Testicular Cancer - What You Need To Know
1 in 250 males will develop testicular cancer in their lifetime. While testicular cancer is not very common, the cancer has increased over the last few decades. The American Cancer Society predicts that there will be 9,190 new cases of testicular cancer in the US in 2023.
Featuring:
Andrew Cook, MD
Andrew Cook, MD is a Radiation Oncologist with Franciscan Health Comprehensive Cancer Institute at Olympia Fields. Transcription:
Scott Webb: One in 250 males will develop testicular cancer in their lifetime. And while it's not very common, the cancer has increased over the last few decades. The American Cancer Society predicts there will be over 9,000 new cases of testicular cancer in the US in 2023. And I'm thankful to have Dr. Andrew Cook here today. He's a radiation oncologist with Franciscan Health Comprehensive Cancer Institute at Olympia Fields, and he's going to tell us about the types symptoms and treatment options for testicular cancer.
This is the Franciscan Health Doc Pod. I'm Scott Webb. So doctor, thanks so much for your time. I mentioned in my intro that one in 250 males will develop testicular cancer in their lifetime. And as a male, I find that statistic to be alarming. So, I'm glad to have you on and glad to have your expertise. Let's start here. What is testicular cancer and are there different types and is there one that's maybe more common than the others?
Dr. Andrew Cook: In terms of what is testicular cancer, the name kind of gives it away that it's really a cancer, primary cancer of the testicle area, so something arising out of that organ there. In terms of the different types, there are a few different types. We split them up into what we call germ cell tumors and non-germ cell tumors. So, the germ cell tumors, those by far are the most common. We're talking about over 95% of patients, that's the kind that they present with. Now within germ cell tumors, that's where we have different categories there too. You may have heard of tumors such as a seminoma and a non-seminomatous tumor. And so, those are by far though the most common compared to the non-germ cell tumors.
Scott Webb: All right. So, germ cell tumors most of the time. And I was also, in doing my research for this, reading about secondary testicular cancer, which also sounds bad. So, which types of cancers can spread to the testicles?
Dr. Andrew Cook: Yeah, that one's a little bit different. So when we're talking about secondary testicular cancer, that's not something that arises in the testicle. That's a cancer that travels there from somewhere else in the body. And so, we do see that a little bit. That's much more rare, of course, than primary testicular cancer. But if you're thinking about a secondary testicular cancer, this is where we're talking about the blood disorders type of things, like lymphomas and leukemias. And by far, the most common is lymphoma that travels to the testicle there. And so, that's what we're dealing with most of the time when we think about a secondary testicular cancer.
Scott Webb: All right. So primary versus secondary, secondary obviously not as common. Is there a profile? When we think about sort of picture the person who's most likely to walk into your office, what's the average age of diagnosis?
Dr. Andrew Cook: I'd say overall average age is 33 around there. But it does depend a little bit on what type of tumor we're talking about. If we're thinking back to those different types I talked about before, like a non-seminomatous germ cell tumor, those are a little bit younger, 20 to 30. If you're thinking about a seminoma, just a little bit older, 30 to 40-year-old men. If we're talking, you know, going to the lymphomas, the secondary cancers, those you start to think a little bit older, so over 60. But you know, the most common, again, those seminomas and things, those are roughly around age 30.
Scott Webb: All right. And I'm sure there are many, but let's go through at least some of the risk factors that men should know about.
Dr. Andrew Cook: Yeah, I would say probably the biggest one that always comes to mind for me here is an undescended testicle. That's really in the history of a lot of these men, something that we ask about and something that comes up there. Of course, you know, if there's a family history of testicular cancer, that'll put someone at a bit of a higher risk. HIV infection can also be a risk factor, and there are some risk factors as well that can be related, like race and ethnicity. And typically, Caucasian men tend to see the highest risk for testicular cancer.
Scott Webb: Yeah. So, a lot of risk factors, some of which maybe we can control, maybe like body size, body weight, obesity, things like that. But in general, a lot of it sounds like it's family history, genetics, race, those things that are, unfortunately, beyond our control sometimes.
Dr. Andrew Cook: Yeah, unfortunately.
Scott Webb: Yeah, especially our family history of course. And I think I know the answer to this, but from your expertise, do you have any sense of what causes at least the primary testicular cancer?
Dr. Andrew Cook: Yeah. Unfortunately, I don't have a great answer for that. I'm not sure anybody really does. It's really an unknown area in medicine right now. In terms of these studies that have come out, some point to some possible genetic causes, but a lot of that's still being parsed out in the literature. And really, I just don't, unfortunately, have a great answer to that right now.
