What is testicular cancer metastasis?

When a cell in one of the body tissues begins to multiply without control, it is called a cancer. A group of cancer cells is sometimes referred to as a tumor. If the cancer cells break away from the tumor and spread to other parts of the body, the tumor is called metastatic.

Testicular cancer is a malignant (life-threatening) tumor that develops from cells in the testicle. A slow growth of malignant cells in the testicle eventually causes the testicle to enlarge or form a lump that can be seen or felt. Usually the lump is painless, at least at first.

In metastatic testicular cancer the primary tumor has spread (metastasized) to other parts of the body and begins developing tumors elsewhere. The most common locations for metastases (the tumors that result from the spread) are the lungs, lymph nodes, and liver.

How does it occur?

The cause of testicular cancer and its metastasis is not known. Men who have or have had an undescended testicle, whether or not it was surgically corrected, are more likely to have testicular cancer than men who have not had this problem. Testicular cancer is most common in men less than 30 years old, although it can also occur in older men, but it tends to be less malignant in older men.

What are the symptoms?

Sometimes the first symptoms of testicular cancer are caused by metastases before the original tumor in the testicle is noticed. The growth of the metastases interferes with the function of the organ in which it grows.

The symptoms of metastases depend on where in the body metastases occur. If a testicular tumor has metastasized, it is often to the back of a lung, so symptoms may include:

• lower back pain and discomfort

• difficult urination

• a cough

• difficult breathing.

How is it diagnosed?

A physical exam, plain x-ray, or CT scan of the back may show that a tumor is growing in another part of the body (for example, the lungs). In some cases there may be hormonal markers in the blood such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). AFP and HCG are made by the body and sometimes by tumors. Your doctor may order tests to evaluate the status of the chemicals. The amount of the chemicals circulating in the blood may relate to the size of the cancer.

How is it treated?

The treatment for metastatic testicular cancer depends on how large the tumor is, what cell type the tumor is, where it has spread, and your physical condition. One or more of the following treatments may be used:

• Orchiectomy: If this was not already done, you will most likely have surgery to remove the testicle containing the cancer.

• Retroperitoneal lymph node dissection: A surgeon removes the lymph nodes in the area to which testicular cancer usually spreads first, around the bones of the lower spine. Lymph is body tissue fluid. The lymph nodes are tissues that filter this fluid as it flows back to the heart. They often catch cancer cells floating away from a testicular tumor. The lymph nodes are examined for cancer under a microscope.

• Radiotherapy: For some types of testicular cancer, radiation to the abdomen and pelvis (after surgery) is very effective in killing cancer cells and may be curative. Extra radiation therapy may be given to specific areas of cancer spread.

• Chemotherapy: Anticancer drugs are used to try to destroy the cancer cells with as little injury as possible to normal body cells. Fortunately, metastatic testicular cancer responds well to chemotherapy. Survival rates for patients with metastatic testicular cancer are greater than 80%.

After treatment your doctor will recommend regular checkups for the first year, then checkups slightly less often for the next 2 years to see if the cancer recurs. It is important to follow your doctor's recommendations so that any recurrence can be detected early. Most recurrences occur within the first 2 years after treatment.

How long will the effects last?

If treatment succeeds in destroying the tumor, the symptoms caused by it will improve. The treatment itself will cause some discomfort or side effects in many cases, but these usually will improve after treatment is completed.

Life expectancy after having metastatic testicular cancer depends on how large the tumor is within the testicle, how much the cancer has spread and where it has spread, and your physical condition. But the chances of a complete recovery are very good and much better than many other cancers.

How can I take care of myself?

If you have cancer, you can help yourself feel better by eating a balanced diet, getting plenty of rest, and following your doctor's advice. In addition, recognize that having the cancer is an added stress in your life, so take more time for your important relationships and for rest.

Ask your doctor any questions you may have about the course of the disease, treatments, side effects of the treatments, sexuality, support groups, and anything else that concerns you. You may also ask your doctor about some alternative methods for pain control, such as relaxation and deep breathing.

Also ask your doctor about fertility after your treatment. Your doctor may recommend that you place sperm in a sperm bank, just in case your treatment decreases your fertility.

Can I help prevent testicular cancer metastasis from recurring?

Because the cause of testicular cancer and its metastasis is unknown, doctors do not know how to prevent its recurrence. New metastatic lumps can develop after treatment. The sooner they are detected, the greater the chance they can be treated successfully.

How can I prevent testicular cancer?

Regular checkups are especially important if you have had an undescended testicle. Report any lump in the scrotum or testicle, pain or discomfort, or enlargement of the scrotum to a doctor as soon as possible.

Because the chance for cure depends on finding the cancer early and treating it before it spreads, it is important to examine your testicles monthly. Support your testicles with one hand and feel each one with your other hand. You will feel the smooth bump or epididymis, which covers the top, back, and bottom of each testicle. Gently separate it from the testicle with your finger and feel the testicle itself. If you find a firm mass in either testicle, you should see a doctor promptly.