American Medical Association Family Medical Guide - American Medical Association [548]
Symptoms
In some men, testicular cancer causes no symptoms. However, in most cases, there is a lump or swelling in a testicle. Other possible symptoms include enlargement of a testicle, a feeling of heaviness in the scrotum, a sudden collection of fluid in the scrotum, or enlargement or tenderness of the breasts. Although testicular cancer usually does not cause pain, some men may experience soreness or discomfort in a testicle or in the scrotum or a dull ache in the back, lower abdomen, or groin. If you have any of these symptoms, see your doctor right away. Although not all lumps are cancerous, any lump in a testicle must be evaluated by a doctor to rule out cancer.
Diagnosis
Most testicular cancers are detected by men themselves, either by chance or while performing a testicle self-examination (see page 139). If your doctor suspects that you may have cancer of the testicle, he or she will perform a complete physical examination, including a careful examination of the testicles. The doctor will also order blood and urine tests to rule out other possible causes of your symptoms, such as an infection. If the examination and tests do not detect an infection or other disorder, the doctor will order additional tests to detect or rule out testicular cancer. You will probably have an ultrasound scan (see page 111) of the testicles, which uses high-frequency sound waves to create images of the testicles.
The only sure way to determine if a testicular tumor is cancerous is for the doctor to perform a biopsy to examine cells in the testicle for cancer. For this biopsy, the entire affected testicle is removed through a small incision in the groin in a surgical procedure called a radical inguinal orchiectomy. Removing just a portion of the testicle is usually not an option because cutting through the outer layer of the testicle can cause any cancer to spread. Removing the testicle also helps prevent the cancer from spreading to other parts of the body. Removal of one testicle usually does not interfere with a man’s fertility or ability to have an erection.
Cancer staging
Once cancer has been diagnosed, a doctor determines how far the cancer has spread by performing tests—such as blood tests, imaging tests, and biopsies—to categorize, or stage, the disease. Staging helps a doctor determine the most appropriate treatment for each case. The three stages of testicular cancer are:
• Stage I—the cancer has not spread beyond the testicle
• Stage II—the cancer has spread to lymph nodes in the back of the abdomen
• Stage III—the cancer has spread beyond the lymph nodes to sites away from the abdomen
The doctor uses blood tests to check for tumor-associated markers, which are substances that are often present in abnormal amounts in people who have cancer. By comparing the levels of these markers before and after surgery, the doctor can determine if a cancer has spread beyond the testicles. Measuring marker levels before and after a person undergoes chemotherapy (see page 23) helps determine how well the chemotherapy is working.
Treatment
Treatment of testicular cancer depends on the type of tumor (seminoma or nonseminoma), how far the cancer has spread, and the person’s age and general health. Because seminomas tend to grow slowly and usually do not spread, they usually are diagnosed in stage I or II. If performed early enough, removal of the entire affected testicle may be the only treatment necessary for a seminoma. However, treatment for seminomas usually combines testicle removal, radiation therapy (see page 23), and chemotherapy. Surgical removal of lymph nodes usually is not necessary for men who have seminomas because this type of tumor responds well to radiation treatment. Doctors usually treat stage