Testicular Cancer

Significance

Incidence and Mortality

It is projected that 7,600 new cases of testicular cancer will be diagnosed and 400 men will die of the disease in the United States in 2003.
Testicular cancer accounts for approximately 1% of all cancers in men. Despite a slow increase in observed incidence, there has been a dramatic decrease in the mortality as a result of effective treatments.
Germ cell tumors (GCT) of the testis constitute 94% of testicular tumors and include 5 basic cell types: seminoma, embryonal carcinoma, yolk sac tumor, teratoma, and choriocarcinoma. Sixty percent of GCT are seminomas; the remainder are nonseminomatous germ cell tumors (NSGCT). Almost half of all germ cell tumors contain more than 1 of the 5 cell types.

Risk Factors

Unlike most other cancers, this disease is generally found in young men. In white men, it is the most common cancer between 20 and 34 years of age, the second most common from 35 to 39 years of age, and the third most common from 15 to 19 years of age.
This type of cancer is 4.5 times more common among white men than black men, with intermediate incidence rates for Hispanics, American Indians, and Asians. Males with cryptorchidism have 3 to 17 times the average risk. There is also an increased risk in males with gonadal dysgenesis and Klinefelter�s syndrome. Men with a family history of testicular cancer may be at a higher risk of this disease.
A history of testicular cancer is associated with a higher risk of a contralateral tumor. Although not consistently found to confer a higher risk, infertility or abnormal semen parameters have been associated with a higher risk of testis cancer in some studies.
An additional risk factor for the development of testicular cancer is the presence of carcinoma in situ (CIS). Carcinoma in situ, if encountered in the contralateral testis, is associated with the development of contralateral testicular cancer in 50% of patients at 5 years of follow up. Carcinoma in situ will be found in approximately 5% of contralateral testes (approximately the same rate as cryptorchid testes). If diagnosed, CIS is usually treated with low-dose radiation therapy that usually preserves Leydig cell function and prevents germ cell tumor development.
Approximately 60% of testicular cancers are localized, 24% regional, and 14% distant stage at diagnosis. Most testicular cancers are discovered by patients themselves or their partners, either unintentionally or by self-examination.
Although there has been no appreciable change in the stage distribution at diagnosis, advances in treatment have been associated with a 60% decrease in mortality. Testicular cancer is so curable even at advanced stages, and there are so few cases, that it would be virtually impossible to document a decrease in mortality associated with screening.

What Are the Symptoms of Testicular Cancer?

The earliest warning signs of testicular cancer usually include:

A change in size or shape of a testicle.
Swelling or thickening of a testicle.
A firm, smooth, initially painless, slow-growing lump in a testicle.
A feeling of testicular heaviness.

Other symptoms of testicular cancer may include:

Testicular pain.
Urinary problems.
A sudden gathering of fluid in the scrotum.
An abdominal mass or abdominal pain.
Loss of weight or appetite; fatigue; lower-back pain; tenderness in the nipples or breast enlargement.
Very rarely, infertility.

Call Your Doctor If:

You detect any sort of unusual lump or swelling in the scrotum. You should have a thorough physical examination as soon as possible in case the abnormality is cancer. Remember, testicular cancer discovered early has the highest likelihood of a cure.

Sources: Healthwise and Web MD