When there are symptoms to suggest the possibility of testicular cancer, a
personal and family history is studied and a physical examination is
given. In addition to the general health routine checking of the pulse, blood
pressure, temperature, etc., the scrotum is carefully examined.
Blood and urine samples will be taken for analyzing and a chest X-ray
is usually done. If the lab tests and exam do not show another infection or
disorder, cancer is suspected.
The only way to know for certain if the testicle has cancerous cells is to
examine a tissue sample beneath a microscope. The affected testicle must be
removed through the groin to obtain the sample. This operation is called inguinal
orchiectomy. A tissue sample cannot be retrieved through the scrotum
because cutting through the outer layer of the testicle could potentially cause
the cancer to spread out, if indeed there are cancerous cells to be found.
Types of Testicular Cancers
The next step (if the tests show cancer) is to figure out which type of
cancer the malignant cells are classified as, seminoma or non-seminoma. If a
single tumor has both types of cells, the tumor is treated as a non-seminoma.
Certain substances (called tumor markers) in the blood can be
revealed by special lab tests. They are often found in abnormal amounts in
patients with some types of cancer. Doctors look at the levels of specific
tumor markers when determining what type of testicular cancer a patient has.
Seminomas are slow-growing, immature germ cells and usually localized
to the testes, but in approximately 25% of the cases, the cancer has spread to
lymph nodes. Seminomas are usually found in men in their 30s and 40s and
account for about 30-40% percent of all testicular tumors.
Non-seminomas are more mature germ cells that grow quickly.
They account for about 60% of all testicular tumors and often have more than
one type of the subcategories listed below.
Choriocarcinoma—rare
Teratomata—about 40%of testicular cancers in young boys and 7% in
adult men.
Yolk sac tumor—about 60% of all testicular cancers in young boys.
Embryonal carcinoma—highly malignant, grows rapidly and spreads to
the liver and lungs. Occurs in 20-30 year olds and accounts for about 20% of
testicular cancers.
Stromal cell tumors are a very rare form that account for only 3-4%
of all testicular tumors. They are comprised of Sertoli cells, Leydig cells,
and granulose cells. These tumors may cause gynecomastia (excessive
development of the male breast) due to their secretions of the hormone estradiol.