Advanced treatment for testicular cancer in San Diego
Advanced treatment for testicular cancer in San Diego
Scripps MD Anderson Cancer Center is a leader in caring for men with testicular cancer. Our oncology specialists treat this rare male genital cancer with advanced therapies designed to preserve function and fertility, including minimally invasive surgery that uses small incisions, potentially resulting in shorter hospital stays and a faster recovery.
Our multidisciplinary, collaborative board of cancer specialists reviews every patient’s care plan to ensure you receive the best possible care from diagnosis to recovery.
About testicular cancer
Testicular cancer is a type of male genitourinary cancer that starts in the testicles, which make and store sperm and produce most of the male hormones. Testicular cancer makes up only 1% of all cancers in men. About 1 of every 263 men will develop testicular cancer during their lifetime.
Younger men are more likely to develop the disease than older men. It’s the most frequently diagnosed cancer among men between the ages of 20 and 34. The average age at diagnosis is 33. Fewer than 10% of testicular cancers occur in children or in men older than 55.
As with other genitourinary cancers — such as prostate cancer, bladder cancer and kidney cancer — early detection can lead to more effective treatment. In fact, 99% of testicular cancers can be successfully treated when detected early.
Types of testicular cancer
Several types of cells make up the testicles. Each cell type can develop into one or more types of testicular cancer. Some of these types raise the blood levels of certain proteins, which can be detected by a simple blood test.
The most common types of testicular cancers include the germ cell tumors and stromal tumors detailed below.
Germ cell tumors
Germ cell tumors start in the cells that produce sperm and represent more than 90% of testicular cancers. The types of germ cell tumors include seminomas, non-seminomas and carcinomas in situ.
Seminomas are the most common germ cell tumor type. They usually grow slowly, and may increase blood levels of a protein called human chorionic gonadotropin (HCG), which can be detected by a blood test. There are two subtypes of seminomas:
- Classical seminoma makes up more than 95% of seminomas. They usually affect men between the ages of 25 and 45.
- Spermatocytic seminoma is rare and usually affects older men. The average age at diagnosis is 65. These tumors tend to grow more slowly and are less likely to spread than classical seminomas.
Non-seminomas are germ cell tumors that usually affect men between their late teens and early 30s. They tend to spread faster than seminomas. There are four subtypes of non-seminomas:
- Embryonal carcinoma are present in about 40% of testicular cancers. They generally grow rapidly and spread beyond the testicle. Embryonal carcinoma can increase blood levels of a tumor marker protein called alpha-fetoprotein (AFP), as well as human chorionic gonadotropin (HCG).
- Yolk sac carcinoma occurs most often in infants and young boys and are usually treated successfully. It’s more of a concern in adults. This tumor type usually increases blood levels of alpha-fetoprotein (AFP).
- Choriocarcinoma is a rare and extremely aggressive adult cancer. It often occurs with other types of non-seminomas in a mixed germ tumor. Choriocarcinomas increase blood levels of human chorionic gonadotropin (HCG).
- Teratomas are usually found as parts of mixed germ cell tumors. Teratomas alone are rare and do not raise blood protein levels.
Mixed germ cell tumors contain both seminoma and non-seminoma cells. They’re usually treated as non-seminomas.
Carcinoma in situ (CIS) is a non-invasive form of testicular germ cell cancer. Also called intratubular germ cell neoplasia, CIS causes cells to look abnormal, but the cells are not cancer. CIS does not always become invasive cancer.
Stromal tumors develop in the stroma, which are the supportive and hormone-producing tissues. Known as gonadal stromal tumors, they make up less than 5% of testicular tumors. There are two main types of stromal tumors:
- Leydig cell tumors develop in the cells that make male sex hormones.
- Sertoli cell tumors develop in the cells that nourish germ cells.
Both types usually are not cancerous, but a small percentage spread to other parts of the body and are difficult to treat.
Testicular cancer causes, risks and family history
The exact causes of testicular cancer are unknown, but the American Cancer Society notes that most testicular cancer cells have extra copies of a part of chromosome 12. Some cancers have abnormal changes in other chromosomes, or abnormal numbers of chromosomes. Studies are underway to determine how this might affect the development of testicular cancer.
Researchers have identified a few risk factors that may increase the likelihood of developing testicular cancer, but they don’t know how much each risk factor actually contributes to the disease. Most men who have testicular cancer do not have any of the known risk factors.
Testicular cancer risk factors include:
Testicular cancer usually affects men ages 15 to 40.
White men are five to 10 times more likely to develop the disease than other races.
