The diagnostic path typically includes BLOOD
tests to look forTUMOR MARKERS(proteins in the
blood circulation that suggest the presence of can-
cer), such as ALPHA FETOPROTEIN(AFP) and lactate
dehydrogenase (LDH), and ULTRASOUNDof the scro-
tum, which may indicate whether the growth is
fluid-filled (more likely a cyst or HYDROCELE) or
solid (more likely a tumor).
Though biopsy (removal of a sample of the
tumor’s tissue for laboratory examination) is the
means of establishing a cancer diagnosis in most
other types of cancer, the risk that the biopsy will
cause the release of cancer cells into the blood or
LY M P Hcirculation is very high with testicular can-
cer because of the circulatory and lymphatic struc-
tures of the testicle. The urologist may consider
biopsy when both testicles are involved or when a
man has only one testicle. In such a circumstance
the OPERATIONbegins as would an inguinal orchiec-
tomy but the surgeon sends a tissue sample for the
pathologist to examine and waits for the report of
cancer or not cancer before proceeding. Otherwise
laboratory analysis of the tumor occurs after
removal of the testicle and its spermatic cord. The
pathologist then identifies the type and stage of
the cancer, which determines appropriate treat-
ment options.
Treatment Options and Outlook
Surgery to remove the testicle containing the can-
cer is the first line of treatment. The operation of
choice is radical inguinal ORCHIECTOMY, performed
with the man under general ANESTHESIA. The sur-
geon makes an incision in the groin and pulls the
testicle up from the scrotum to remove it, intact,
along with its spermatic cord. The spermatic cord
contains the blood and lymph vessels that supply
the testicle; removing the entire testicular struc-
ture significantly reduces the risk for stray cancer
cells entering the blood and lymph circulations to
spread elsewhere in the body.
For seminomas or large tumors, the surgeon
may also remove lymph nodes in the lower
abdomen that are the path of lymph drainage
from the spermatic cord (retroperitoneal LY M P H
NODEdissection). Though a more extensive sur-
gery, such an operation is very successful in pre-
venting the spread of the cancer.
Most men then receive adjuvant (accompany-
ing) treatment with RADIATION THERAPY or
CHEMOTHERAPY, depending on the type and stage of
the cancer. Tumors that contain only seminoma
cells (pure seminoma) tend to stay contained
longer and are very sensitive to radiation therapy.
Tumors that contain nonseminoma cells tend to
metastasize (spread) earlier and are more respon-
sive to chemotherapy. Oncologists typically admin-
ister chemotherapy using combinations of drugs for
several cycles (three or four) of treatment.CHEMOTHERAPY AGENTS TO TREAT TESTICULAR CANCER
bleomycin carboplatin
cisplatin cyclophosphamide
etoposide ifosfamide
vinblastineTesticular cancer is among the most treatable
cancers. Testicular cancer detected and treated
while it remains localized in one testicle (stage 0
or stage 1) has a current five-year survival rate of
99 percent; oncologists consider this a cure rate
because the cancer rarely recurs. The RECURRENCE
rate (likelihood for the cancer to return after treat-
ment) is very low, though a man who has had tes-
ticular cancer has increased risk for cancer in the
remaining testicle (usually a new cancer rather
than a metastasis of the original cancer) or for
other types of cancer.
Treatment for testicular cancer does not affect a
man’s sexuality though may affect his FERTILITY.
Most people feel fatigued during cancer treatment,
which often lowers LIBIDO(interest in sexual activ-
ity). However, most testicular cancer treatments
do not affect a man’s ability to obtain ERECTION,
reach orgasm, or achieve EJACULATION. Extensive
retroperitoneal lymph node dissection has a slight
risk for NERVEdamage that can result in RETRO-
GRADE EJACULATION (in which SEMEN enters the
BLADDERrather than exiting the PENISduring ejacu-
lation). Many men retain fertility after testicular
cancer, though doctors recommend sperm bank-
ing for men who may desire to father children
because many factors influence fertility so it is not
certain. A man may choose to have a testicular
prosthesis implanted to restore the cosmetic
appearance and feel of the scrotum.testicular cancer 345