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Shahram Shawn Gholami, M.D.

Internationally recognized expert
in Robotic Surgery

performed thousands of laparoscopic and robotic
procedures since 2000. Learn more about Dr. Gholami

 

Testicular Cancer

Testicular cancer occurs in the testicles (testes), which are located inside the scrotum, a loose bag of skin underneath the penis. The testicles produce male sex hormones and sperm for reproduction.

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 34.

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. Regular testicular self-examinations can help identify growths early, when the chance for successful treatment of testicular cancer is highest.
Source: Mayo Clinic

Symptoms
Signs and symptoms of testicular cancer include:

  • A lump or enlargement in either testicle
  • A feeling of heaviness in the scrotum
  • A dull ache in the abdomen or groin
  • A sudden collection of fluid in the scrotum
  • Pain or discomfort in a testicle or the scrotum
  • Enlargement or tenderness of the breasts

Cancer usually affects only one testicle.

When to see us
See Dr. Gholami if you detect any pain, swelling or lumps in your testicles or groin area, especially if these signs and symptoms last longer than two weeks.
Source: Mayo Clinic

Causes
It’s not clear what causes testicular cancer in most cases. Doctors know that testicular cancer occurs when healthy cells in a testicle become altered. Healthy cells grow and divide in an orderly way to keep your body functioning normally. But sometimes some cells develop abnormalities, causing this growth to get out of control — these cancer cells continue dividing even when new cells aren’t needed. The accumulating cells form a mass in the testicle.
Nearly all testicular cancers begin in the germ cells — the cells in the testicles that produce immature sperm. What causes germ cells to become abnormal and develop into cancer isn’t known.
Source: Mayo Clinic

Risk Factors
Factors that may increase your risk of testicular cancer include:

  • An undescended testicle (cryptorchidism). The testes form in the abdominal area during fetal development and usually descend into the scrotum before birth. Men who have a testicle that never descended are at greater risk of testicular cancer in either testicle than are men whose testicles descended normally. The risk remains even if the testicle has been surgically relocated to the scrotum. Still, the majority of men who develop testicular cancer don’t have a history of undescended testicles.
  • Abnormal testicle development. Conditions that cause testicles to develop abnormally, such as Klinefelter’s syndrome, may increase your risk of testicular cancer.
  • Family history. If family members have had testicular cancer, you may have an increased risk.
  • Age. Testicular cancer affects teens and younger men, particularly those between ages 15 and 34. However, it can occur at any age.
  • Race. Testicular cancer is more common in white men than in black men.

Source: Mayo Clinic

Tests
Most men discover testicular cancer themselves, either unintentionally or while doing a testicular self-examination to check for lumps. In other cases, Dr. Gholami or another doctor may detect a lump during a routine physical exam.

To determine whether a lump could be testicular cancer, Dr. Gholami generally first recommends a testicular ultrasound.

  • Ultrasound. A testicular ultrasound test uses sound waves to create an image of the scrotum and testicles. During an ultrasound you lie on your back with your legs spread. The ultrasound technician then applies a clear gel to your scrotum. A hand-held probe is moved over your scrotum to make the ultrasound image.

    An ultrasound test can help Dr. Gholami determine the nature of any testicular lumps, such as if the lumps are solid or fluid filled. Ultrasound also tells Dr. Gholami whether lumps are inside or outside of the testicle. He uses this information to determine whether a lump is likely to be testicular cancer.

Dr. Gholami may also recommend other tests for evaluation:

  • Computerized tomography (CT). CT scans take a series of X-ray images of your abdomen/pelvis. Dr. Gholami uses CT scans to look for signs of cancer.
  • Blood tests. Dr. Gholami may order tests to determine the levels of tumor markers in your blood. Tumor markers are substances that occur normally in your blood, but the levels of these substances may be elevated in certain situations, including testicular cancer. A high level of a tumor marker in your blood doesn’t mean you have cancer, but it may help Dr. Gholami in determining your diagnosis.

