Types and Stages of Testicular Cancer

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Testicular cancer affects about one out of every 250 boys and men in the United States, resulting in over 9,500 cases a year. The good news is if it’s caught early, testicular cancer can often be treated successfully. Several factors affect the overall prognosis, including the type of testicular cancer, testicular cancer staging, and the patient’s individual history.

Testicular Cancer Testing

Like most cancers, testicular cancer is staged according to how far it has spread. Initial screening typically begins with a physical exam to check for any lumps. If there are any, your doctor will likely order an ultrasound of your scrotum and testicles to confirm if there is a lump and how large it is. The ultrasound can also tell your doctor if the lump is solid or filled with fluid. Blood tests can show if there are any tumor markers, substances that your body might produce to try to fight the cancer cells, or products from the cancer cells themselves.

For most other cancers, doctors remove a small amount of tissue for a biopsy to determine the type of cancer. With testicular cancer, the entire affected testicle is removed in a procedure called a radical inguinal orchiectomy. The tissue is then examined to determine the specific type of testicular cancer.

Types of Testicular Cancer
There are two main types of testicular cancer: germ cell tumors and stromal tumors. Germ cell tumors are the most common type, accounting for more than 90% of adult testicular cancers. These tumors start in the germ cells, which produce sperm. Germ cell tumors have two subtypes—seminoma and nonseminoma—and it is possible to have both at the same time.

Seminomas, which tend to be slower-growing, are divided into two more subgroups:

  • Classical seminoma is the most common, making up about 95% in this category, and typically occurs in men 25 to 45.
  • Spermatocytic seminoma make up the remaining germ cell tumors and occur more often in older men over age 65.

Nonseminoma germ cell tumors are divided into four categories, and men can have more than one at the same time:

  • Embryonal carcinoma is a rapidly growing and aggressive form; these cells are found in 40% of testicular tumors.
  • Yolk sac carcinoma is more common among boys and has a good prognosis with chemotherapy.
  • Choriocarcinoma is a rare but very aggressive type of cancer that is more likely to spread to other parts of the body.
  • Teratoma is most often seen mixed with another type of germ cell tumor.

Stromal tumors are much rarer than germ cell tumors, making up less than 5% of adult testicular cancer cases. (However, they account for 20% of testicular tumors in children.) They are divided into two subtypes—Leydig cell and Sertoli cell—and they have a good prognosis when treated early.

Testicular Cancer Staging

Testicular cancer treatment is based not only on testicular cancer type, but by its stage:

  • Stage 0: Stage 0 is considered to be pre-cancerous and is also called “in situ,” which means in place. There is no actual tumor yet, although there are cancerous cells and some changes in the tissue. These can be treated with surgery and/or radiation therapy, but your doctor may recommend a “watchful waiting” approach first, particularly if maintaining your fertility is important.
  • Stage 1 (I): The tumor is still localized to the testicle. Stage 1 has subgroups IA, IB and IS. This indicates how deep into the testicle tissue the tumor has invaded.
  • Stage 2 (II): The tumor has spread to areas near the testicle, such as the retroperitoneal lymph nodes, the pelvis, or behind the intestines.
  • Stage 3 (III): The cancer has spread beyond the lymph nodes, most often to the chest, lungs, or lymph nodes in the neck and chest.

Doctors use the same TNM staging system used for other cancers to describe a testicular cancer stage, but with the addition of an S factor:

  • T stands for the tumor—how large it is and where it is located.
  • N stands for the lymph nodes and if the cancer has spread.
  • M stands for metastasis, or if the cancer has spread to other parts of the body.
  • S stands for the serum tumor marker, which is determined from a blood test.

Talking to Your Oncologist About Testicular Cancer Treatments

Once your type and stage of testicular cancer have been confirmed, your oncologist will outline a treatment plan. Ask questions if you don’t understand something and ask your doctor to repeat the information if needed. You are an important part of your cancer treatment team, and by knowing all of your options, you and your doctors can work together to find the right treatment plan for you.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 May 20
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