Testicular Cancer

GENERAL INFORMATION:

What is it? Testicular (tes-TIK-u-lar) cancer is cancer of the testicles (TES-ti-kls), or testes (TES-tis). The testicles are the egg-shaped glands inside the scrotum (sack of skin hanging behind the penis). Testicles make sperm and hormones. Hormones are special chemicals that control how different parts of your body work. Hormones cause a man's sexual organs to develop. They give a man his body and facial hair, low voice, and broad shoulders. Testicular cancer occurs most commonly in men age 15 to 39 years. It can also happen to men at any other age. The chances for curing this cancer are good if it is found and treated early.

How does testicular cancer form? Testicular cancer starts as a tumor (lump). Normal cells divide (split) in a planned way, making more cells only when needed. Cancer happens when cells grow and divide without control or order, often making too much tissue (tumor). Testicular cancer may grow into nearby healthy tissue. The cancer cells may break away from the tumor and spread. These cells may travel to other parts of the body through the blood stream or lymphatic (lim-FAT-ik) system. The lymphatic system acts like a filter to catch germs and to get rid of waste in your body.

Who is at high risk for getting testicular cancer? There is no known cause of testicular cancer, but there are risk factors. You have a greater chance of getting testicular cancer if you have any of the following risk factors:

• You had undescended (un-de-SEN-ded) testicles when you were born. You were born with one or both testicles in your abdomen (belly) instead of your scrotum.
  
  
• You are a Caucasian (white) man.
  
  
• You have Klinefelter's (KLEYEN-fel-terz) syndrome or another condition where your testicles are not normally formed.
  
  
• You have a father or brother who has had testicular cancer.
  
  
• You have had testicular cancer in the past.

What are the signs and symptoms? Testicular cancer can cause many signs and symptoms. These signs and symptoms may also be caused by other medical conditions. Call your caregiver if you have one or more of the following signs and symptoms:

• A painless lump in either testicle.
  
  
• Either testicle becomes larger or smaller than before.
  
  
• A feeling of heaviness in the scrotum. A change in how your testicle feels.
  
  
• A dull ache in the lower abdomen (belly) or in the groin. The groin is the area where your leg and abdomen meet.
  
  
• Fluid suddenly collects in the scrotum.
  
  
• Pain or discomfort in your testicle or scrotum.
  
  
• Your breasts become swollen or start to hurt.

How is testicular cancer diagnosed?

• Your caregiver will do a medical exam. He may dim the lights in the room and shine a penlight (tiny flashlight) on your scrotum. This may help the caregiver see a lump in or on your testicles. Your caregiver may tell you to go to a urologist (u-ROL-ah-jist) or other special caregivers. These special caregivers can do more exams and tests, and may treat you if you have testicular cancer.
  
  
• Tests: You may need an ultrasound. This test uses sound waves to find lumps and other changes in your testicles and scrotum. This is usually the first test that is done to look for testicular cancer. You may need tests to learn if the cancer has spread to other areas of your body. These may include blood tests and chest x-rays. These may include computerized axial tomography (TOH-moh-graf-ee) (CT scan) or positron emission (ee-MISH-un) tomography (PET scan). These may include lymphangiography (lim-fan-jee-OG-rah-fee). During these tests, caregivers put dye into your body and take x-rays to look for cancer.
  
  
• Surgery: A radical inguinal (ING-gwi-nal) orchiectomy (ohr-kee-EK-toh-mee) is a surgery done to remove the testicle that has cancer in it. Tissue from the testicle is tested to learn what type of cancer cells were growing in your testicle. If you have lymph nodes that have cancer in them, they may be removed also. Lymph nodes are found throughout your body, and also near your testicles.

How do caregivers plan my treatment? Caregivers will plan your treatment based on the following factors:

• The stage of your testicular cancer. Your cancer may be ranked as stage one, two, or three. These stages describe whether the cancer has stayed in the testicle or if it has spread.
  
  
• The type of cancer cells that developed. Most testicular cancer starts in the sperm-making cells of the testicles. These cells are called "germ cells". The two types of germ cell cancer are called seminoma (sem-ih-NO-mah) and nonseminoma (non-sem-ih-NO-mah). There are other types of testicular cancer, but they are much less common.
  