Undescended testicle (cryptorchidism)
Men whose testicles did not descend into the scrotum before birth have a higher risk, even if they have had surgery to correct the condition. Abnormal testicular development also raises the risk.
Men who have this chromosome disorder — characterized by low levels of male hormones, sterility, breast enlargement and small testes — have an increased risk.
Human immunodeficiency virus (HIV) or AIDS
Men who have HIV or AIDS seem to have an increased testicular cancer risk.
Carcinoma in situ (CIS)
This non-invasive form of testicular germ cell cancer causes cells to look abnormal. In some cases, CIS progresses to invasive cancer.
Family or personal history
If your father or brother has had testicular cancer, or you have previously had it, your risk is higher. But most men with testicular cancer do not have a family history of the disease, and no genetic link is known.
Having any of these risk factors does not mean you will develop testicular cancer. If you’re concerned about your risk, talk with your doctor.
Testicular cancer prevention, screenings and early detection
Many testicular cancers can be detected at an early stage, when treatment is most likely to be successful. While there are no screening tests, a lump or a swollen testicle is often the first sign. The American Cancer Society recommends that men have their testicles examined by a physician as part of a routine checkup.
Between exams, practice awareness — know the signs and symptoms of testicular cancer and call your doctor if you notice anything unusual.
Testicular cancer symptoms, diagnosis and stages
Testicular cancer symptoms can vary. Some men have symptoms early on, while others will have none until the cancer has advanced. Learn more about testicular cancer symptoms, diagnostic testing and stages below. As with most cancers, the earlier testicular cancer is found, the greater the likelihood of successful treatment.
Testicular cancer symptoms
Symptoms of testicular cancer include:
- A lump or swelling in the testicle that is usually painless
- Change in consistency of the testicles
- Feeling of heaviness or aching in the scrotum or lower abdomen
- Pain or discomfort in a testicle or in the scrotum
- Breast growth or tenderness
- In young boys, growth of facial and body hair at an unusually young age
- Lower back pain, if cancer spreads
Any of these symptoms may be caused by other conditions that are not cancer, such as an infection or inflammation of the testicle. But let your doctor know if you’re experiencing anything unusual, so that you can identify and treat any potential problems.
If you do have symptoms or a physical exam finds anything unusual, your doctor may recommend further testing. Scripps physicians use advanced imaging and lab tests to diagnose testicular cancer. These may include:
Blood tests may be used to detect certain protein "markers" in the blood that may indicate testicular cancer. These tests include:
- Alpha-fetoprotein (AFP) to check for elevated levels of this protein, which may indicate the presence of a germ cell tumor
- Beta human chorionic gonadotropin (b-HCG) to check for increased levels that may indicate testicular cancer
- Lactate dehydrogenase (LDH) to check for this enzyme linked to increased activity in the body's cells and tissues, which may indicate cancer
Diagnostic ultrasound is an imaging procedure that uses sound waves to create pictures of the tissue. During ultrasound, a wand-like instrument is moved over the testicles, and the images are recorded and displayed for review.
During a biopsy, the doctor removes a small tissue sample from the testicle to be examined under a microscope for cancer. Biopsy may be used in some cases to confirm testicular cancer, but it’s more likely that the doctor will remove the entire tumor if possible.
Testicular cancer stages
Scripps oncologists use testicular cancer stages to determine whether cancer has spread from the testicles to other areas of the body. Staging is important for developing a testicular cancer prognosis and treatment plan.
Stage 0 (carcinoma in situ)
Abnormal cells are found in the tiny tubules where sperm cells develop. In some cases, these abnormal cells may become cancer. All blood tumor marker levels are normal. Stage 0 testicular cancer is also called carcinoma in situ.
In stage IA testicular cancer, cancer is in the testicle and epididymis (the tube that connects ducts in the testicle to vas deferens) and may have spread to the inner layer of the membrane around the testicle. All tumor marker levels are normal.
