The male reproductive system includes two testicles or testes. They produce sperm from germ cells and testosterone. More than 90% of the tumors develop in the germ cells of the testicles. There are two types of germ cell tumors, seminoma and non-seminoma. Each responds differently to treatment options.

Cancer of the testicles affects approximately 8,000 men each year in the United States. Unlike prostate cancer that tends to appear in older men, testicular cancer afflicts men between 20 and 30 years of age. But it has one of the highest cancer cure rates when detected early: 95%.

The first sign of testicular cancer may be a lump or swelling in one of your testicles that may or may not be painful. You may also feel heaviness or pain in the scrotum; the sack-like skin that contains the testicles as well as sharp pain in your lower abdomen. Testicular cancer that has gone into lymph nodes below the diaphragm may cause lower back pain, too.

There is a range of treatment options that can successfully cure or manage testicular cancer. These include surgery, chemotherapy, high-dose chemotherapy with stem cell transplants, hormone therapy and radiation therapy. You and your doctor will determine which approach is best for you.

Surgery

Because most patients diagnosed with testicular cancer are young and otherwise in good health, surgery is typically the first form of treatment. In a radical inguinal orchiectomy the entire testicle in removed from an incision made in the groin. If the lymph nodes behind the abdomen are affected, then they will be removed in a second procedure. This can be done laparoscopically through small incisions in the abdomen or using a traditional open incision technique.

Chemotherapy

Chemotherapy uses drugs circulated through the blood stream to destroy cancer cells. It is used if the cancer has spread outside the testicle. It can also be used after surgery if the tumor was not confined to the testicle, to destroy any cancerous cells left behind and prevent recurrence of the cancer. Most chemotherapy for testicular cancer is injected intravenously.

Stem Cell or Bone Marrow Transplant

Testicular cancer typically responds well to chemotherapy, but in some cases the cancer returns. Higher doses of chemotherapy could be more effective to treat the recurrence, but can damage the bone marrow where red blood cells are formed. This can lead to problems such as infections and bleeding. In a process called leukapheresis, blood and/or marrow are collected and the blood forming stem cells are separated out. The blood is then returned to the body and the stem cells are frozen.  The tumor is then subjected to high-dose chemotherapy to destroy all of the cancer cells in the testicle. The stem cells are then intravenously returned to the body. You may undergo one or two high-dose chemotherapy stem cell transplants six to 12 months apart.

Radiation Therapy

Your doctor may recommend External Beam Radiation Therapy (EBRT) as the primary treatment for seminoma germ cell tumors or in conjunction with surgery such as an orchiectomy, where the testicle is removed. Seminoma germ cell tumors are very sensitive to radiation therapy and this helps to prevent recurrence of the cancer. EBRT is not commonly used for non-seminoma germ cell tumors because they are not sensitive to radiation. Radiation can also be used if the cancer has spread beyond the testicle to treat the area of the lymph nodes.

3D-Conformal Radiation Therapy and Intensity-Modulated Radiation Therapy (IMRT)

3D-Conformal Radiation Therapy and Intensity-Modulated Radiation Therapy (IMRT) are two forms of External Beam Radiation Therapy. During 3D-Conformal treatments, a device called a "multi-leaf collimator" will shape the individual radiation beams to “conform” to the shape of your tumor according to the data and instructions it receives from the system computer. IMRT uses thousands of radiation “beamlets” from many different angles to deliver a single dose of radiation. The intensity of the “beamlets” can change during the treatment session to modulate the dose, so that the tumor receives a very precise high dose of radiation, while minimizing damage to surrounding, normal tissue.

Before each session, a Radiation Therapist will carefully position you on the treatment table using a body immobilizer for precise body placement. Image guidance will be used to confirm the location of the tumor before the therapy begins. During your treatment sessions, the radiation delivery system will revolve around you, delivering the radiation according to the plan set by your Radiation Oncologist. Each treatment session lasts from 10 to 30 minutes. If radiation is your primary form of treatment, you will be scheduled for five sessions a week for seven to eight weeks. If it is used in adjuvant to surgery, you will be treated for five to six weeks. The sessions are pain-free and require no sedation so you can return to your normal activities right away.