Testicular cancer is a disease in which malignant (cancer) cells form in the tissues of one or both testicles.
Possible signs of testicular cancer include swelling or discomfort in the scrotum.
These and other symptoms may be caused by testicular cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
•A painless lump or swelling in either testicle
•A change in how the testicle feels
•A dull ache in the lower abdomen or the groin
•A sudden build-up of fluid in the scrotum
•Pain or discomfort in a testicle or in the scrotum
Listen in as Dr Jonathan Yamzon Discusses testicular cancer, it's symptoms and the latest advances in treatments.
Testicular Cancer: What Every Man Needs to Know
Featured Speaker:
Dr. Jonathan Yamzon
Dr. Yamzon is a surgical expert specializing in the treatment of urologic cancers. He joined City of Hope's surgical team following the completion of a robotic surgery fellowship within City of Hope's Division of Urology and Urologic Oncology Surgery. Dr. Yamzon received his medical doctorate from Keck School of Medicine of University of Southern California (USC). His clinical interests include the treatment of urologic cancers using robotic and open surgical techniques, benign prostatic disease, stone disease, incontinence and general urology. He speaks fluent Spanish and Tagalog. Transcription:
Testicular Cancer: What Every Man Needs to Know
Melanie Cole (Host): City of Hope is actively developing tomorrow’s treatment protocols today for testicular cancer. My guest today is Dr. Jonathan Yamzon. He’s a clinical assistant professor in urology and urologic oncology at City of Hope Comprehensive Cancer Center. Welcome to the show, Dr. Yamzon. What is testicular cancer?
Dr. Jonathan Yamzon (Guest): Good morning, Melanie. Thanks for having me. Testicular cancer is probably the most common solid organ tumor of young men, anywhere from puberty to age range of 45, and it develops in the testicle. You can have multiple tumors in the testicle, but testicular cancer, 95 percent of it is what we call a germ cell tumor. It develops or it is first detected upon feeling or examining the testicle, and it typically is a firm, nodular hardness to the testicle that, surprisingly, men feel and sometimes don’t get evaluated right away. It is detected upon examination, and ultrasound of the testicle can further delineate this from anything else.
Melanie: Well, I can understand how men would not get it checked right away because men typically, we’re the ones who have to shove them in to see a urologist anyway. Do you advise that men do a check, just like women, we do a self-breast exam? Do you advise men to do this check?
Dr. Yamzon: We do. In fact, this is a standard thing for men when they see their primary care physician. Their primary care physicians will routinely do a testicular exam when they’re from that age group, the young age group, that is. I do recommend that men perform self-examination and get familiar with the anatomy down there, and if there is any sort of change, then they should call this to the attention of their physician, who can then order the appropriate tests or refer them appropriately to the urologist to examine this further.
Melanie: Are there certain risk factors which would predispose a man to having testicular cancer?
Dr. Yamzon: Great question. There are. The single most notable risk factor is when a man has a history of the testicle being undescended in childhood. The descent of the testicle happens late in utero, and sometimes it fails to descend completely when children are born prematurely. That kind of history where the testicle did not make it all the way down into the scrotum or required some sort of assistance or surgical intervention, it’s those men that will have an increased risk of developing a tumor in the testicle. Sometimes, about maybe 5 percent of the time, whatever [insult] took place for one site descend, it affects the opposite or normal testes, and tumors can develop rarely on that side. There are other risk factors including what we call testicular atrophy. If the testes didn’t develop fully for some unknown reason, that testicle also has an increased risk of developing testicular cancer. Interestingly, maybe 10 to 15 percent of testes cancers are detected when men are seeking assistance with regard to infertility issues, and so it’s upon the workup of infertility that physicians recognize, hey, there’s a tumor here in your testicle and we need to further look this up.
Melanie: If a man feels a lump, goes in to see you, are there other symptoms that you want to let the listeners know about that, if they’re not feeling a lump, that might come up?
