Testicular Cancer: What You Need to Know
April marks testicular cancer awareness month.
The American Cancer Society (ACS) estimates about 8,720 new cases of testicular cancer will be diagnosed in 2016 with 380 men dying of the disease. The incidence rate of testicular cancer has been increasing for several decades. The exact reasons why are unknown. However, recently the rate of increase has slowed.
Testicular cancer is uncommon; with about 1 of every 263 males developing testicular cancer during their lives. The average age at the time of diagnosis is about 33. Despite it being largely a disease of young and middle-aged men, about 7% occur in children and about 7% occur in men over the age of 55.
What is testicular cancer?
Cancer of the testes can arise from any of the cells that make of the testes. Greater than 90% of tumors arise from germ cells, cells which produce sperm. These are called germ cell tumors and are divided into:
Non-seminomatous germ cell tumors (NSGCT) which includes embryonal carcinoma, yolk sac tumor, choriocarcinoma and teratoma.
Seminomas usually occur between the ages of 25-45. NSGCT often occur in the late teens and early 30s. Commonly, tumors are a mix of seminoma and NSGCT elements and are designated mixed germ cell tumors.
Less than 5% of tumors are derived from the supporting cells of the testes. These are called stromal tumors. The two most common are Leydig cell tumors and Sertoli cell tumors.
The remainder of testicular tumors include lymphoma and secondary tumors (metastases) from other tumors.
Signs and symptoms
Commonly the first symptom of testicular cancer is a lump on the testicle. The testicle may be swollen. Other symptoms can include pain and a feeling of heaviness or aching in the lower abdomen or scrotum.
Testicular cancer is often found after symptoms arise. It can also be found incidentally during the work up for another reason. A thorough physical exam and imaging studies such as ultrasound, CT, MRI, PET scan and bone scan may be performed to assess the extent of disease.
An important part of the evaluation is measurement of serum tumor markers. Not only are these crucial for diagnosis, but are necessary for future monitoring of patients for any signs of recurrence. Pathologists are responsible for the accurate and precise reporting of these laboratory values. The pathologist will also diagnose the type of tumor once it is removed. The correct diagnosis determines next steps for treatment and also prognosis.
Pathologists are important members of the care team. Ask about the pathologist and lab that will be examining your tissue.
What can you do?
The ACS states that most doctors agree that testicular exam should be part of a general physical exam. and recommends a testicular exam as part of a routine cancer-related checkup. Because regular testicular self-exams have not been studied enough to show they reduce the death rate from this cancer, the ACS does not have a recommendation on regular testicular self-exams for all men. If you have any risk factors for testicular cancer, such as a family history of testicular cancer, personal history of prior testicular cancer or an undescended testis, talk with your doctor about monthly self-exam.
Use this month to learn more about testicular cancer and the other doctor involved in your care; the pathologist. Take control of your health.