In stage IB testicular cancer, all tumor marker levels are normal, and cancer is found in one of the following:
- In the testicle and epididymis and has spread to the blood or lymph vessels in the testicle
- In the outer layer of the membrane surrounding the testicle
- In the spermatic cord or the scrotum and may be in the blood or lymph vessels of the testicle
In stage IS testicular cancer, cancer is found anywhere within the testicle, spermatic cord or the scrotum and either:
- All tumor marker levels are slightly above normal
- One or more tumor marker levels are moderately above normal or high
In stage IIA testicular cancer, all tumor marker levels are normal or slightly above normal, and cancer is found in one of the following:
- Anywhere within the testicle, spermatic cord or scrotum
- In up to five lymph nodes in the abdomen, none larger than 2 cm
In stage IIB testicular cancer, all tumor marker levels are normal or slightly above normal, and cancer is anywhere within the testicle, spermatic cord or scrotum and has spread to either:
- Up to five lymph nodes in the abdomen, with at least one of the lymph nodes that is larger than 2 cm, but none is larger than 5 cm
- More than five lymph nodes that are not larger than 5 cm
In stage IIC testicular cancer, all tumor marker levels are normal or slightly above normal, and the cancer:
- Is anywhere within the testicle, spermatic cord or scrotum, and
- Has spread to a lymph node in the abdomen and the tumor is larger than 5 cm
In stage IIIA testicular cancer, the level of one or more tumor markers may range from normal to slightly above normal, and cancer is found in all of the following:
- Anywhere within the testicle, spermatic cord or scrotum
- One or more lymph nodes in the abdomen
- Distant lymph nodes or in the lungs
In stage IIIB testicular cancer, the level of one or more tumor markers may range from normal to high, and the cancer:
- Is anywhere within the testicle, spermatic cord or scrotum
- May have spread to one or more nearby or distant lymph nodes or to the lungs
In stage IIIC testicular cancer, the level of one or more tumor markers may range from normal to very high, and the cancer:
- Is anywhere within the testicle, spermatic cord or scrotum
- May have spread to one or more nearby or distant lymph nodes or to the lungs or anywhere else in the body
Understanding your diagnosis
No one wants to hear that they have cancer. It’s completely normal to feel anxious, scared, depressed or overwhelmed. Learning all you can about your diagnosis and your options can help you make informed, confident decisions about the next steps to take.
Questions and considerations
Here are some questions you may want to ask your doctor or health insurance provider regarding your diagnosis:
- Should I get a second opinion?
- How do I find a specialist?
- What is my cancer treatment plan?
- Will I have to miss work/school?
- What are the side effects of testicular cancer treatment?
- How successful is my treatment likely to be?
- What costs will be covered by insurance?
- Which costs will I be responsible for?
Your Scripps cancer team is here to help you find the answers you need to take an active role in your care. In addition, there are a number of community resources that provide education, information and helpful resources — often at no cost.
Learn more about the many cancer patient resources available to you and your loved ones via Scripps.
Treatment and clinical trials
When you’ve been diagnosed with testicular cancer, you want a team of expert cancer specialists on your side. Scripps MD Anderson’s multidisciplinary oncology teams fight testicular cancer using the latest evidence-based treatments and therapies, including minimally invasive surgery and targeted radiation therapy.
Our approach to treating testicular cancer
Your Scripps MD Anderson cancer care team includes professionals from every area of oncology, including surgeons, radiation oncologists and nurses who specialize in cancer care. Should you need reconstructive surgery after your treatment, count on our plastic surgeons for the expertise that has helped many men feel comfortable with their appearance.
In addition, your nurse navigator will help coordinate your care and ensure you have support and guidance throughout your treatment and recovery. Learn more about how Scripps puts you at the center of care.
Testicular cancer treatment options at Scripps MD Anderson
Treatment for testicular cancer typically involves surgery, and may involve radiation therapy and/or chemotherapy if the cancer has spread. Your Scripps MD Anderson cancer care team will customize your treatment plan based on several factors, including:
- The type and stage of your cancer
- Whether your cancer has spread
- Your age and overall health
Surgery for testicular cancer may involve the following procedures. Whenever possible, Scripps surgeons use minimally invasive procedures, such as laparoscopic surgery or robotic-assisted surgery. Minimally invasive surgery can offer benefits such as fewer incisions, a shorter hospital stay and a faster recovery.
- Orchiectomy is when surgeons remove the testicle through an incision in the groin. The procedure can also be part of the approach to diagnosing testicular cancer. Tissue removed from the testicle is examined to determine the stage of the cancer, and typically involves removal of some of the nearby lymph nodes.
- Retroperitoneal lymph node dissection (RPLND) is when the surgeon removes and tests lymph nodes in the abdominal area. RPLND is typically done at the same time as the orchiectomy.
Radiation therapy is often effective in treating seminomas, the most common type of testicular cancer. Radiation therapy is generally performed after orchiectomy surgery.
- Intensity-modulated radiation therapy (IMRT) is an advanced form of radiation therapy. IMRT allows the radiation oncologist to specify the dose of radiation for the tumor while restricting the dose to surrounding healthy tissues.
