1. Cancer Education Slides
Testicular Cancer
2009

2. What is Cancer? A group of 100 different diseases
The uncontrolled, abnormal growth of cells
Cancer may spread to other parts of the body

3. What is Testicular Cancer?
An estimated 8,400 men diagnosed in the United States in 2009
A disease of one or both testicles in which cells grow uncontrollably and form a tumor
Mainly develops in the sperm-producing cells called germ cells; called germ cell tumors
Two types: seminoma and non-seminoma.
Teratoma: type of non-seminoma that is unlikely to spread but can become cancerous if not removed

4. What is the Function of the Testicles?
Part of the male reproductive system, also called the testes or gonads
Located under the penis in a sac-like pouch called the scrotum
Produce sperm and testosterone

9. What are the Risk Factors for Testicular Cancer?
Age
Family history
Personal history
Race
Cryptorchidism (undescended testicle)
Klinefelter’s syndrome
Human immunodeficiency virus (HIV) infection

10. What are the Symptoms of Testicular Cancer?
Painless lump or swelling on either testicle
Pain or discomfort in a testicle or the scrotum
Enlarged testicle or a change in the way it feels
Feeling of heaviness in the scrotum
Dull ache in the lower abdomen or groin
Buildup of fluid in the scrotum
Breast tenderness or growth
Lower back pain, shortness of breath, chest pain, and bloody phlegm may be symptoms of advanced cancer

11. Testicular Cancer and Early Detection
Can often be detected early
Many men find the cancer during a self-examination
Some doctors recommend that men ages 15 to 55 perform a monthly self-examination
Men who notice a lump, hardness, enlargement, pain or any other change in one or both of their testicles should see their doctor as soon as possible

12. How is Testicular Cancer Diagnosed?
Physical examination
Ultrasound
Blood tests/tumor markers
Diagnosis is confirmed by surgically removing the testicle
Needle biopsy not used (except in very specific situations)
Surgical pathology tests
X-ray
Computed tomography (CT or CAT) scan

13. Testicular Cancer Staging
Staging is a way of describing a cancer, such as the size of a tumor and if and where it has spread
Staging is the most important tool doctors have to determine a patient’s prognosis
Staging is described by the TNM system: the size and location of the Tumor, whether cancer has spread to nearby lymph Nodes, and whether the cancer has Metastasized (spread to other areas of the body)
Serum tumor markers (S): includes the amount of AFP, hCG, and LDH in the blood

17. Testicular Cancer Staging, continued
Testicular cancer staging is described using one of four stages: 0 (zero), I, II, or III
Some stages are divided into smaller groups that help describe the tumor in even more detail
Treatment depends on the stage of the cancer
Recurrent cancer is cancer that comes back after treatment

18. Stage 0 Testicular Cancer
Carcinoma in situ
Also called intratubular germ cell neoplasia

19. Stage I Testicular Cancer
Tumor is in the testicle only, the inner or outer membrane surrounding the testicle, the spermatic cord (connects the testicle to the rest of the body), and/or the scrotum
Stage IA: cancer is only in the testicle, has not spread to lymph nodes or other areas, and serum markers are normal
Stage IB: cancer is outside the testicle or has spread to blood or lymphatic vessels in the testicle, but there is no spread to lymph nodes or other areas, and serum markers are normal
Stage IS: imaging tests show that the cancer has not spread to lymph nodes or other areas but serum markers remain above normal levels after the cancerous testicle has been removed

20. Stage II Testicular Cancer
Cancer has spread to lymph nodes in the back of the abdomen (retroperitoneum), but not lymph nodes in other parts of the body
Stage IIA: cancer has spread to 1 to 5 lymph nodes, none of which are larger than 2 centimeters (cm), and serum marker levels are normal or slightly elevated
Stage IIB: cancer has spread to regional lymph nodes, one of which is greater than 2 cm but none are greater than 5cm; or cancer has spread to more than 5 lymph nodes with none greater than 5cm. Serum markers are normal or slightly elevated
Stage IIC: cancer has spread to at least 1 lymph node that is larger than 5cm, and serum marker levels are normal or slightly elevated

21. Stage III Testicular Cancer
Stage IIIA: cancer has spread to distant lymph nodes or the lungs, and serum marker levels are normal or slightly elevated
Stage IIIB: cancer has spread to any lymph nodes and/or the lungs but not to other organs, and serum marker levels are substantially elevated
Stage IIIC: Either or both of the following
Serum marker levels are highly elevated, and cancer has spread to at least 1 lymph node or organ
Cancer has spread to an organ other than the lungs

22. Advanced Testicular Cancer: Risk Group Classification
Used if cancer has spread to lymph nodes or other organs to predict the effectiveness of treatment
Based on tumor location, tumor spread, and serum marker levels
Divided into 3 groups for both seminoma and non-seminoma
Good risk
Intermediate risk
Poor risk
Patients with poor-risk cancer still have about a 50% chance of successful treatment

23. How is Testicular Cancer Treated?
Treatment depends on stage of cancer and the type of tumor
More than one treatment may be used
Surgery
Active surveillance
Radiation therapy
Chemotherapy
Patients should talk with their doctor about whether treatment plan could affect sexual function and fertility before treatment begins

