Testicular cancer is the most common form of cancer in men 15 to 34 years old. Yet it accounts for only 1 percent of all cancers in men in the United States. According to the American Cancer Society, about 8,800 men are diagnosed with testicular cancer each year, and about 380 men die of the disease. However, if detected early, the disease has an overall five-year survival rate of 96 percent. For Stage 1 patients, the five-year survival rate is an astonishing 99 percent.
Here, urologist Jonathan Yamzon, M.D., assistant clinical professor and surgeon in City of Hope’s Division of Urology and Urologic Oncology, discusses how early detection and the use of advanced treatment options can help cure men of this rare disease and allow them to lead healthy, normal lives.
The most common types of testicular cancer form in germ cells, where sperm is made. They fall into two categories: seminomas and nonseminomas. Seminomas are slow-growing and tend to stay within the testicle. Nonseminomas are faster-growing, tend to spread outside the testicle and strike younger men. More than 90 percent of testicular cancers begin in the germ cells.
Testicular cancer is not only rare, accounting for only 1 percent of all cancers that occur in men, it is also one of the most curable forms of cancer. It is the most common cancer in American males between the ages of 15 and 34, with Caucasian men having a higher incidence.
It most commonly presents with a firm and sometimes painful mass on the testicle. Often times, men will only notice the mass when they experience inadvertent trauma to the testicle, such as during physical activities. And even when noticed, there appears to be an average delay of six months from discovery of the mass to when a doctor is seen. Here at City of Hope, we see men present with advanced disease who have experienced delayed diagnosis, attributing their symptoms to other causes.
To assure correct diagnosis, a physical examination, testicular ultrasound, blood work for serum tumor markers unique to germ cell tumor and a computed tomography (CT) scan are obtained to determine the extent of disease. Once diagnosed, the affected testicle is then surgically removed. Surgery is the only way to know for sure if it is testicular cancer and what kind of cancer it is. This information also helps in planning any other treatment that may be needed.
An increasing option for some early-stage testicular cancer patients is active surveillance which requires intensive monitoring to make sure any relapse of the disease is caught and treated right away. Men whose tumor marker profiles normalize after surgical removal of the testicle and do not show evidence of disease on a CT scan are eligible for this approach. Approximately 80 percent of men with tumor marker normalization and a negative CT scan are cured with removal of the testicle alone.
Surgery should be carried out at a specialized high-volume center to minimize this potential complication. Prior to commencement of treatment, we recommend men participate in sperm banking in the event they experience post-treatment infertility.
Surgical intervention, specifically after chemotherapy, are very technically challenging and should be performed at high-volume centers by a urologic oncologist.
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Learn more about the testicular cancer program at City of Hope.
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