What is testicular cancer?
Testicular cancer starts in the testicles. It typically develops in one or both testicles in young men, although it can occur at any age. It is a highly treatable and usually curable type of cancer.
To understand testicular cancer, it helps to know about the normal structure and function of the testicles.
The testicles (also called the testes; a single testicle is called a testis) are part of the male reproductive system. These 2 organs are each normally somewhat smaller than a golf ball in adult males and are contained within a sac of skin called the scrotum. The scrotum hangs beneath the base of the penis.
The testicles have 2 main functions:
- They make male hormones (androgens) such as testosterone.
- They make sperm, the male cells needed to fertilize a female egg cell to start a pregnancy.
Sperm cells are made in long, thread-like tubes inside the testicles called seminiferous tubules. They are then stored in the epididymis, a small coiled tube behind each testicle, where they mature.
During ejaculation, the sperm cells are carried from the epididymis through the vas deferens to the seminal vesicles, where they mix with fluids made by the vesicles, the prostate gland, and other glands to form semen. This fluid then enters the urethra, the tube in the center of the penis through which both urine and semen leave the body.
The testicles are made up of several types of cells, each of which can develop into one or more types of cancer. It is important to distinguish these types of cancers from one another because they differ in how they are treated and in their prognosis (outlook).
Germ cell tumors
More than 90% of cancers of the testicle develop in special cells known as germ cells. These are the cells that make sperm. There are 2 main types of germ cell tumors (GCTs) in men:
Seminoma and non-seminoma cells look very different under a microscope.
These 2 types occur about equally. Many testicular cancers contain both seminoma and non-seminoma cells. These mixed germ cell tumors are treated as non-seminomas because they grow and spread like non-seminomas.
Seminomas tend to grow and spread more slowly than non-seminomas. The 2 main subtypes of these tumors are classical (or typical) seminomas and spermatocytic seminomas. Doctors can tell them apart by how they look under the microscope.
Classical seminoma: More than 95% of seminomas are classical. These usually occur in men between 25 and 45.
Spermatocytic seminoma: This rare type of seminoma tends to occur in older men. The average age of men diagnosed with spermatocytic seminoma is about 65. Spermatocytic tumors tend to grow more slowly and are less likely to spread to other parts of the body than classical seminomas.
Some seminomas can increase blood levels of a protein called human chorionic gonadotropin (HCG). HCG can be detected by a simple blood test and is considered a tumor marker for certain types of testicular cancer. It can be used for diagnosis and to check how the patient is responding to treatment.
These types of germ cell tumors usually occur in men between their late teens and early 30s. There are 4 main types of non-seminoma tumors:
- Embryonal carcinoma
- Yolk sac carcinoma
Most tumors are a mix of 2 or more different types (sometimes with a seminoma component as well), but this does not change treatment. All non-seminoma cancers are treated the same way.
Embryonal carcinoma: This type of non-seminoma is present to some degree in about 40% of testicular tumors, but pure embryonal carcinomas occur only 3% to 4% of the time. When seen under a microscope, these tumors can look like tissues of very early embryos. This type of non-seminoma tends to grow rapidly and spread outside the testicle.
Embryonal carcinoma can increase blood levels of a tumor marker protein called alpha-fetoprotein (AFP), as well as HCG.
Yolk sac carcinoma: These tumors are so named because their cells look like the yolk sac of an early human embryo. Other names for this cancer include yolk sac tumor, endodermal sinus tumor, infantile embryonal carcinoma, or orchidoblastoma.
This is the most common form of testicular cancer in children (especially in infants), but pure yolk sac carcinomas (tumors that do not contain other types of non-seminoma cells) are rare in adults. When they occur in children, these tumors usually are treated successfully. But they are of more concern when they occur in adults, especially if they are pure. Yolk sac carcinomas respond very well to chemotherapy, even if they have spread.
This type of tumor almost always increases blood levels of AFP.
Choriocarcinoma: This is a very rare and aggressive type of testicular cancer in adults. Pure choriocarcinoma is likely to spread rapidly to distant organs of the body, including the lungs, bones, and brain. More often, choriocarcinoma cells are present with other types of non-seminoma cells in a mixed germ cell tumor. These mixed tumors tend to have a better outlook than pure choriocarcinomas.
