What Are the Types of Testicular Cancer?

About 90% of all testicular cancer arises from germ cells in your testicles that clump together to form a mass or tumor. Germ cells eventually develop into sperm. Two types of testicular cancer arise from germ cells:

• Seminoma: Slow-growing cancer that primarily affects people in their 40s or 50s.

• Non-seminoma: Cancer that grows more rapidly than seminomas. It mainly affects people in their late teens, 20s and early 30s. There are four types of non-seminoma tumors. Each is named after the type of germ cell that makes up the tumor. Non-seminoma tumors include embryonal carcinoma, yolk sac carcinoma, choriocarcinoma and teratoma.

Some testicular cancer tumors consist of both seminoma and non-seminoma cells.

How Common Is Testicular Cancer?

Testicular cancer is rare, affecting only about 1 in 250 people with testicles in their lifetimes. Still, it’s the most common cancer among people assigned male at birth aged 15 to 35.

Diagnosis and Tests

How Is Testicular Cancer Diagnosed?

Your provider may diagnose testicular cancer after investigating a lump or other change in your testicle you found during a self-exam. Sometimes testicular cancer gets diagnosed during a routine physical exam.

Common procedures and tests to help diagnose testicular cancer include:

• A physical exam and history: Your provider will ask about your symptoms and examine you closely to check for signs of testicular cancer. They may feel your testicles for lumps and inspect your lymph nodes for signs of cancer spread.

• Ultrasound: If your provider notices an abnormality during the exam, they’ll likely order an ultrasound. An ultrasound is a painless medical procedure that uses high-energy sound waves to create pictures of tissue inside your body.

• Inguinal orchiectomy and biopsy: If the ultrasound shows evidence of cancer, your provider will remove the affected testicle through an incision (cut) in your groin. A specialist will examine tissue from your testicle using a microscope to check for cancer cells.

Other tests may include:

• A serum tumor marker test: This procedure examines a blood sample to measure the amounts of certain substances linked to specific types of cancers. These substances are called tumor markers. The tumor markers that are often elevated in testicular cancer are alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG or beta-HCG) and lactate dehydrogenase (LDH). Different types of tumors elevate different markers. For example, seminomas sometimes raise HCG but not AFP. Non-seminomas may raise AFP but not HCG. Elevated LDH levels may indicate cancer spread.

• CT scans, X-rays and MRIs: A CT scan (or CAT scan) uses X-rays to form pictures of the inside of your body. Your provider may perform a CT scan of your abdomen and pelvis to see if your cancer’s spread to your abdominal organs. They may order a CT scan or standard X-ray to see if cancer’s spread to your lungs. If your provider suspects cancer has spread to your central nervous system (brain and spinal cord), you may get an MRI. An MRI uses magnets and radio waves to form pictures of the inside of your body.

What Are the Stages of Testicular Cancer?

Diagnosis also involves cancer staging. Staging provides important information that will guide treatment decisions, such as tumor size and whether the cancer’s spread.

• Stage 0: Abnormal cells have developed but are still inside the testicles where sperm cells start to develop. Stage 0 is also called germ cell neoplasia in situ (GCNIS).

• Stage I: Cancer is confined to the testicle, which may include nearby blood or lymph vessels. Tumor markers may or may not be elevated.

• Stage II: Cancer has spread to the lymph nodes in the back of your abdomen (also called the retroperitoneum) but not anywhere else. If you have cancer in your lymph nodes along with moderately or highly elevated tumor markers, then you’re in stage III rather than stage II.

• Stage III: Cancer has spread to lymph nodes beyond your abdomen or to an organ.

Management and Treatment

What Are the Treatments for Testicular Cancer?

Treatment depends on several factors, including your health, treatment preferences, cancer stage, and tumor type. Seminomas tend to grow more slowly and respond better to radiation therapy than non-seminomas. Both kinds of testicular cancer tumors respond well to chemotherapy treatments.

If testicular cancer involves both seminoma and non-seminoma tumors, your provider will treat it as a non-seminoma.

• Surgery: Surgery to remove the cancerous testicle is the most common treatment for testicular cancer, regardless of cancer stage or tumor type. In some cases, your provider may also remove your lymph nodes.

• Radical inguinal orchiectomy: Your provider may perform orchiectomy (removing the testicle) to treat both seminoma and non-seminoma testicular cancers. During the procedure, your provider will make an incision into your groin to remove the testicle with the tumor. They’ll also close off blood vessels and lymphatic tissue to prevent the spread of cancer from the tumor site to the rest of your body.

• Retroperitoneal lymph node dissection (RPLND): Your provider may perform retroperitoneal lymph node dissection depending on your cancer’s stage and the tumor type. RPLND is more common with non-seminoma testicular cancers. During the procedure, your provider makes an incision into your abdomen and removes the lymph nodes behind your abdominal organs. RPLND may be used to treat cancer and may also be used for cancer staging.

Your provider may also perform surgery to remove tumors that have spread to your lungs or liver.

• Radiation therapy: Radiation therapy uses high-dose X-rays to kill cancer cells. Radiation might be used after surgery to prevent the tumor from returning. Usually, radiation is limited to the treatment of seminomas.

• Chemotherapy: Chemotherapy uses drugs such as cisplatin, bleomycin, and etoposide to kill cancer cells. Chemotherapy has improved the survival rate for people with both seminomas and non-seminomas. Depending on your cancer, you may receive chemotherapy instead of surgery. It may be used before an RPLND procedure or after a radical inguinal orchiectomy. Chemotherapy may also be used to treat cancer that’s returned (recurred) following remission.

Living With

How Do I Take Care of Myself?

Many people wonder how having a testicle removed will impact their sex drive and fertility. One testicle is usually all you need to make enough testosterone to keep your hormone levels healthy and maintain your sex drive. You should still be able to get an erection and ejaculate.

In some instances, people with lymph nodes removed can get an erection but may have difficulty ejaculating.

Talk to your provider about any risks related to treatment. If you’re concerned about your fertility, sperm banking, or freezing your sperm for later, use may be an option.