Diagnosis & Treatment

Because testicular cancer tumors show up in a very consistent way, the diagnosis of this cancer also tends to be very accurate. Fortunately, it is almost always caught early — 75 percent of men diagnosed with testicular cancer for the first time are Stage 1, which means the cancer hasn’t spread beyond the testicle, and patients can expect successful treatment through surgery alone.

Confirming the cancer

Testicular cancer diagnosis is confirmed by physical exam and ultrasound and supplemented by blood tests that indicate tumor markers, though not all types of testicular cancer tumors produce blood markers. When there are unusual lumps in the testicle itself, they are generally cancerous.

Importance of treatment expertise at a high-volume center

Testicular cancer is rare, so most medical facilities see just one or two cases per year. Testicular cancer patients are best served by multidisciplinary centers like Virginia Mason that see 30 to 50 testicular cancer patients each year and have teams of highly-skilled specialists with the experience to customize treatment for each patient. Many of the national and international guidelines for treating testicular cancer come from the work of our experts, who also lead and participate in testicular cancer research studies.

Symptoms of testicular cancer

  • Enlargement of a testicle or a change in the way it feels
  • Lump or swelling in either testicle (note that a cancerous testicular cancer tumor may or may not cause pain)
  • Dull ache in the back or lower abdomen
  • Development of male breast tissue (this can be normal in adolescent males and not necessarily be a testicular cancer symptom)
  • Discomfort/pain or a feeling of heaviness in the scrotum

Stages of testicular cancer

  • Stage 1 — it has not spread beyond the testicle 
  • Stage 2 — it has spread to all or some of the lymph nodes in the back of the abdomen (retroperitoneum); stages 2A, 2B, and 2C are based on the size of the mass in the retroperitoneal lymph nodes
  • Stage 3 — the cancer has spread beyond the retroperitoneal lymph nodes; it could be as far as the liver or lungs

Testicular cancer treatment

Testicular cancer treatment depends on the type of tumor, the stage of the tumor, and if and where it has spread. Treatments consist of:

  • Surgical removal of the testicle
  • Abdominal surgery to remove lymph nodes if the cancer has spread there
  • Chemotherapy
  • Radiation

For later-stage testicular cancer, treatment will consist of some combination of these.

  • Stage 1 patients are almost always treated by removing the testicle through a surgical procedure (called an inguinal orchiectomy) in which an incision is made near the groin. (The procedure is not done through the scrotum.) Stage 1 patients are then put on a program of monitoring (called “surveillance”) that provides for regular checkups throughout the patient’s lifetime.

    Surveillance typically consists of:

         — First year – blood tests and chest X-rays each month; CT scans every three months
         — Second year – blood tests and chest X-rays every two months; CT scans every four months
         — For years 3 and 4, blood tests and chest X-rays every three to four months; plus for third year, CT scans every six months 
         — For years 5 and 6, blood tests and chest X-rays every six months
     
    Patients on a program of surveillance are strongly encouraged to stay on their course of follow-up visits so that if the cancer should come back, it will be caught early.
     
  • Stage 2 patients either need to have surgery or radiation treatment to remove the cancer that has invaded the nearby lymph nodes (back of the abdomen, or retroperitoneum) and/or a relatively short course of chemotherapy. A critical program of surveillance will be established for each Stage 2 patient.
     
  • Stage 3 patients must have surgery to remove the cancer that has invaded the nearby lymph nodes (back of the abdomen, or retroperitoneum) and aggressive chemotherapy. Radiation may also be an option for some patients, but radiation as a treatment for testicular cancer is increasingly rare. A critical program of surveillance will be established for each Stage 3 patient.

Risk Factors for testicular cancer

  • Past medical history of undescended testicle(s) – (the testicle at one point had not yet moved into the scrotum)
  • A man’s father or brother had or has testicular cancer 
  • Abnormal testicular development
  • Previous testicular cancer
  • Klinefelter syndrome, also known as the “XXY condition,” characterized by low levels of male hormones and all or some combination of sterility, breast tissue and small testicles

For more information about diagnosis or treatment options, call (206) 341-1420.