This type of tumor increases blood levels of HCG.
Teratoma: Teratomas are germ cell tumors with areas that, under a microscope, look like each of the 3 layers of a developing embryo: the endoderm (innermost layer), mesoderm (middle layer), and ectoderm (outer layer).
Pure teratomas of the testicles are rare and do not increase AFP or HCG levels. More often, teratomas are seen as parts of mixed germ cell tumors.
There are 3 main types of teratomas:
Mature teratomas are tumors formed by cells similar to cells of adult tissues. They rarely spread to nearby tissues and distant parts of the body. They can usually be cured with surgery, but some come back (recur) after treatment.
Immature teratomas are less well-developed cancers with cells that look like those of an early embryo. This type is more likely than a mature teratoma to grow into (invade) surrounding tissues, to spread (metastasize) outside the testicle, and to come back (recur) years after treatment.
Teratoma with somatic type malignancy is a very rare cancer. These cancers have some areas that look like mature teratomas but have other areas where the cells have become a type of cancer that normally develops outside the testicle (such as a sarcoma, adenocarcinoma, or even leukemia).
Carcinoma in situ
Testicular germ cell cancers may begin as a non-invasive form of the disease called carcinoma in situ (CIS) or intratubular germ cell neoplasia. In CIS, the cells look abnormal under the microscope, but they have not yet spread outside of the walls of the seminiferous tubules (where sperm cells are formed). Carcinoma in situ may not always progress to invasive cancer.
It is hard to find CIS before it develops into invasive cancer because it generally does not cause symptoms and often does not form a lump that you or the doctor can feel. The only way to diagnose testicular CIS is to have a biopsy (a procedure that removes a tissue sample and looks at it under a microscope). Some cases are found incidentally (by accident) in men who have a testicular biopsy for some other reason, such as infertility.
Experts don’t agree about the best treatment for CIS. Since CIS doesn’t always become an invasive cancer, many doctors in the United States consider observation (watchful waiting) to be the best treatment option.
When a testicular tumor like CIS becomes invasive, its cells are no longer just in the seminiferous tubules but have grown into other structures of the testicle. These cancer cells can then spread either to the lymph nodes (small, bean-shaped collections of white blood cells) through lymphatic channels (fluid-filled vessels that connect the lymph nodes), or through the blood to other parts of the body.
Tumors can also develop in the supportive and hormone-producing tissues, or stroma, of the testicles. These tumors are known as gonadal stromal tumors. They make up less than 5% of adult testicular tumors but up to 20% of childhood testicular tumors. The 2 main types are Leydig cell tumors and Sertoli cell tumors.
Leydig cell tumors
These tumors develop from the Leydig cells in the testicle that normally make male sex hormones (androgens like testosterone). Leydig cell tumors can develop in both adults and children. They often make androgens but sometimes produce estrogens (female sex hormones).
Most Leydig cell tumors are benign – they do not spread beyond the testicle and are cured with surgery. But the small portion of Leydig cell tumors that have spread to other parts of the body tend to have a poor outlook because they usually do not respond well to chemotherapy or radiation therapy.
Sertoli cell tumors
These tumors develop from normal Sertoli cells, which support and nourish the sperm-making germ cells. Like the Leydig cell tumors, these tumors are usually benign. But if they spread, they usually don’t respond to chemotherapy and radiation therapy.
Secondary testicular tumors
Secondary testicular tumors start in another organ and then spread to the testicle. These are not true testicular cancers – they are named and treated based on where they started.
Lymphoma is the most common secondary testicular cancer. Testicular lymphoma occurs more often than primary testicular tumors in men older than 50. The outlook depends on the type and stage of lymphoma. The usual treatment is surgical removal, followed by radiation and/or chemotherapy.
In boys with acute leukemia, the leukemia cells can sometimes form a tumor in the testicle. Along with chemotherapy to treat the leukemia, this might require treatment with radiation or surgery to remove the testicle.
Cancers of the prostate, lung, skin (melanoma), kidney, and other organs also can spread to the testicles. The prognosis for these cancers tends to be poor because these cancers have usually spread widely to other organs as well. Treatment depends on the specific type of cancer.
Last Medical Review: 11/01/2013
Last Revised: 02/11/2014