Scott Webb: Yeah, for sure. And as I said, you know, there's just so many things beyond our control that would put us at risk, gender, age, race. And we don't really know what causes it. So, it would be hard to think in terms of prevention anyway. So then, let's talk about if men are experiencing some of the signs and symptoms. You know, so many things could be one thing or it could be something else. So, give us a sense of when we should reach out to a provider and say, you know, "Something's wrong down here. I think I need someone to take a look."
Dr. Andrew Cook: Of course, anytime you're concerned about anything, that's why we're here. By far the most common symptom that men will present with to start this whole process out is a painless mass, or there's some kind of painless swelling of one of their testicles. A little bit less often that there can be kind of a dull ache down there. And sometimes these tumors can secrete these certain substances throughout the body. Men can actually grow breasts and that can be a presenting symptom for them. And actually, over 50% of men who have these tumors, they can actually present with infertility too. So, that's kind of these masses, these testicular cancers are found during the workup of, you know, men who are just having issues with infertility.
Scott Webb: Sure. Yeah. It's one of these things. You know, I do a lot of these and so I get experts like yourself on, it's like there's a lot we don't know, but there's a lot we do know. And the stuff you do know is really helpful today. So as we wrap up here, doctor, let's talk about treatment, right? I'm sure it's surgery and radiation and so on, but take us through this. What are our options if we're diagnosed with either primary or maybe secondary, but definitely primary testicular cancer.
Dr. Andrew Cook: Yeah. So especially primary testicular cancer, the first thing that's going to happen for these guys is they go to surgery, meaning that the testicle is removed as well as what we call the spermatic cord that's attached to the testicle there. So, that's first thing, got to do that. We get a lot of information from that. And then, after, you know, some workup and things like that, we can get a sense of the stage of the patient.
And particularly, so thinking about the seminomas for these primary testicular cancers, stage I, actually we found that a lot of these men after they get the surgery, they can continue to just be watched very closely, but we can actually spare a lot of these men who have these early stage tumors from getting chemotherapy or radiation. When you start to get into like the stage II category for seminomas, meaning sometimes there's lymph nodes, some other types of characteristics, that's when you start to think along the lines of giving radiation afterwards and sometimes chemotherapy.
For those nonseminomatous germ cell tumors after surgery, radiation isn't used too much in that category and more of those patients, we tend to give chemo a little bit more often for them. So radiation, more so with the seminomas; nonseminomatous, definitely chemo after the surgery.
Scott Webb: Yeah. And it sounds like especially, you know, again, doing many of these when it comes to cancer, early diagnosis would be really helpful and beneficial, both to the patients and those treating them like yourself. So, really informational, educational. Great job today, doctor. Thanks so much. You stay well.
Dr. Andrew Cook: Yeah. Thanks so much, Scott. You take care.
Scott Webb: And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.
Scott Webb: One in 250 males will develop testicular cancer in their lifetime. And while it's not very common, the cancer has increased over the last few decades. The American Cancer Society predicts there will be over 9,000 new cases of testicular cancer in the US in 2023. And I'm thankful to have Dr. Andrew Cook here today. He's a radiation oncologist with Franciscan Health Comprehensive Cancer Institute at Olympia Fields, and he's going to tell us about the types symptoms and treatment options for testicular cancer.
This is the Franciscan Health Doc Pod. I'm Scott Webb. So doctor, thanks so much for your time. I mentioned in my intro that one in 250 males will develop testicular cancer in their lifetime. And as a male, I find that statistic to be alarming. So, I'm glad to have you on and glad to have your expertise. Let's start here. What is testicular cancer and are there different types and is there one that's maybe more common than the others?
Dr. Andrew Cook: In terms of what is testicular cancer, the name kind of gives it away that it's really a cancer, primary cancer of the testicle area, so something arising out of that organ there. In terms of the different types, there are a few different types. We split them up into what we call germ cell tumors and non-germ cell tumors. So, the germ cell tumors, those by far are the most common. We're talking about over 95% of patients, that's the kind that they present with. Now within germ cell tumors, that's where we have different categories there too. You may have heard of tumors such as a seminoma and a non-seminomatous tumor. And so, those are by far though the most common compared to the non-germ cell tumors.
Scott Webb: All right. So, germ cell tumors most of the time. And I was also, in doing my research for this, reading about secondary testicular cancer, which also sounds bad. So, which types of cancers can spread to the testicles?
Dr. Andrew Cook: Yeah, that one's a little bit different. So when we're talking about secondary testicular cancer, that's not something that arises in the testicle. That's a cancer that travels there from somewhere else in the body. And so, we do see that a little bit. That's much more rare, of course, than primary testicular cancer. But if you're thinking about a secondary testicular cancer, this is where we're talking about the blood disorders type of things, like lymphomas and leukemias. And by far, the most common is lymphoma that travels to the testicle there. And so, that's what we're dealing with most of the time when we think about a secondary testicular cancer.
