Testicular Cancer

Testicular Cancer, although relatively rare, is the most common malignancy in men in the 15-35 year-old age group. Treatment of testicular cancer is one of the major success stories of modern medicine. What was once a deadly cancer 30 years ago is now one of the most curable types of human solid cancers. Current treatment often involves surgery, chemotherapy and radiation therapy in various combinations as described below. Undescended testes (a pediatric condition consisting of one or both testicles located above the scrotum) is a risk factor for this cancer even if an operation is performed to place the testicle in the scrotum. This cancer rarely occurs in both testes. It is crucial that young men with abnormalities of the testis be evaluated by a urologist immediately. The cure rate for testis cancer is so high that we cannot afford to allow any cases to be missed. Patients usually notice a nodule, hardness, or painless swelling of the testis. Approximately 30-40% of patients may complain of a dull ache or a heavy sensation in the scrotum or lower abdomen. Approximately 10% of patients will present with acute or sudden pain. Another 5-10% of patients will present with spread of cancer to the neck (mass), abdomen or back, causing nausea or vomiting or low back pain.

Multidisciplinary treatment modalities are often required for cure of the tumor. Surgery, radiation, and chemotherapy have a particular role in the management of testicular tumors. As a means of establishing local control and firmly establishing the diagnosis, removal of the testis by a urologist is preferred as the first step. The pathologist examines the tissue under the microscope and provides a detailed description of the type of cancer present. After obtaining CT scans and other studies, the multidisciplinary team of urologic oncologists, radiation oncologists, and medical oncologists at Wayne State University recommend the most appropriate treatment plan. Some patients require no further treatment but must continue to come in to the office for frequent examinations. Other patients may undergo further surgery aimed at removal of lymph nodes in the abdomen (retroperitoneal lymph node dissection). At our institution, we have special expertise in performance of this type of operation with the twin goals of removal of all cancer and simultaneous preservation of fertility and sexual function. Other patients may undergo chemotherapy or radiation therapy. One type of testicular cancer (seminoma) responds to either irradiation or chemotherapy; the other types usually respond well to chemotherapy. Of course, each patient's treatment is individualized depending not only on the type of cancer found, but also on the location and amount of tumor in the testis and elsewhere.