24. Cancer Treatment: Surgery – Radical inguinal orchiectomy
Removal of affected testicle
Typically part of both diagnosis and treatment
Most men are still able to have children after the removal of one testicle
Removal of one testicle is very unlikely to affect a man’s ability to have a normal erection and orgasm (men with sexual problems after surgery should have their testosterone level checked)
Some men may choose to have an artificial testicle implanted

25. Cancer Treatment: Surgery – Bilateral orchiectomy
Removal of both testicles
While uncommon, some men may develop cancer in both testicles at the same time
After bilateral surgery, a man will no longer produce sperm or testosterone and will not be able to biologically produce children
Some men choose to store sperm in a sperm bank prior to surgery
Testosterone hormone replacement therapy will be needed

26. Cancer Treatment: Surgery – Retroperitoneal lymph node dissection (RPLND)
Removal of the retroperitoneal lymph nodes that lie at the back of the abdomen
Performed in two situations:
Men with a stage I or IIa non-seminoma
Men who have retroperitoneal tumors remaining after completing chemotherapy for advanced stage cancer

27. Cancer Treatment: Surgery – RPLND, continued
Side effects may include bowel obstruction or wound infections
Unlikely to affect fertility or a man’s ability to have an erection or orgasm
May cause infertility if the nerves that control ejaculation are damaged (more common for men who have surgery to remove tumors remaining after chemotherapy)

28. Cancer Treatment: Active Surveillance
Surveillance refers to a schedule of doctor’s appointments and medical tests to watch for evidence that the cancer may have come back
May be recommended after surgery for men with stage I testicular cancer
Regular CT scans, chest x-rays, physical examination, and blood tests
For a non-seminoma, testing is performed every one to two months for the first 2 years and less often thereafter
For a seminoma, testing is performed every four months for the first 3 years and less often thereafter

29. Cancer Treatment: Radiation Therapy
The use of high-energy x-rays to destroy cancer cells
Usually external-beam radiation therapy
More effective for seminoma than non-seminoma
Used for stage I, IIa, or IIb seminomas
Side effects include fatigue, mild skin reactions, upset stomach, and loose bowel movements, peptic ulcers, cardiovascular disease, and secondary cancers
Can cause problems with sperm production; the remaining testicle needs to be shielded if the man wishes to preserve fertility

32. Cancer Treatment: Chemotherapy
Use of drugs to kill cancer cells
The drugs bleomycin (Blenoxane), etoposide (VePesid, Etopophos, Lastet), and cisplatin (Platinol) are a commonly used combination called BEP
Side effects may include fatigue, infection, nausea and vomiting, hearing loss, skin marks, numbness and tingling, loss of hair, lung damage, kidney damage, cardiovascular disease, and secondary cancers

47. Current Research Stem cell transplantation/bone marrow transplantation
Genetic studies
Long-term side effects and quality of life

48. The Role of Clinical Trials for the Treatment of Cervical Cancer
Clinical trials are research studies involving people
They test new treatment and prevention methods to determine whether they are safe, effective, and better than the standard treatment
The purpose of a clinical trial is to answer a specific medical question in a highly structured, controlled process
Clinical trials can evaluate methods of cancer prevention, screening, diagnosis, treatment, and/or quality of life

49. Clinical Trials: Patient Safety
Informed consent: participants should understand why they are being offered entry into a clinical trial and the potential benefits and risks; informed consent is an ongoing process
Participation is always voluntary, and patients can leave the trial at any time
Other safeguards exist to ensure ongoing patient safety

50. Clinical Trials: Phases
Phase I trials determine the appropriate dose of a new treatment in a small group of people and provide preliminary information about the drug’s safety
Phase II trials provide information about the safety of the new treatment and provide the first evidence as to whether or not the new treatment is effective in treating the cancer that is being studied
Phase III trials compare two or more different treatments. Most commonly, they test whether a new treatment is better than the standard treatment. Patients are typically divided randomly into two or more different groups. Each group gets a different treatment, and the researchers evaluate which group has had the best results. This is the best way to measure whether a new treatment results in longer life or better quality of life for patients

51. Clinical Trials Resources
Coalition of Cancer Cooperative Groups (
CenterWatch (
National Cancer Institute (
EmergingMed (

52. Coping with Side Effects
Side effects are treatable; talk with the doctor or nurse
Fatigue is a common, treatable side effect
Pain is treatable; non-narcotic pain-relievers are available
Antiemetic drugs can reduce or prevent nausea and vomiting
For more information, visit

53. After Treatment
Talk with the doctor about developing a follow-up care plan
Regular physical examinations and/or medical tests may be required to monitor for the following long-term effects
Effect of bleomycin on lungs
Effect of chemotherapy on kidneys and blood vessels
Effect of cisplatin on nerves, hearing, and the brain
Secondary cancers
Fertility problems
Testosterone levels
Fear of recurrence is common; talk with your doctor about ways to cope

54. Where to Find More Information Cancer
Where to Find More Information Cancer.Net Guide to Testicular Cancer ( testicular)
Overview
Medical Illustrations
Risk Factors
Symptoms
Diagnosis
Staging
Treatment
Clinical Trials
Side Effects
After Treatment
Current Research
Questions to Ask the Doctor
Patient Information Resources

55. Cancer.Net (www.cancer.net)
Comprehensive, oncologist-approved cancer information
Guides to more than 120 types of cancer and cancer-related syndromes
Coping resources
Survivorship information
Cancer information in Spanish
Weekly feature articles
The latest cancer news
For patient information resources, please call