Diagnosis and Treatment
The options for treating your testicular cancer depend on several factors, including your overall health and your own preferences. The first treatment option Dr. Gholami generally recommends for potentially cancerous testicular masses is surgery.

Surgery
If it’s determined that the lump on your testicle may be cancerous after doing an ultrasound and/or blood tests, Dr. Gholami will generally recommend surgery to remove the testicle. Your removed testicle will be analyzed in a laboratory to determine if the lump is cancerous and, if so, what type of cancer. Surgery is the primary treatment for nearly all stages and types of testicular cancer. To remove your testicle, Dr. Gholami makes an incision in your groin and extracts the entire testicle through the opening. You’ll receive anesthetics during surgery. All surgical procedures carry a risk of pain, bleeding and infection.

You may also have surgery to remove the lymph nodes in your groin (retroperitoneal lymph node dissection). Sometimes this is done at the same time as surgery to remove your testicle. In other cases it can be done later. The lymph nodes are removed through a large incision in your abdomen. Dr. Gholami takes care to avoid severing nerves surrounding the lymph nodes, but in some cases severing the nerves may be unavoidable. Severed nerves can cause difficulty with ejaculation, but won’t prevent you from having an erection.

In cases of early-stage testicular cancer, surgery may be the only treatment needed. If you have a more advanced testicular cancer, Dr. Gholami may recommend other treatments after surgery.

Diagnosis
Your extracted testicle will be analyzed to determine if it contains cancerous cells and, if so, the type of testicular cancer. The type of testicular cancer you have determines your treatment and your prognosis. In general, there are two types of testicular cancer:

  • Seminoma. Seminoma tumors occur in all age groups, but if an older man develops testicular cancer, it is more likely to be seminoma. Seminomas, in general, aren’t as aggressive as nonseminomas and are particularly sensitive to radiation therapy.
  • Nonseminoma. Nonseminoma tumors tend to develop earlier in life and grow and spread rapidly. Several different types of nonseminoma tumors exist, including choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumor. Nonseminomas are sensitive to radiation therapy, but not as sensitive as seminomas are. Chemotherapy is often very effective for nonseminomas, even if the cancer has spread.

Sometimes both types of cancer are present in a tumor. In that case, the cancer is treated as though it is nonseminoma.

Staging the cancer
Your testicular cancer is also assigned a stage. The stages of testicular cancer are:

  • Stage I. Cancer is limited to the testicle.
  • Stage II. Cancer has spread to the lymph nodes in the abdomen.
  • Stage III. Cancer has spread to other parts of the body. Testicular cancer most commonly spreads to the lungs, liver, bones and brain.

In some cases, Dr. Gholami may recommend radiation therapy or chemotherapy for you.

Radiation therapy
Radiation therapy is a treatment option that’s frequently used in people who have the seminoma type of testicular cancer. Radiation therapy is also used in certain situations in people who have the nonseminoma type of testicular cancer. Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. During radiation therapy, you’re positioned on a table and a large machine moves around you, aiming the energy beams at precise points on your body. Side effects may include fatigue, as well as skin redness and irritation in your abdominal and groin areas.

Chemotherapy
Chemotherapy treatment uses drugs to kill cancer cells. Chemotherapy drugs travel throughout your body to kill cancer cells that may have migrated from the original tumor. Dr. Gholami might recommend chemotherapy after surgery. Chemotherapy may be used before or after lymph node removal. Side effects of chemotherapy depend on the drugs being used. Ask Dr. Gholami what to expect. Common side effects include fatigue, nausea, hair loss, infertility and an increased risk of infection. There are medications and treatments available that reduce some of the side effects of chemotherapy.

Follow-up
Dr. Gholami will continue to monitor you to check for signs that your cancer has returned every few months for the first few years, and then less frequently after that. At these follow-up visits, you’ll undergo blood tests (metabolic panel with AFP, LDH, and bHCG), a chest X-ray, and CT scan of the abdomen/pelvis.

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