The most common type of testicular cancer is called a seminoma, a slow progressing type of cancer that does not usually spread to other areas of the body. This type of cancer is more common in men between the ages of 25-55, with a peak age of 35 years old. A rarer type of testicular cancer is called non-seminoma and may contain several types of cancer including one called teratoma.This less common type of cancer tends to affect men between the ages of 15-35, with a peak age of 25 years old.
Both of these cancers are also known as germ cell tumours. About 95% of testicular cancers will be germ cell cancers. Germ in this term means “seed” and refers to the sperm making process. Other tumours (mixed cell tumours) may contain elements of both types of the above.
Other rarer non germ cell tumours (Sertoli, Leydig) account for only a small percentage of testicular cancers. In addition 4% of men with lymphoma, usually over the age of 50 years may also have similar symptoms to testicular cancer with testicular swelling.
The type of testicular cancer that is present will be diagnosed when the results of the removed testicle have been analysed in the laboratory. This analysis will be able to differentiate between the various types of testicular cancer and in combination with the blood tests and scans that have been performed can be used to give an accurate picture of the extent of testicular cancer.This is known as a clinical stage and can be described using a medical method of categorising the extent of cancer called the TNM system, where:
T stands for tumour size
- TIS (testicular carcinoma insitu). Cancer cells are within the testes but they have not invaded the surrounding testicular tissue
- T1 Tumour confined to testicle and epididymis
- T2 Tumour has begun to infiltrate the blood vessels or lymph nodes close to the testicle
- T3 Tumour has grown as far as the spermatic cord and possibly blood vessels and lymph nodes
- T4 Tumour has invaded the scrotum.
N stands for lymph nodes
- N0 lymph nodes do not contain cancer cells
- N1 lymph nodes are smaller than 2cm wide
- N2 At least one lymph node is larger than 2cm but smaller than 5cm wide
- N3 At least one affected lymph node is bigger than 5cm
M stands for metastases
Metastases are deposits of cancer which form as a result of the primary cancer travelling to other organs in the body or bones. They are sometimes referred to as “secondaries”.Testicular cancer which has spread from its primary site in this way tends to be deposited in the lungs, liver or brain.
- M0 There is no evidence that the cancer has spread to other organs
- M1a The cancer has spread to the lungs or distant lymph nodes furthest away from the testicle.
- M1b Organs such as the liver or brain have been affected.
A further way of categorising testicular cancer is to split it into 3 stages (see below).
The results of tumour markers can also be added to either of these systems to predict possible treatment success. This is denoted as S where S stands for Serum markers.
- S0: Tumour marker levels within normal limits
- S1: LDH < 1.5 X Normal and HCG < 5,000 and AFP < 1,000
- S2: LDH 1.5-10 X Normal or HCG 5,000-50,000 or AFP 1,000-10,000
- S3: LDH > 10 X Normal or HCG > 50,000 or AFP > 10,000
Once a man has had an orchidectomy their follow up care will be carried out by an oncologist who will specialise in deciding whether any further treatment such as chemotherapy is needed.To ensure that men get the best possible treatment in line with current national and international cancer guidelinesan individuals particular circumstances will be discussed at a specialist medical forum called a Multi-Disciplinary Team Meeting (MDT).
The MDT Process
An MDT will consist of a group of medical experts including urologists, oncologists, radiologists (X-ray specialists) and other healthcare professionals. They will discuss each particular medical case taking into account the results of the operation, cancer findings along with the blood tests and scan results. They will then come up with a consensus opinion as to what if any, further treatment is needed. This will then be explained to men when they attend a follow up clinic appointment. Any decision made by this team will reflect their experience in dealing with similar cases to and will be based on the latest medical research and techniques. The recommendation or outcome of the meeting will always be in a man’s best interest.
Some hospitals will have nurses who specialise in testicular cancer (germ cell tumour nurse specialists) who will be able to guide men through their treatment or answer any specific questions they may have. They may also know of local support groups for men with testicular cancer which men may find helpful.
To read personal stories of men who have been affected and treated for testicular cancer please click here
To download a PDF file discussing diagnosis please click here
Last updated 27/7/17 Next review January 2018.
References available on request.