Testicular Cancer and Laboratory Tests

Testicular cancer is a rare form of cancer (the abnormal, uncontrolled growth of cells) that occurs in the testicles. Typically, males have two testicles, which are part of the reproductive system. Also referred to as gonads, these egg-shaped glands are held in a sac known as scrotum just below the penis. They have a slightly spongy feel, with uniform firmness and similar size. Testicles are responsible for sperm production and ideally make hormones like testosterone, which controls sex drive and starts the growth of muscles and body hair in males.

Testicular cancer can affect any boy or man of any age, but it usually affects those between the age of 20 and 35, and the average diagnosis age is 33. According to the American Cancer Society, around 9,000 men are diagnosed with the condition in the US each year, and about 4% of the patients die of it.

Fortunately, testicular cancer is treatable, and it’s one of the most curable forms of cancer. It has a five-year relative survival rate of 99% if it hasn’t spread beyond the testicles. However, if left unattended, it can spread to nearby organs, affecting the lymph nodes and even making its way to vital organs like lungs. The survival rate for regional cancer (one that has spread to nearby tissues or lymph nodes) is 96%, and that of distant cancer (spread to other organs) is 73%. When it comes to curing testicular cancer, early detection and treatment are vital.

Testicular Cancer Risk Factors Include:

  • Gonadal dysgenesis- the abnormal development of testicles
  • Prior cancer in one gonad
  • Cryptorchidism or undescended testicles.
  • History of a father or brother with testicular cancer
  • Abnormal cells in the testicles known as germ cell neoplasia in situ.
  • HIV infection
  • Stature- According to some studies, tall men have a higher risk of getting testicular cancer, but this hasn’t been proven.
  • Race- Caucasian men are at a higher risk for this type of cancer compared to Hispanic, African, and Asian males. However, the cause of this risk hasn’t been discovered.

Types of Testicular Tumors

  • Stromal Tumors: These types of tumors account for 5% of testicular tumors in adults and 20% in children. They form in the tissues that make hormones and support the testicles. They are usually non-cancerous, and the primary types include:
  • Leydig Cell Tumor: This type of tumor forms in the cells responsible for producing male sex hormones like testosterone. The tumor itself can produce male sex hormones and, sometimes, estrogen (a female sex hormone), which leads to breast enlargement.
  • Sertoli Cell Tumor: This one affects cells that support germ cells, which are responsible for sperm production.
  • Germ Cell Tumor: This one affects the cells that produce sperm. It accounts for over 90% of testicular cancers. These can be separated into two categories, seminomas, and nonseminomas. Some of these tumors have both seminoma and nonseminomas tissues. The former type is less aggressive, meaning they develop slowly are less likely to metastasize or spread to other tissues or organs. They come two types, typical or classical (which make up around 95% of seminomas) and spermatocytic, which are rare and tend to affect older males. Nonseminomas or non-seminomatous germ cell tumors come in four types. These include teratomas, yolk sac tumors, choriocarcinomas, and embryonal carcinomas. These tend to spread faster than seminomas and usually affect younger men.

Some other forms of cancer, like lymphoma, can spread from other tissues and organs to the testicles, but they are not considered true testicular cancers as they are treated differently.

Signs & Symptoms

Often, testicular cancer is initially detected as a painless swelling or lump in the testicle. Affected individuals usually discover these tumors by accident or when examining themselves. However, they can ideally be discovered during a routine physical evaluation or a medical test that’s being conducted for other reasons like infertility evaluation.

Testicular cancer usually doesn’t give warning signs, but it may cause subtle symptoms like:

  • Dull pain in the groin or abdomen
  • Breast growth
  • Pain in the testicles
  • Early puberty with signs like body or facial growth and deepening of the voice

Keep in mind that these symptoms can be a result of other conditions like inflammation or injury and so, you should not be quick to conclude its cancer.

Early Testicular Cancer Detection

Currently, there are no means to screen for testicular cancer. Also, there are no studies that show if self-exams, regular evaluations by a practitioner, or other screening tests in males with no testicular cancer symptoms would reduce the risk of death from the condition.

Some doctors recommend individuals between 15 and 55 years to do a monthly self-evaluation to identify any changes in their gonads. Most, if not all, doctors agree that a testicular exam should be included in every general physical evaluation. The American Cancer Society (ACS) recommends the exam as part of cancer-related checkups, but it doesn’t have recommendations for testicular self-exams. Those who are at a higher risk for the condition may want to do a self-exam once per month.

Testicular Cancer Lab Tests

Various tests can be done to check for testicular cancer. These are primarily blood tests that look for elevated amounts of the proteins discussed below:

Alpha-fetoprotein (AFP)

Nonseminoma germ cells usually produce AFP. Seminoma germ cell tumors, on the other hand, don’t. So, if an individual’s AFP levels are high, the doctor will know that their tumor is composed of nonseminoma cells, and the cancer should be treated as such.

Human Chorionic Gonadotropin (hCG)

Both seminomas and nonseminomas (non-seminomatous germ cell tumors) can lead to the elevation of hCG levels in the blood.

Keep in mind that Sertoli and Leydig cell tumors (going under the umbrella term Stromal tumors) don’t produce hCG or AFP, and so, they won’t lead to the increase in blood levels of each.

Lactate dehydrogenase (LDH)

The levels of this protein can go up in the presence of most testicular cancer types. LDH is a type of enzyme present in many body tissues and makes its way into the bloodstream when a cell is damaged. However, it’s not specific for this type of cancer, as many conditions can cause LDH levels to rise. If an individual has testicular cancer, high LDH levels can be a sign that it is widespread.

Testicular ultrasound can also be conducted to check for suspicious lumps. X-rays can also be done to check whether the cancer has spread to lymph nodes and other vital organs.