  
• The size of your tumor.
  
  
• If the cancer has spread into your lymphatic system (lymph nodes).

How is testicular cancer treated? There are many ways to treat testicular cancer. The testicle with cancer will need to be surgically removed. You may need more surgery to remove cancer if it has spread. You may also need radiation (ray-dee-AY-shun) or chemotherapy (kee-moh-THER-ah-pee) medicines. Often two or more kinds of treatment will be used together.

• Radiation: This treatment uses a high dose (large amount) of x-rays to kill your cancer cells. You may have external (outside the body) or internal (inside the body) radiation. External radiation uses an x-ray machine to beam x-rays directly at your tumor. Internal radiation is done in a different way. Your caregiver will plant (put) and leave a radioactive (x-ray) substance inside your body. The caregiver will use a wire, needle, "seed", or catheter (tube) filled with the radioactive substance. The caregiver will put the wire, needle, seed, or catheter next to or inside your tumor.
  
  
• Chemotherapy: This is medicine used to treat cancer. It is sometimes called "chemo". Chemo may kill or help stop the cancer cells from growing. It may help shrink lymph nodes that have cancer in them.

How will testicular cancer affect my sex life? Men often worry that having one testicle removed will make them impotent (unable to have sex). They may also worry that they will be sterile or infertile (unable to make babies). A man with one normal healthy testicle can still have sex and make sperm. However, surgeries and treatments such as radiation and chemo can affect these abilities. Ask your caregiver how your sexual ability may be affected before you have any surgery or treatment. Some men have their sperm removed and frozen so that they can make a woman pregnant later. An artificial testicle called a prosthesis (pros-THEE-sis) can be put in your scrotum after the cancer is treated.

How should I do a testicular self-examination?

• Sometimes, testicular cancer is found by a caregiver during a physical exam. Other times, testicular cancer is found by men themselves. Checking your testicles for lumps and other changes is called a testicular self-examination (TSE). Doing regular TSE can help you learn how your testicles normally look and feel. Then if you have lumps or changes, you may find them and tell your caregiver right away. Talk to your caregiver and decide when and how often you should do TSE. Ask your caregiver to teach you how to do a TSE if you are not sure that you are doing it correctly.
  
  
• You may start checking your testicles regularly after you have gone through puberty. Puberty is the change that a boy goes through to become a man. During this time, a man gets broad shoulders, a low voice, and body and facial hair. An easy way to remember to do TSE is to do the exam on the same day of each month.
  
  
  • The best time to do a TSE is after a warm shower or bath. This is the time when your scrotum is most relaxed.
    
    
  • Look: Stand in front of a mirror and look at your scrotum. Look for changes in its shape, size, and color. It may be normal for one side of your scrotum to be larger or to hang lower than the other.
    
    
  • Feel: Examine one testicle at a time. Put the thumbs of both hands in front of the testicle. Put the second (pointer) fingers behind the testicle. Gently roll each testicle between the thumbs and fingers of both hands. Feel for any lumps or changes in the testicle. Feel all parts of the scrotum and testicle. It may be normal for one of your testicles to feel slightly larger than the other.
    
    
  • Using your fingers, try to find the epididymis (ep-i-DID-i-mis). This is a long, cord-like tube on top and in back of each testicle. The epididymis holds and carries sperm from the testicle to the end of the penis. It is important that you know what the epididymis feels like. This way you will know what is normal and what is not.
    
    
  • Call your caregiver if you find a lump or other changes in your testicles. Also, make sure your caregiver checks your testicles whenever you have regular physical exams.

How can I get more information about testicular cancer? Accepting that you have testicular cancer is hard. You and those close to you may feel scared, depressed, angry, or sad. These are normal feelings. Talk to your caregivers, family, or friends about your feelings. You may also want to join a cancer support group. This is a group of people who also have cancer. Contact the following organizations for more information about testicular cancer and support groups:

• American Cancer Society
  Phone: 1-800-227-2345
  Web Address: http://www.cancer.org
  

• Cancer Information Service
  Cancer Information Service
  Phone: 1-800-422-6237
  Web Address: http://www.nci.nih.gov
  

• The Testicular Cancer Resource Center
  Web Address: http://tcrc.acor.org
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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