Dr. Yamzon: Usually the lump is the primary thing. On occasion, you get symptoms of disease that has already disseminated or spread. We’ve had patients present in advanced matters where they’re feeling abdominal pain, abdominal fullness, even back pain. The route of spread of testes cancer follows, for the most part, a relatively set pattern where the lymph nodes and the back of the abdomen or its retroperitoneum become involved or metastatic sites. These tumors can be quite large where they are impinging or applying pressure to the adjacent organs and musculature so that patient feels these kinds of symptoms of back pain, etcetera. Those are the kinds of symptoms that would manifest as well, beside patients present with shortness of breath because they’ve developed tumor metastases into the lungs, or even feeling palpable masses all the way up into the lymph node chain toward the neck, which were firm and they just sort of developed over time, and sometimes they are overlooked. Patients within this age group have very busy lives and they sort of just blow them off, and finally when they get evaluated, they recognize that hey, there’s a large testicle also. And finally, the imaging reveals that this is a testes cancer.
Melanie: Dr. Yamzon, once it is diagnosed, how is it treated? What are the typical treatments. Because I think this is probably the scariest but yet, most interesting part of this conversation is because men are worried about what the treatment involves.
Dr. Yamzon: Well, the treatment will depend at the stage at the time of diagnosis. In general, if men present early and the testicle is really the primary site of detection, then the testicle is removed. And then, depending on what the pathologist finds, because the testicle is removed and sent off to a pathologist and they’ll look at it under a microscope and tell us the different cellular subtypes of testes cancer and then, based on that, the treatment regimens are a little different. You can have things called seminoma, where it is very radio and chemo-sensitive. In general, if there is no evidence of spread, the removal of the testicle may be curative at usually 80 percent of the time. Part of the staging process is not only looking at or examining the testicle with the ultrasound, but also doing what we call a CT scan. The CT scan will cover the chest, the abdomen, and the pelvis and will tell us to what extent the disease has spread. The unique thing about testes cancer is that it also has tumor markers. It’s really the model of a lot of cancers in that it has specific blood detectable markers that are indicative of the subcellular subtypes and the activity, and we can use these tumor markers to monitor its response to therapies. Going back to treatment, if the tumor was confined only to the testicle, we opt to survey or watch everybody moving forward because up to 80 percent of these patients are cured with just the removal of the testicle alone. If there is disease in the retroperitoneum, and depending on the size of the disease --- but usually, if there is disease in the retroperitoneum, they move on to something like chemotherapy. If there is a very small or limited disease in the retroperitoneum, they may be eligible for radiotherapy if it’s only seminoma. But if there are multiple subtypes of testes cancer, then they’ll want to get chemotherapy. Usually these tumors respond well, for the most part, to the chemotherapy. If there are residual tumors remaining despite the chemo, then these could be surgically removed.
Melanie: Now, side effects. If you have to remove a testes, men I’m sure are worried about -- is there any involvement or sexual dysfunction that goes with that removal? I mean, if the cancer is gone, they should be happy about that, but then may worry about the side effects.
Dr. Yamzon: Good question. With regard to sexual dysfunction, upon removal of the testicle -- really the only thing that we concern ourselves about at that level is the potential for infertility, the potential compromising the natural conception of a child because it may potentially affect one’s sperm counts. Before we embark on any therapy, we encourage men to engage in sperm banking. It’s a difficult thing in today’s medical, and a lot of insurances don’t cover this. So it becomes a difficult task for those who don’t have the means to do so. We do encourage men to cryopreserve their sperm in the event that they wish to father a child in the future. The removal of testicle may affect one’s fertility, and subsequent therapy such as chemotherapy may also do that. And it’s for these reasons we have patients bank sperm when it’s feasible for them. I did mention to you the surgery earlier, which we pretty much do now after chemotherapy when there are residual masses after chemotherapy. There are a set of nerves in the area of the retroperitoneum that make the way down to the pelvis, and they’re responsible for the coordinated contractions that occur in the act of ejaculation. This is the forward propagation of semen so that it’s deposited into the vaginal vault. When some of these nerves are disrupted or if it’s infeasible to preserve them, then we have to compromise these nerves to remove the tumor. Men may have difficulty or men may not experience ejaculation appropriately. They may not propel semen in a forward direction, let alone propel any at all following a surgery like that.
Melanie: But they can still have an erection? One thing has nothing to do with the other, right?
Dr. Yamzon: Exactly. They can still have an erection. They can still experience orgasm or heightened sense of climax during intercourse, but it really becomes a conception or fertility issue at that point.
Melanie: In just the last minute if you would, Dr. Yamzon, please tell the listeners why they should come to City of Hope for their urologic cancer care.