Scott Webb: All right. So primary versus secondary, secondary obviously not as common. Is there a profile? When we think about sort of picture the person who's most likely to walk into your office, what's the average age of diagnosis?
Dr. Andrew Cook: I'd say overall average age is 33 around there. But it does depend a little bit on what type of tumor we're talking about. If we're thinking back to those different types I talked about before, like a non-seminomatous germ cell tumor, those are a little bit younger, 20 to 30. If you're thinking about a seminoma, just a little bit older, 30 to 40-year-old men. If we're talking, you know, going to the lymphomas, the secondary cancers, those you start to think a little bit older, so over 60. But you know, the most common, again, those seminomas and things, those are roughly around age 30.
Scott Webb: All right. And I'm sure there are many, but let's go through at least some of the risk factors that men should know about.
Dr. Andrew Cook: Yeah, I would say probably the biggest one that always comes to mind for me here is an undescended testicle. That's really in the history of a lot of these men, something that we ask about and something that comes up there. Of course, you know, if there's a family history of testicular cancer, that'll put someone at a bit of a higher risk. HIV infection can also be a risk factor, and there are some risk factors as well that can be related, like race and ethnicity. And typically, Caucasian men tend to see the highest risk for testicular cancer.
Scott Webb: Yeah. So, a lot of risk factors, some of which maybe we can control, maybe like body size, body weight, obesity, things like that. But in general, a lot of it sounds like it's family history, genetics, race, those things that are, unfortunately, beyond our control sometimes.
Dr. Andrew Cook: Yeah, unfortunately.
Scott Webb: Yeah, especially our family history of course. And I think I know the answer to this, but from your expertise, do you have any sense of what causes at least the primary testicular cancer?
Dr. Andrew Cook: Yeah. Unfortunately, I don't have a great answer for that. I'm not sure anybody really does. It's really an unknown area in medicine right now. In terms of these studies that have come out, some point to some possible genetic causes, but a lot of that's still being parsed out in the literature. And really, I just don't, unfortunately, have a great answer to that right now.
Scott Webb: Yeah, for sure. And as I said, you know, there's just so many things beyond our control that would put us at risk, gender, age, race. And we don't really know what causes it. So, it would be hard to think in terms of prevention anyway. So then, let's talk about if men are experiencing some of the signs and symptoms. You know, so many things could be one thing or it could be something else. So, give us a sense of when we should reach out to a provider and say, you know, "Something's wrong down here. I think I need someone to take a look."
Dr. Andrew Cook: Of course, anytime you're concerned about anything, that's why we're here. By far the most common symptom that men will present with to start this whole process out is a painless mass, or there's some kind of painless swelling of one of their testicles. A little bit less often that there can be kind of a dull ache down there. And sometimes these tumors can secrete these certain substances throughout the body. Men can actually grow breasts and that can be a presenting symptom for them. And actually, over 50% of men who have these tumors, they can actually present with infertility too. So, that's kind of these masses, these testicular cancers are found during the workup of, you know, men who are just having issues with infertility.
Scott Webb: Sure. Yeah. It's one of these things. You know, I do a lot of these and so I get experts like yourself on, it's like there's a lot we don't know, but there's a lot we do know. And the stuff you do know is really helpful today. So as we wrap up here, doctor, let's talk about treatment, right? I'm sure it's surgery and radiation and so on, but take us through this. What are our options if we're diagnosed with either primary or maybe secondary, but definitely primary testicular cancer.
Dr. Andrew Cook: Yeah. So especially primary testicular cancer, the first thing that's going to happen for these guys is they go to surgery, meaning that the testicle is removed as well as what we call the spermatic cord that's attached to the testicle there. So, that's first thing, got to do that. We get a lot of information from that. And then, after, you know, some workup and things like that, we can get a sense of the stage of the patient.
And particularly, so thinking about the seminomas for these primary testicular cancers, stage I, actually we found that a lot of these men after they get the surgery, they can continue to just be watched very closely, but we can actually spare a lot of these men who have these early stage tumors from getting chemotherapy or radiation. When you start to get into like the stage II category for seminomas, meaning sometimes there's lymph nodes, some other types of characteristics, that's when you start to think along the lines of giving radiation afterwards and sometimes chemotherapy.
For those nonseminomatous germ cell tumors after surgery, radiation isn't used too much in that category and more of those patients, we tend to give chemo a little bit more often for them. So radiation, more so with the seminomas; nonseminomatous, definitely chemo after the surgery.
Scott Webb: Yeah. And it sounds like especially, you know, again, doing many of these when it comes to cancer, early diagnosis would be really helpful and beneficial, both to the patients and those treating them like yourself. So, really informational, educational. Great job today, doctor. Thanks so much. You stay well.
Dr. Andrew Cook: Yeah. Thanks so much, Scott. You take care.
Scott Webb: And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.