Several chemotherapy drugs may be used following surgery to treat cancer that has spread, or to help prevent cancer from returning. High-dose chemotherapy in combination with stem cell transplant can also be part of treatment.
Following surgery to remove testicular cancers that have not spread beyond their starting point, your physician may recommend monitoring and testing to see if the cancer returns instead of radiation and chemotherapy to prevent recurrence. Follow-up visits and tests may be needed for up to 10 years.
Testicular cancer clinical trials
Some testicular cancer treatment plans may involve clinical trials. Talk with your physician about whether a clinical trial is right for you.
For a list of clinical trials that are currently enrolling patients, see our current list of clinical trials.
Your custom cancer treatment plan
Your Scripps MD Anderson cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.
Your testicular cancer treatment plan generally includes:
- Family and medical history
- A summary of your cancer diagnosis and staging information
- Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
- Plans for surgery, radiation, chemotherapy and/or other treatments
- Potential side effects of treatments
- Contact information for your cancer care team members
Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.
Your cancer care team
Your testicular cancer care team includes health and medical professionals from a wide range of specialties. Scripps MD Anderson will customize your team to ensure you have the expertise and support you need.
Your team may include:
- Surgeons and surgical oncologists
- Radiation oncologists
- Medical oncologists
- Registered nurses
- Nurse navigators
- Oncology social workers
Visit your cancer care team for more on Scripps MD Anderson’s multidisciplinary approach to treatment.
Testicular cancer treatment locations
Scripps diagnoses and treats testicular cancer at numerous locations throughout San Diego County. From Chula Vista and La Jolla to Encinitas and beyond, our extensive network of Southern California cancer care centers includes:
- Four Scripps hospitals on five campuses
- Outpatient clinics
- Specialty cancer treatment centers
For details on specific centers and their services, visit cancer care locations.
Support groups, services and resources
Scripps offers a comprehensive lineup of support groups, support services and resources to help you along every step of your cancer journey.
Testicular cancer support groups, workshops and events
In support of our patients, survivors, their family members and the community, we host a handful of cancer support groups as well as a range of free workshops and health and wellness events on a number of topics, such as:
- Expressive writing
Check the current list of support offerings or contact your oncology social worker or cancer care coordinator.
For info about other cancer support groups in the San Diego community, call the American Cancer Society at 800-227-2345.
Support services for cancer patients
We are here for you — not only as your oncologists, but as a robust multidisciplinary team of experts who understands that your cancer journey is about much more than your medical treatment. Specifically, Scripps MD Anderson offers a variety of patient support services to ensure your physical, psychological and emotional well-being as well as resources for dealing with the logistical and financial aspects of cancer care. Our services and resources include:
- Oncology nurses and nurse navigators with extensive clinical expertise in cancer care to help guide you and your caregivers to make informed decisions and ensure your optimal care.
- Palliative care to provide an extra layer of supportive care to manage pain and relieve symptoms, offer emotional and spiritual support, and improve your quality of life.
- Oncology social workers specially trained to provide counseling, connect you with community and medical resources, assist with transportation and housing and coordinate care after discharge.
- Our registered dietitian nutritionists offer individualized nutrition support for patients whose efforts to optimize their nutrition may be affected by cancer symptoms or treatment side effects.
- Referrals and professional care from experts in psychology, psychiatry and emotional health, including individual and family counseling to help with the emotional challenges of cancer.
- Physical rehabilitation and occupational therapy services, including wound care, voice therapy and swallowing therapy, lymphedema therapy, balance and vestibular rehabilitation, yoga and more.
- Scripps Center for Integrative Medicine for patients interested in mind-body healing through acupuncture, biofeedback, herbal nutrition, massage therapy, integrative cancer care and more.
- Nondenominational spiritual care offered by our chaplains to help coordinate spiritual care with your own clergy, rabbi or spiritual advisor.
- Visiting patient services if you reside beyond San Diego and want help arranging appointments or learning more about short-term lodging.
For the full spectrum of offerings, please visit our cancer patient support services section.
Additional resources for patients, caregivers and family members
Patient education is an integral part of understanding and coping with your cancer diagnosis and treatment. To stay informed, we encourage our patients, along with their caregivers and family members, to:
- Bookmark the Scripps glossary of cancer terms for easy referencing.
- Download the appointment form and list of medications form on our resources page.
- Consult your oncology team for educational materials and a list of trusted online sources beyond the Scripps site.
Navigating cancer might seem overwhelming — especially with so much information online. To ensure you receive the most accurate details, always look to your multidisciplinary team of cancer care experts first.