Testicular Cancer Metastasis

What is testicular cancer metastasis?

When abnormal cells in the body grow out of control, it is called cancer. A growth of cancer cells is called a tumor. If the cancer cells break away from the primary tumor and spread to other parts of the body, the tumor is called metastatic.

Testicular cancer is uncontrolled growth of abnormal cells, usually in one testicle. The testicles are part of the male reproductive system. They are in a sac of loose skin, called the scrotum or scrotal sac, which lies directly below the base of the penis. With time, the growth of the cancer causes the testicle to enlarge or form a lump that can be seen or felt. The lump may not cause any discomfort or it may be painful.

In metastatic testicular cancer the cancer has spread to other parts of the body. The most common places for the new tumors (metastases) are the lungs, lymph nodes, lungs, and later the liver and brain.

How does it occur?

The cause of testicular cancer is not known, but there are several risk factors. For example, men who have or have had an undescended testicle, whether or not it was surgically corrected, have a higher risk of developing testicular cancer. Testicular cancer is most common in men aged 15 to 35. It is unusual after the age of 40.

What are the symptoms?

Sometimes the first symptoms of testicular cancer are caused by metastases before the original tumor in the testicle is noticed. The new tumors may cause symptoms because they affect the function of the organs in which they are growing.

The symptoms of metastases depend on where the tumors are. If a new tumor has grown into the abdominal lymph nodes and lungs, for example, possible symptoms are:

• lower back pain and discomfort
• a cough
• trouble breathing.

How is it diagnosed?

A physical exam, chest X-ray, or CT scan may show that a tumor is growing in another part of the body (for example, the lungs). You will have blood tests to measure alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (beta-hCG). These substances are made normally by the body in small amounts but often by testicular cancers in large amounts. The amounts of these substances in the blood may relate to the amount of cancer in your body. However, AFP and beta-hCG are not, in themselves, damaging or dangerous.

How is it treated?

The treatment for this cancer depends on how large the tumor is, what cell type the tumor is, where it has spread, and your physical condition. Possible treatments are:

• Surgery (orchiectomy): The cancerous testicle is removed with surgery. This is almost always done, both as treatment and for diagnosis, even if the cancer has spread.
• Retroperitoneal lymph node dissection: The lymph nodes in the area around the bones of the lower spine are surgically removed. These lymph nodes are where testicular cancer usually spreads first. Lymph is body tissue fluid. The lymph nodes are tissues that drain and filter lymph as it flows back to the lungs and heart. They often catch cancer cells floating away from a testicular tumor. The lymph nodes are examined under a microscope for cancer.
• Radiation therapy: For a type of testicular cancer called seminoma, radiation to the lymph nodes after surgery is very effective in killing cancer cells. It may cure the cancer. Although extra radiation therapy may be given to specific areas of cancer spread, less than the usual amount of radiation is necessary to kill this kind of testicular cancer.
• Chemotherapy: Anticancer drugs are used to kill the cancer cells. Metastatic testicular cancer usually responds well to chemotherapy and can very often be cured. Your sperm may be collected before the start of chemotherapy because you could become temporarily or permanently sterile from the treatment.

After treatment your healthcare provider will recommend regular checkups for the first year. Then you will need checkups slightly less often for the next 2 years to see if the cancer recurs. It is important to follow your provider's recommendations so that any recurrence can be detected early. Most recurrences happen within the first 2 years after treatment.

How long will the effects last?

If your treatment destroys the cancer, the symptoms caused by the cancer will go away. The treatment may cause some discomfort or side effects, but these usually improve or go away after treatment is completed.

How long you will live after metastatic testicular cancer is discovered depends on how much the cancer has spread, where it has spread, your physical condition, and the type of testicular cancer. The chances of a complete recovery are usually very good and much better than they are for many other cancers. Cure rates for metastatic testicular cancer are 80 to 90%.

How can I take care of myself?

• Follow your healthcare provider's advice.
• Eat a healthy diet.
• Get plenty of rest.
• Recognize that having the cancer is an added stress in your life. Take more time for your important relationships and for rest.
• Ask your healthcare provider any questions you have about the course of the disease, treatments, side effects of the treatments (such as sterility), sexuality, support groups, and anything else that concerns you.
• Ask your provider about alternative methods of pain control, such as relaxation techniques, guided imagery, and hypnosis.
• Ask your provider about your ability to have children after your treatment. Your provider may recommend that you place sperm in a sperm bank before you start treatment, just in case it decreases your fertility.
• For more information, contact:

  American Cancer Society, Inc.
  Phone: 800-ACS-2345 (800-227-2345)
  Web site: http://www.cancer.org

  National Cancer Institute
  Phone: 1-800-4CANCER, or 1-800-422-6237 (TTY: 1-800-332-8615)
  Web site: http://www.cancer.gov

How can I prevent the spread of testicular cancer?

Because the chance for cure depends on finding the cancer early and treating it before it spreads too far, it is important to examine your testicles often. Support your testicles with one hand and feel each one with your other hand. You will feel the smooth bump or epididymis, which covers the top, back, and bottom of each testicle. Gently separate it from the testicle with your finger and feel the testicle itself. Report any lump in the scrotum or testicle, pain or discomfort, or enlargement of the scrotum to a healthcare provider as soon as possible.

Regular checkups are especially important if you have had an undescended testicle.