Testicular Cancer: Who Gets It?

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There are two main types of testicular cancer:  seminomas, usually found in men between the ages of thirty and fifty, and non-seminoma cancers, which tend to develop earlier, usually in men in their twenties.  Seminomas grow more slowly than non-seminomas and usually don’t spread.  So a seminoma case generally has a better prognosis, although both types are quite curable.

White American men have four times the risk of African-American men.  A brother with the disease is also an indicator of risk.  But the main risk factor for testicular cancer is a condition called cryptorchidism, or undescended testicles, which occurs in about 3 percent of boys at birth.  About 14 percent of testicular cancers occur in men with a history of this disorder.

The symptoms include a painful lump on a testicle, or testicular swelling.  Men may also experience a sensation of heaviness or aching in the lower abdomen or scrotum.  In rare cases, they may experience breast tenderness or enlargement.  Lower back pain is common in late-stage cases.  However, some men with testicular cancer have no symptoms at all, and are diagnosed during checkups.

If a man comes to the doctor with a lump, the doctor will first rule out bacterial infection.  Other disorders, such as cysts, are rare, so most lumps in the testicles are cancerous.  Blood tests can often detect tumor-marker proteins that may be present in abnormal amounts.  To make a definitive diagnosis, the affected testicle is removed – a procedure called inguinal orchiectomy—in order to obtain a tissue sample.  A surgeon won’t remove just part of the testicle because cancer cells could be released into the surrounding tissue.

To determine if the cancer has spread, most patients will have an ultrasound screening and CAT scan of various sections of the body.  “But this can be a fast-growing cancer and can escalate in a few months,” says George J. Bosl, M.D., from the department of medicine at Memorial Sloan-Kettering.  “If you feel a lump, don’t wait around—get to the doctor fast.”

Both types of testicular cancer are 90 percent curable if detected early enough.  In such cases, non-seminomas can be treated with surgery, which usually entails the removal of the testicle and some of the lymph nodes in the abdomen.  Early-stage seminoma tumors normally require surgical removal of the testes along with external beam radiation to the lymph nodes of the abdomen. With either type, if the cancer has spread, chemotherapy is generally used.