Dr. Yamzon: Well, at City of Hope we have a very experienced team. We cover all aspects of urologic oncology, and we’re a tertiary cancer center. We specialize in treatment of these very advanced cancers, and we have got it broken down into a very set pattern. We got minimal variations. We minimize our complications, and we are contributors to the national comprehensive cancer network guidelines. And so, we find ourselves at the forefront in conjunction with other major cancer centers in developing the treatment paradigms and optimizing them.
Melanie: Thank you so much. You are listening to City of Hope radio. For more information, you can go to cityofhope.org. That is cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Testicular Cancer: What Every Man Needs to Know
Melanie Cole (Host): City of Hope is actively developing tomorrow’s treatment protocols today for testicular cancer. My guest today is Dr. Jonathan Yamzon. He’s a clinical assistant professor in urology and urologic oncology at City of Hope Comprehensive Cancer Center. Welcome to the show, Dr. Yamzon. What is testicular cancer?
Dr. Jonathan Yamzon (Guest): Good morning, Melanie. Thanks for having me. Testicular cancer is probably the most common solid organ tumor of young men, anywhere from puberty to age range of 45, and it develops in the testicle. You can have multiple tumors in the testicle, but testicular cancer, 95 percent of it is what we call a germ cell tumor. It develops or it is first detected upon feeling or examining the testicle, and it typically is a firm, nodular hardness to the testicle that, surprisingly, men feel and sometimes don’t get evaluated right away. It is detected upon examination, and ultrasound of the testicle can further delineate this from anything else.
Melanie: Well, I can understand how men would not get it checked right away because men typically, we’re the ones who have to shove them in to see a urologist anyway. Do you advise that men do a check, just like women, we do a self-breast exam? Do you advise men to do this check?
Dr. Yamzon: We do. In fact, this is a standard thing for men when they see their primary care physician. Their primary care physicians will routinely do a testicular exam when they’re from that age group, the young age group, that is. I do recommend that men perform self-examination and get familiar with the anatomy down there, and if there is any sort of change, then they should call this to the attention of their physician, who can then order the appropriate tests or refer them appropriately to the urologist to examine this further.
Melanie: Are there certain risk factors which would predispose a man to having testicular cancer?
Dr. Yamzon: Great question. There are. The single most notable risk factor is when a man has a history of the testicle being undescended in childhood. The descent of the testicle happens late in utero, and sometimes it fails to descend completely when children are born prematurely. That kind of history where the testicle did not make it all the way down into the scrotum or required some sort of assistance or surgical intervention, it’s those men that will have an increased risk of developing a tumor in the testicle. Sometimes, about maybe 5 percent of the time, whatever [insult] took place for one site descend, it affects the opposite or normal testes, and tumors can develop rarely on that side. There are other risk factors including what we call testicular atrophy. If the testes didn’t develop fully for some unknown reason, that testicle also has an increased risk of developing testicular cancer. Interestingly, maybe 10 to 15 percent of testes cancers are detected when men are seeking assistance with regard to infertility issues, and so it’s upon the workup of infertility that physicians recognize, hey, there’s a tumor here in your testicle and we need to further look this up.
Melanie: If a man feels a lump, goes in to see you, are there other symptoms that you want to let the listeners know about that, if they’re not feeling a lump, that might come up?
Dr. Yamzon: Usually the lump is the primary thing. On occasion, you get symptoms of disease that has already disseminated or spread. We’ve had patients present in advanced matters where they’re feeling abdominal pain, abdominal fullness, even back pain. The route of spread of testes cancer follows, for the most part, a relatively set pattern where the lymph nodes and the back of the abdomen or its retroperitoneum become involved or metastatic sites. These tumors can be quite large where they are impinging or applying pressure to the adjacent organs and musculature so that patient feels these kinds of symptoms of back pain, etcetera. Those are the kinds of symptoms that would manifest as well, beside patients present with shortness of breath because they’ve developed tumor metastases into the lungs, or even feeling palpable masses all the way up into the lymph node chain toward the neck, which were firm and they just sort of developed over time, and sometimes they are overlooked. Patients within this age group have very busy lives and they sort of just blow them off, and finally when they get evaluated, they recognize that hey, there’s a large testicle also. And finally, the imaging reveals that this is a testes cancer.
