beneath the base of the penis.
The testicles make the male hormones testosterone. They also make sperm. Sperm cells are carried from the testicles through small tubes (the vas deferens) to the seminal vesicles. Fluid from the vesicles and from the prostate gland is added. During ejaculation (orgasm), this fluid, now called semen, travels through a tube (the urethra) in the center of the penis and out of the body
The testicles have several kinds of cells. The different cells may develop into one or more types of cancer. It is important to know which kind of cell the cancer started from because these types of cancer are treated differently. They also differ in the chance of survival for the patient (prognosis).
Main types of testicular tumors
•Germ cell tumors are the most common type of testicular tumors. Germ cell tumors grow in the cells that make sperm.
•Stromal tumors grow in other parts of the testicles like the cells that make hormones.
•Secondary testicular tumors are from cancer that has spread to the testicles from other parts of the body.
Each of the 3 types is explained in more detail below.
Germ cell tumorsMore than 9 out of 10 of cancers of the testicles start in the germ cells. As used here, the term "germ" means seed. These are the cells that make sperm.
The 2 main types of germ cell tumors are seminomas and nonseminomas.
Seminomas start from germ cells of the testicle that make sperm. Within this group there are also subtypes. Seminomas usually happen in men between their late 30s and early 50s.
Nonseminomas tend to develop earlier in life than seminomas. They are often found in men between their late teens and early 40s. There are 4 main subtypes. Most tumors are mixed, having at least 2 different subtypes. But all nonseminoma germ cell cancers are treated the same way, so the exact type is not that important.
Carcinoma in situ: Testicular germ cell cancers may begin as a non-invasive form of the disease called carcinoma in situ (CIS). Carcinoma in situ may not always go on to become invasive cancer. It can take about 5 years for CIS to progress to the invasive form of germ cell cancer.
It is hard to find CIS because it often causes no symptoms and may not form a lump that you or the doctor can feel. Some cases are found by chance in men who have a testicular biopsy for some other reason, such as infertility.
Experts don't agree about the best treatment for CIS. Since CIS doesn't always become an invasive cancer, many doctors in this country suggest watching and waiting to be the best course of action.
Stromal tumorsTumors can also grow in the cells that make hormones and in the supportive tissues (the stroma) of the testicles. Stromal cell tumors are often benign (not cancer). They usually do not spread beyond the testicle and can be cured by taking them out. But a few stromal cell tumors spread to other parts of the body (metastasize). Metastatic stromal cell tumors have a poor outlook because they do not respond well to chemotherapy or radiation treatment. The 2 main types of stromal tumors are Leydig cell tumors and Sertoli cell tumors.
Secondary testicular tumors Secondary testicular tumors start in another organ and then spread to the testicle. Lymphoma is the most common cancer that does this. Among men over age 50, testicular lymphoma is more common than tumors that start in the testicle. Their outlook depends on the type and stage of lymphoma. The usual treatment is to remove the testicle. Surgery is followed by radiation and/or chemotherapy. In boys with acute leukemia, the leukemia cells can sometimes form a tumor in the testicle.
Cancers of the prostate, lung, skin, kidney, and other organs can also spread to the testicles. The outlook for these cancers is usually poor. That's because these cancers have generally spread widely to other organs, too. Treatment depends on the exact type of cancer.
Surgery
Surgery is often the first treatment for testicular cancer.
Radical inguinal orchiectomyAll stages of testicular cancer are treated with surgery. The testicle (or testicles) with cancer are taken out of the scrotum through a cut (incision) in the groin. The surgeon also cuts through the spermatic cord that attaches the testicle to the belly (abdomen). This is known as a radical inguinal orchiectomy. If both testicles are removed, you can no longer make sperm cells and can no longer father children (you become infertile).
Retroperitoneal lymph node dissectionDepending on the type and stage of your cancer, some lymph nodes behind the belly (abdomen) may also be removed. This can be done at the same time or during a second operation. This operation is called a retroperitoneal lymph node dissection. A large cut (incision) is often needed to remove these lymph nodes. This is a difficult and long operation. It should be done by a surgeon who does them often.
In some cases, the surgeon can remove lymph nodes through very small cuts in the belly. A narrow lighted tube with a camera (called a laparoscope) is used to see. Long, thin tools are put in the cuts to do the surgery. Although there are advantages to this type of surgery-- for example, the patient recovers much more quickly-- there is not yet agreement about whether it is as good as the standard operation. This approach should only be used if the surgeon has a lot of experience with this surgery.
How treatment can affect sexualitySurgery to remove lymph nodes behind the belly can damage nearby nerves that control sexual climax (ejaculation). If these nerves are damaged, when a man has a climax the sperm do not go out of the body. Instead, they go into the bladder. Damage to these nerves does not affect a man's ability to have an erection, but may make him unable to father children (infertile). To avoid this problem, surgeons have developed nerve-sparing surgery) that has a very high rate of success when done by a doctor with a lot of experience.
If both testicles are removed a man cannot make testosterone. He will need to take supplements, either in the form of a gel, patches, or a shot. As a rule, testosterone pills don't work.
Testicular cancer often affects men at an age when they are trying to have children. These men may wish to talk about nerve-sparing surgery with their doctors. They may also want to talk about storing frozen sperm cells before treatment (sperm banking). Men with testicular cancer often have lower than normal sperm counts, which may make sperm banking hard. You should talk about this with your doctor when making treatment choices.
When a testicle is removed, that side of the scrotum looks and feels empty. Men with testicular cancer are usually young. They may be single and dating. Or they may be athletic and feel embarrassed by the missing testicle when in locker rooms. A man can have an artificial testicle (prosthesis) placed in his scrotum to give a more natural look. The prosthesis approved for use in the United States is filled with salt water (saline). It comes in many sizes to match the other testicle. It can look much like a normal testicle. There may be a scar after the surgery, but it is often partly hidden by pubic hair. Some men want to have prosthesis and others do not. You should discuss your wishes with your surgeon as you think about this surgery. It may also help to talk with someone who has had a testicular prosthesis, to see what their experience was like.
Losing a testicle usually has no effect on a man's ability to get an erection and have sex. Men who have had both testicles removed are also still able to have sex as long as they are getting enough testosterone.
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