Testicular cancer (TC) is a malignancy that begins when cells in the testicles, the male reproductive glands, grow out of control. The outlook for those diagnosed with TC is exceptionally positive. This disease is widely recognized as one of the most treatable and curable forms of cancer. Advances in detection and treatment protocols have resulted in a very high rate of successful remission.
Understanding the High Rate of Survival
The prognosis for testicular cancer is excellent, with overall five-year survival rates exceeding 95% across all stages in the United States. This success is a direct result of biological and clinical factors unique to this disease. When the cancer is localized, confined entirely within the testicle, the five-year survival rate approaches 99.2%.
Even if the cancer has spread to regional lymph nodes, the five-year survival rate remains very high, at approximately 96.4%. Germ cell tumors, the most common type, are highly sensitive to chemotherapy, particularly platinum-based drugs like cisplatin. This sensitivity means that even advanced or metastatic disease maintains a five-year survival rate of around 72.8%.
The biological nature of germ cell tumors, which tend to be fast-dividing, makes them vulnerable to modern chemotherapy drugs. Furthermore, the testicles are easily examined, often allowing detection at an early, localized stage. This combination of early detection potential and treatment sensitivity contributes significantly to the high cure rates observed today.
Diagnosis and Determining the Extent of Cancer
Diagnosis begins with a physical examination, followed by imaging studies and blood work to confirm the presence and extent of the disease. A scrotal ultrasound is typically the first imaging tool used to visualize the testicle and determine if a mass is solid and suspicious for cancer. If cancer is suspected, blood tests measure specific substances known as tumor markers.
The primary tumor markers for testicular cancer include Alpha-fetoprotein (AFP), Human Chorionic Gonadotropin (HCG), and Lactate Dehydrogenase (LDH). Elevated levels of these markers can indicate the presence of TC and help distinguish between the two main types, seminoma and non-seminoma. Seminoma rarely raises AFP, whereas non-seminoma frequently raises both AFP and HCG.
The levels of these markers, along with imaging like a Computed Tomography (CT) scan of the chest, abdomen, and pelvis, determine the cancer’s stage. Staging, often using the TNM (Tumor, Node, Metastasis) system, classifies the size of the tumor and whether it has spread to lymph nodes or distant organs. This categorization is fundamental, as the stage directly dictates the subsequent treatment plan.
Standard Treatment Pathways
The initial step in treating nearly all testicular cancers is a surgical procedure called a radical inguinal orchiectomy. This involves the removal of the entire affected testicle and spermatic cord through an incision in the groin. This procedure is both diagnostic, by providing tissue for pathology, and therapeutic, by removing the primary tumor.
Following surgery, the remaining treatment pathway is highly individualized based on the cancer stage and type. For many patients with low-risk Stage I disease, particularly seminoma, treatment may conclude with active surveillance, which involves close monitoring without immediate further intervention. If the cancer is more aggressive or has spread to regional lymph nodes, additional therapy is required to prevent recurrence.
Chemotherapy is standard for more advanced stages or aggressive tumors, often using the BEP regimen (Bleomycin, Etoposide, and Cisplatin). This platinum-based combination is exceptionally effective at killing germ cell cancer cells throughout the body. In cases of seminoma that have spread only to regional lymph nodes, radiation therapy may be used instead, as seminomas are highly radiosensitive.
For certain non-seminoma cases, or if lymph nodes remain enlarged after chemotherapy, a Retroperitoneal Lymph Node Dissection (RPLND) may be performed. This surgery removes the lymph nodes at the back of the abdomen where the cancer commonly spreads first. Treatment selection between surveillance, chemotherapy, radiation, and further surgery is carefully made by a multidisciplinary team based on pathology and risk factors.
Life After Treatment and Long-Term Monitoring
After successful treatment, a long-term surveillance plan monitors for recurrence, which is most likely to occur within the first two years. Monitoring includes regular physical examinations, blood tests to check tumor marker levels, and periodic imaging, such as CT scans. Consistent follow-up care is important because even if the cancer returns, it is often still curable if found early.
Survivors must also be monitored for potential long-term side effects related to their treatment, particularly if they received chemotherapy with cisplatin. These late effects can include an increased risk of cardiovascular disease, such as hypertension and high cholesterol, many years after treatment. There is also a small risk of developing secondary cancers later in life.
A significant concern for this young demographic is fertility, as chemotherapy and radiation can temporarily or permanently reduce sperm production. Patients are offered sperm banking before treatment begins to preserve their options for future parenthood. Additionally, some men may experience hormonal imbalances, such as low testosterone (hypogonadism), which may require hormone replacement therapy.