Testicular cancer and young men

We often hear that cancer is more common in older adults. But one cancer, testicular cancer, is frequently diagnosed in young men ages 15 to 45. In fact, roughly 50% of testicular cancers are found in men ages 20 to 34.

Testicular cancer starts in the testes, part of the male reproductive system, which are held within the scrotum under the penis. Testes — also called testicles — produce male hormones, including testosterone and sperm. Most testicular cancer starts in the cells that make sperm, called germ cells.

"Testicular cancers are primarily germ cell tumors categorized as two types: seminomas and non-seminomas,” says Dr. Ruben Carmona, a Sharp Community Medical Group board-certified radiation oncologist affiliated with Sharp Chula Vista Medical Center. “Sixty percent of testicular germ cell tumors are seminomas, 30% are non-seminomas and 10% are mixed type. Testicular germ cell tumors, compared to prostate and bladder cancer, affect far fewer men and the annual number of cases in the U.S. is about 8,700."

According to the American Cancer Society, seminoma tumors often grow and spread slower than non-seminoma tumors. Additionally, seminoma tumors usually occur in younger men (late teens and early 30s).

Testicular cancer signs and risk factors

The first sign of testicular cancer is commonly a painless lump or swelling in the testicle. Other symptoms include breast growth or soreness, decreased sex drive, a feeling of heaviness or aching in the abdomen or scrotum, and early puberty in boys.

While most men with testicular cancer don’t have known risk factors for developing this type of cancer, there are factors that may make someone more likely to develop it, including:

• An undescended testicle

• Genetics or a family history of testicular cancer

• HIV infection

• Carcinoma in situ of the testicle, a noninvasive form of cancer

• Having had testicular cancer before

• Being of a certain race or ethnicity — white, American Indian and Alaskan men are at greater risk than men of other races or ethnicities; however, all men are at some risk

• Body size — some studies have found tall men are at increased risk

A man’s risk for testicular cancer — and other types of cancer and disease, including diabetes and heart disease — may be reduced by making healthy lifestyle changes. These include eating a healthy diet, exercising regularly, maintaining a healthy weight, quitting smoking and reducing the consumption of alcohol.

Testicular cancer treatments and their impact

Testicular cancer is highly curable when appropriate treatment is received. Treatment for testicular cancer can include surgery, radiation therapy (also known as radiotherapy), chemotherapy and stem cell transplant.

“Stage 1 testicular cancer is usually treated with surgery, known as orchiectomy, and observation,” Dr. Carmona says. “Radiotherapy is often reserved for stage I patients who cannot undergo active surveillance with close follow-up and routine screening. Alternatively, stage I patients may be treated with orchiectomy followed by radiotherapy or single-drug chemotherapy, as these treatments reduce the risk of cancer persisting or reappearing compared to no follow-up treatment."

Patients with stage 2 cancer that has spread to the retroperitoneal lymph nodes, which are located behind the abdomen, are treated with orchiectomy and follow-up radiotherapy, he says.

Dr. Carmona notes that post-surgery follow-up care is very important to ensure the cancer has been removed or destroyed. Follow-up screening should be performed on a regular basis to watch for signs the cancer has returned.

Additionally, having testicular cancer and its treatment can affect a man’s fertility. “Treatment can damage sperm and reduce sperm count, which may have a negative impact on the patient’s ability to have children,” Dr. Carmona says.

Men and teens should talk with their doctor before receiving treatment for testicular cancer to determine whether storing sperm in a sperm bank is advised. Testosterone replacement treatments are available, and fertility may return in men who have one remaining testicle.

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