Cancer of the testis occurs most commonly in young men, and is the most common cancer in men between the ages of 20 and 34. Death from testis cancer is now extremely rare because combination chemotherapy can cure even advanced disease. Lance Armstrong is just one example.
Symptoms of Testis Cancer
Most patients with testis tumor notice a lump within the testis. Sometimes pain in the testis is the initial symptom, and this pain is sometimes attributed to an injury. If pain is more than would be expected from the injury careful examination should be made for a mass within the testis. Testis cancers can grow very rapidly and can spread to the abdomen or lungs, causing abdominal swelling or pain and even shortness of breath. Lymph nodes above the collar bone on the left can be enlarged and breasts may become enlarged and painful.
The testis proper is oval in shape and uniform in consistency. Any lump or firm area within the testis itself is suspicious for cancer. Sperm produced in the testis go through tubules to a structure on back of the testis that runs from one end to the other. This structure, the epididymis, contains the long, coiled tube that transmits sperm and adds nutrients. Lumps in the epididymis are common and are almost never cancer.
A careful examination by a urologist, sometimes supplemented by a scrotal ultrasound to visualize these structures, is often all that is required to be certain that cancer is not present.
Causes and Risk Factors for Testis Cancer
Testis cancer is commonly associated with improper or delayed descent of the testis from the abdomen to the scrotum (cyrptorchidism). Undescended testis should be corrected with surgery, but even with placement of the testis in its proper location, the risk for testis tumor remains. The risk of testis cancer is increasing and concern has been raised that this may be related to the increased use of pesiticides. Atrophy of the testis, which may be caused by infection, trauma, cryptorchidism, or chemicals increases the risk of testis cancer.
Tumors within the testis require biopsy and excision- generally removing the entire testis and cord through an incision in the groin.
Malignant tumors of the testis tend to spread early to the lymph nodes in the abdomen. At times removal of these nodes is needed, but often, depending on the type of tumor, the tumor markers, and the pathologic findings radiation therapy or combination chemotherapy with cisplatin, etopsoide, and bleomycin.