What is testicular cancer?
Testicular cancer typically develops in one or both testicles in young men. It is a highly treatable and usually curable type of cancer.
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 make the male hormone testosterone. They also produce sperm. Sperm cells are carried from the testicle through the vas deferens to the seminal vesicles, where they are mixed with a fluid produced by the prostate gland. During ejaculation, sperm cells, seminal vesicle fluid, and prostatic fluid enter 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, and each may develop into one or more types of cancer. It is important to distinguish these types of cancers from one another because they differ in the ways 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 produce sperm. There are 2 main types of germ cell tumors (GCTs) in men: seminomas and non-seminomas. These 2 types occur about equally. Seminoma and non-seminoma cells look very different when seen under a microscope.
Some cancers contain both non-seminoma and seminoma cells. These are treated as non-seminomas because they grow and spread like non-seminomas.
Seminomas develop from the sperm-producing germ cells of the testicle. 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 typical. These usually occur in men when they are 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 for response to therapy.
This type of germ cell tumor usually occurs 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 mixed with at least 2 different types, but this does not change treatment. All non-seminoma germ cell cancers are treated the same way.
Embryonal carcinomas: 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 carcinomas: These 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.
Yolk sac carcinoma is the most common form of testicular cancer in children. When they occur in children, these tumors usually are treated successfully. But when yolk sac tumors develop in adults, they are of more concern, especially if they are "pure" (that is, the tumor does not contain other types of non-seminoma cells). Yolk sac carcinomas respond very well to chemotherapy, even if they have spread. This type of tumor almost always increases blood levels of AFP.
Choriocarcinomas: This is a very rare and aggressive type of testicular cancer that occurs in adults. These cancers are likely to spread rapidly to distant organs of the body, including the lungs, bone, and brain. Pure choriocarcinoma does not often occur in the testicles. More often, choriocarcinoma cells are present with other types of non-seminoma cells in a mixed germ cell tumor. This type of tumor increases blood levels of HCG.
Teratomas: Teratomas are germ cell tumors with areas that, when seen under the microscope, look like each of the 3 layers of a developing embryo: the endoderm (innermost layer), mesoderm (middle layer), and ectoderm (outer layer). The 3 main types of these tumors are the mature teratoma, immature teratoma, and teratoma with malignant transformation. Pure teratomas do not increase AFP or HCG levels.
Mature teratomas are tumors formed by cells similar to cells of adult tissues. They are generally benign and rarely spread to nearby tissues and distant parts of the body. They can usually be cured with surgery.
Sometimes deposits of mature teratoma are found after chemotherapy to treat a non-seminomatous mixed germ cell tumor is finished. These may be the part of a tumor that was left behind after chemotherapy has killed the other components of the tumors. Some experts believe that chemotherapy can change other types of non-seminoma into teratoma.
Immature teratomas are less well-developed cancers with cells that look like those of an early embryo. Unlike mature teratomas, this type is more likely to grow into (invade) surrounding tissues and to spread (metastasize) outside the testicle. It can also sometimes recur (come back) years after treatment.
Teratoma with malignant transformation 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 develops outside of the testicle, in tissues such as muscles, glands of the lungs or intestines, or the brain.
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. Carcinoma in situ may not always progress to invasive cancer. Researchers have estimated that it can take about 5 years for CIS to progress to the invasive form of germ cell cancer.
It is hard to find CIS before it develops into invasive cancer because it generally causes no symptoms and often does not form a lump that you or the doctor can feel. The only way to diagnose testicular carcinoma in situ 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 this country 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 (where sperm cells are formed) 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 that fight infection) through lymphatic channels (fluid-filled vessels that connect the series of lymph nodes), or through the blood circulation 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 generally benign tumors develop from the Leydig cells in the testicle that normally produce male sex hormones (androgens like testosterone). Leydig cell tumors can develop in both adults (75% of cases) and children (25% of cases). They often produce androgens but sometimes produce estrogens (female sex hormones).
Most Leydig cell tumors do not spread beyond the testicle and are cured with surgery. But sometimes these tumors do spread to other parts of the body. If they do metastasize, Leydig cell tumors have a poor prognosis 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-producing germ cells. Like the Leydig cell tumors, they 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. Lymphoma is the most common secondary testicular cancer. Testicular lymphoma is more common than primary testicular tumors in men older than 50. Their prognosis 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.
Cancers of the prostate, lung, skin (melanoma), kidney, and other organs also can spread to the testicles. The prognosis for these cancers is usually poor because these cancers generally spread widely to other organs as well. Treatment depends on the specific type of cancer.
Last Medical Review: 05/04/2012
Last Revised: 01/17/2013