The Function of the Testes
The testes are the male reproductive glands. They produce the spermatozoa , or sperm cells, needed to fertilize female egg cells. The epididymis, a comma-shaped structure resting on the top and back surfaces of each testis, stores the sperm cells until they are ejaculated, or expelled, from the body. The testes also produce the male hormone testosterone, which is responsible for deepening of the voice at puberty, a more muscular build, pubic and facial hair, and other male traits.
Each testis is approximately two inches long and one inch in diameter. They are suspended from the body by the spermatic cord and are enclosed in the scrotum, a pouch made of membrane and loose skin.
Cancer of the testes is a relatively rare form of cancer, accounting for approximately one percent of cancers in American men. An estimated 7,400 new cases of testicular cancer occur each year. The great majority of these cancers, however, occur between the ages of 20 and 44, precisely the time when a man may be planning a family. Most patients treated for early stage disease can retain sexual function and fertility.
Once the leading cause of cancer death in men between 15 and 35, it is now estimated that more than 95 percent of patients with testicular cancer will survive if the disease is detected early and treated appropriately.
Recent advances in managing the disease, particularly with the use of powerful anti-cancer drugs, have resulted in cure rates approaching 83 percent for even some advanced types of testicular cancer.
Testicular cancer rates for Caucasian men are higher than those for black men. The rates for Hispanics, Native Americans and Asians are higher than those for African American men, but still less than those for Caucasian men.
The major risk factor for testicular cancer is undescended testes — that is, the testes, which are formed up in the body near the kidneys, fail to descend into the scrotum. This condition increases the risk of developing testicular cancer by five times. It can be easily corrected by surgery, however, and if done before a boy is 6 years old, the risk is reduced to normal.
Although physical injury to the testes has sometimes been associated with testicular cancer, it may just be that the injury prompted the person to have his testes checked, leading to a diagnosis of an already existing tumor, rather than actually causing the cancer.
Types of Testicular Cancer
Almost all testicular tumors occur in the cells that produce sperm and are known as germ cells. These tumors are grouped into two main classes: seminomas and nonseminomas.
Seminoma arises from sex cells, or germ cells, at a very early stage in their development. This is the most common type of testicular cancer, accounting for 30 to 40 percent of all such tumors. It occurs most often in men between the ages of 25 and 45 and is usually slow-growing.
Nonseminoma tends to be more aggressive than seminoma. Although 75 percent of seminomas have not spread beyond the testes when first diagnosed, 60 to 70 percent of patients with nonseminomas have cancer that has already spread to the lymph nodes. Nonseminomas can be further divided into four types, although they sometimes occur in combination and are then known as mixed tumors.
- The most common symptom of testicular cancer is a hard lump in the testicle. The lump might be as small as a pea or as large or larger than the testicle.
- Painless swelling and a feeling of heaviness in the groin area or scrotum. In most cases, there is no pain unless the patient also has an inflamed epididymis. These symptoms can also be caused by other conditions, but even the mildest symptom should be checked by a doctor.
Men can help detect cancer of the testes in its earliest stages by practicing a simple technique known as testicular self-examination (TSE) every month. Ideally, this should be performed after a warm shower or bath, when the skin of the scrotum is relaxed, making it easier to feel anything unusual.
The man stands in front of a mirror and then gently rolls each testis between the thumb and fingers of both hands. If he finds lumps or other changes, he should contact his doctor immediately. The doctor will also feel the testes and surrounding structures as part of a complete physical exam and may order additional tests.
- Ultrasound: New tests make it easier to distinguish between cancer of the testes and other conditions. Such techniques might include ultrasound of the scrotal area, which is a painless and harmless test using high-frequency sound waves that bounce off body tissue to produce images of the internal structures. Any cancerous tumors found are projected on a small screen.
- Biopsy: The only way a physician can make a firm diagnosis of testes cancer and its type is to do a biopsy, a surgical procedure to remove a sample of tissue to examine it for cancer.
- Orchiectomy – removal of the testis: When a suspicious mass is present and other conditions are ruled out, the testis is removed through the groin in a procedure known as orchiectomy. Tissue is then studied under a microscope. Because testicular tumors often are of a mixed type, many different sections of the removed testes will be examined to make a complete and accurate diagnosis.
- Surgical removal of the affected testis is both part of the diagnostic process and the first step in treatment of the disease. Testicular cancer rarely occurs in both testes; a man only needs one testicle to produce sperm and testosterone, so he should still be able to father children.
Surgery may be required to remove nearby lymph nodes because the cancer may have metastasized, or spread, beyond the testicle. The lymph nodes are then checked for evidence of the disease. If none is apparent, no further treatment may be needed. In more advanced cases, chemotherapy may be used.
- Chemotherapy, using combinations of several different anti-cancer drugs, has greatly improved survival rates, bringing complete remission in 80 percent of patients with nonseminomas and limited metastasis. Newer drug combinations can help save additional patients who don’t respond to the initial drug treatment or who later have a relapse.
Side effects of chemotherapy depend on the drugs used and may include hair loss, nausea and vomiting, a feeling of tiredness, and changes in the patient’s blood count. The hair grows back and most other side effects end when chemotherapy is stopped.
- BEP (Bleomycin, Etoposide, and Cisplatin): A newer regimen of drug combinations called BEP (Bleomycin, Etoposide, and Cisplatin) is now recognized as standard therapy, helping even patients with advanced disease. Plus, the new treatment has reduced side effects, including tingling of the skin, stomach cramps and muscle pain.
- Radiation therapy is the treatment of choice for patients with seminomas and may be used at times for those with nonseminomas. The aim of radiation therapy is to destroy cancer cells by injuring their ability to divide. For patients with testicular cancer, radiation is usually beamed at the abdomen and pelvis, and sometimes the chest and neck. Chemotherapy or the surgical removal of nearby lymph nodes may also be part of the treatment.
If you are experiencing any of the above symptoms call us to schedule an appointment for a complete evaluation to determine the best option for you.