Melanie: Dr. Yamzon, once it is diagnosed, how is it treated? What are the typical treatments. Because I think this is probably the scariest but yet, most interesting part of this conversation is because men are worried about what the treatment involves.
Dr. Yamzon: Well, the treatment will depend at the stage at the time of diagnosis. In general, if men present early and the testicle is really the primary site of detection, then the testicle is removed. And then, depending on what the pathologist finds, because the testicle is removed and sent off to a pathologist and they’ll look at it under a microscope and tell us the different cellular subtypes of testes cancer and then, based on that, the treatment regimens are a little different. You can have things called seminoma, where it is very radio and chemo-sensitive. In general, if there is no evidence of spread, the removal of the testicle may be curative at usually 80 percent of the time. Part of the staging process is not only looking at or examining the testicle with the ultrasound, but also doing what we call a CT scan. The CT scan will cover the chest, the abdomen, and the pelvis and will tell us to what extent the disease has spread. The unique thing about testes cancer is that it also has tumor markers. It’s really the model of a lot of cancers in that it has specific blood detectable markers that are indicative of the subcellular subtypes and the activity, and we can use these tumor markers to monitor its response to therapies. Going back to treatment, if the tumor was confined only to the testicle, we opt to survey or watch everybody moving forward because up to 80 percent of these patients are cured with just the removal of the testicle alone. If there is disease in the retroperitoneum, and depending on the size of the disease --- but usually, if there is disease in the retroperitoneum, they move on to something like chemotherapy. If there is a very small or limited disease in the retroperitoneum, they may be eligible for radiotherapy if it’s only seminoma. But if there are multiple subtypes of testes cancer, then they’ll want to get chemotherapy. Usually these tumors respond well, for the most part, to the chemotherapy. If there are residual tumors remaining despite the chemo, then these could be surgically removed.
Melanie: Now, side effects. If you have to remove a testes, men I’m sure are worried about -- is there any involvement or sexual dysfunction that goes with that removal? I mean, if the cancer is gone, they should be happy about that, but then may worry about the side effects.
Dr. Yamzon: Good question. With regard to sexual dysfunction, upon removal of the testicle -- really the only thing that we concern ourselves about at that level is the potential for infertility, the potential compromising the natural conception of a child because it may potentially affect one’s sperm counts. Before we embark on any therapy, we encourage men to engage in sperm banking. It’s a difficult thing in today’s medical, and a lot of insurances don’t cover this. So it becomes a difficult task for those who don’t have the means to do so. We do encourage men to cryopreserve their sperm in the event that they wish to father a child in the future. The removal of testicle may affect one’s fertility, and subsequent therapy such as chemotherapy may also do that. And it’s for these reasons we have patients bank sperm when it’s feasible for them. I did mention to you the surgery earlier, which we pretty much do now after chemotherapy when there are residual masses after chemotherapy. There are a set of nerves in the area of the retroperitoneum that make the way down to the pelvis, and they’re responsible for the coordinated contractions that occur in the act of ejaculation. This is the forward propagation of semen so that it’s deposited into the vaginal vault. When some of these nerves are disrupted or if it’s infeasible to preserve them, then we have to compromise these nerves to remove the tumor. Men may have difficulty or men may not experience ejaculation appropriately. They may not propel semen in a forward direction, let alone propel any at all following a surgery like that.
Melanie: But they can still have an erection? One thing has nothing to do with the other, right?
Dr. Yamzon: Exactly. They can still have an erection. They can still experience orgasm or heightened sense of climax during intercourse, but it really becomes a conception or fertility issue at that point.
Melanie: In just the last minute if you would, Dr. Yamzon, please tell the listeners why they should come to City of Hope for their urologic cancer care.
Dr. Yamzon: Well, at City of Hope we have a very experienced team. We cover all aspects of urologic oncology, and we’re a tertiary cancer center. We specialize in treatment of these very advanced cancers, and we have got it broken down into a very set pattern. We got minimal variations. We minimize our complications, and we are contributors to the national comprehensive cancer network guidelines. And so, we find ourselves at the forefront in conjunction with other major cancer centers in developing the treatment paradigms and optimizing them.
Melanie: Thank you so much. You are listening to City of Hope radio. For more information, you can go to cityofhope.org. That is cityofhope.org. This is Melanie Cole. Thanks so much for listening.