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Testicular cancer is an uncommon type of cancer that typically affects young men. Testicular cancer occurs when cells in the testicles start growing uncontrollably and form tumors. Because the testicles house several different types of cells, there are multiple forms of testicular cancer. The specific type of testicular cancer you’re diagnosed with will affect your treatment options.
Although testicular cancer is often diagnosed at an early stage, recurrences are not uncommon. That is why it is important to commit to follow-up testing, sometimes even years after an initial diagnosis.
Quite a bit of research has been devoted to this topic but, as of right now, we're not entirely sure what causes testicular cancer. What we do know is that most testicular cancer begins in the germ cells and that testicular cancer is linked to a number of other conditions.
Scientists are studying DNA to better understand how chromosome changes and certain genes may lead to testicular cancer.
There are several risk factors related to testicular cancer.
Age. Testicular cancer can affect men of any age but more than half of men with testicular cancer are diagnosed between the ages of 20 and 34.
Race. Caucasians are four to five times more likely to develop testicular cancer than African-American or Asian-American men. Slightly lower rates of testicular cancer are documented in Native Americans, although the reasoning behind this is unknown.
Genetics. Men who have fathers or brothers with testicular cancer may be more likely to develop it themselves. However, the family history of most men diagnosed with testicular cancer does not include the disease.
Undescended Testicles. Cryptorchidism, also known as undescended testicles, significantly increases the risk of developing testicular cancer. This condition affects approximately 3% of males in utero.
Some studies have indicated that those who live with human immunodeficiency virus (HIV), particularly AIDS, have a higher risk of developing testicular cancer.
Luckily, most testicular cancers can be diagnosed early through regular self-exams before they've spread to other parts of the body. Although some testicular cancers don't cause symptoms until they reach late stages, in most cases swelling and lumps in the testes are the first obvious signs.
While some doctors recommend men self-examine their testicles on a monthly basis, the American Cancer Society does not have a recommendation regarding routine self-examinations. They do, however, advise men to familiarize themselves with potential symptoms of testicular cancer and see a doctor immediately if they detect a lump.
Once a diagnosis takes place, doctors will work to determine if the cancer has spread and how far using a process known as staging. During the staging process, they'll quantify the amount of cancer present and calculate its severity as well as how to best approach treatment. Doctors determine the stage using the results of exams, blood tests, and various imaging tests.
The stages of testicular cancer are graded using the TNM staging system. When diagnosing testicular cancer, an additional category is added.
Tumor (T): How big is the tumor and where is it located? Nodes (N): Has the tumor spread to the lymph nodes? If so, in what part of the body and how many? Metastasis (M): Has the cancer metastasized? If so, in what part of the body and how much? Serum (S): Are the blood marker levels higher than usual? If so, how high are they?
From there, the cancer will be graded on a scale of 0 to IV with 0 being the least advanced and IV being the most advanced.
The staging system for testicular cancer is complicated but your team at BIDMC will go over it with you in more detail to ensure you're able to make informed decisions regarding your treatment.
Depending on the treatment, patients may or may not have any issues. If the cancer was low stage then you will feel similar to before treatment. If you require advanced surgery such as an RPLND, you can suffer from reduced or absent ejaculation. Some form of chemotherapy also can result in quality of life changes including fatigue, infections, neuropathy (nerve pains) and fertility issues.
Another common concern is whether treatment can cause infertility. Treatment for testicular cancer, including both chemotherapy and RPLND surgery, as well as the cancer itself, can cause infertility which is why some men opt to utilize sperm banks prior to receiving treatment. Boys who develop testicular cancer early may run into fertility issues later in life.
If you have concerns about infertility, you should discuss them with your doctor prior to starting treatment.
If it recurs, testicular cancer typically does so within the first two years following treatment.
Common treatments for recurrent testicular cancer usually include high-dose chemotherapy, surgery, stem cell transplants, or a combination of treatments. You might also be referred to a clinical trial to learn about whether you'd be a good candidate to try a new treatment.