Testicles have 2 main functions: They make male hormones androgens such as testosterone. They make sperm, the male cells needed to fertilize a female egg cell to start a pregnancy. Sperm cells are made in long, thread-like tubes inside the testicles called seminiferous tubules.
They are then stored in a small coiled tube behind each testicle called the epididymis, where they mature. During ejaculation, sperm cells are carried from the epididymis through the vas deferens to seminal vesicles, where they mix with fluids made by the vesicles, prostate gland, and other glands to form semen.
This fluid then enters the urethra, the tube in the center of the penis through which both urine and semen leave the body. The testicles are made up of several types of cells, each of which can develop into one or more types of cancer. It is important to distinguish these types of cancers from one another because they differ in how they are treated and in their prognosis outlook. These are the cells that make sperm. These 2 types occur about equally.
Many testicular cancers contain both seminoma and non-seminoma cells. These mixed germ cell tumors are treated as non-seminomas because they grow and spread like non-seminomas. Seminomas Seminomas tend to grow and spread more slowly than non-seminomas. The 2 main subtypes of these tumors are classical or typical seminomas and spermatocytic seminomas.
Doctors can tell them apart by how they look under the microscope. These usually occur in men between 25 and Spermatocytic seminoma: This rare type of seminoma tends to occur in older men. The average age of men diagnosed with spermatocytic seminoma is about Spermatocytic tumors tend to grow more slowly and are less likely to spread to other parts of the body than classical seminomas.
Some seminomas can increase blood levels of a protein called human chorionic gonadotropin HCG. HCG can be detected by a simple blood test and is considered a tumor marker for certain types of testicular cancer. It can be used for diagnosis and to check how the patient is responding to treatment.
Non-seminomas These types of germ cell tumors usually occur in men between their late teens and early 30s. When seen under a microscope, these tumors can look like tissues of very early embryos. This type of non-seminoma tends to grow rapidly and spread outside the testicle.
Embryonal carcinoma can increase blood levels of a tumor marker protein called alpha-fetoprotein AFP , as well as human chorionic gonadotropin HCG. Yolk sac carcinoma : These tumors are so named because their cells look like the yolk sac of an early human embryo. Other names for this cancer include yolk sac tumor, endodermal sinus tumor, infantile embryonal carcinoma, or orchidoblastoma.
This is the most common form of testicular cancer in children especially in infants , but pure yolk sac carcinomas tumors that do not have other types of non-seminoma cells are rare in adults. When they occur in children, these tumors usually are treated successfully. But they are of more concern when they occur in adults, especially if they are pure.
Yolk sac carcinomas respond very well to chemotherapy, even if they have spread. This type of tumor almost always increases blood levels of AFP alpha-fetoprotein. Choriocarcinoma: This is a very rare and aggressive type of testicular cancer in adults. Pure choriocarcinoma is likely to spread rapidly to distant organs of the body, including the lungs, bones, and brain. More often, choriocarcinoma cells are present with other types of non-seminoma cells in a mixed germ cell tumor.
These mixed tumors tend to have a somewhat better outlook than pure choriocarcinomas, although the presence of choriocarcinoma is always a worrisome finding. This type of tumor increases blood levels of HCG human chorionic gonadotropin.
Teratoma: Teratomas are germ cell tumors with areas that, under a microscope, look like each of the 3 layers of a developing embryo: the endoderm innermost layer , mesoderm middle layer , and ectoderm outer layer. Pure teratomas of the testicles are rare and do not increase AFP alpha-fetoprotein or HCG human chorionic gonadotropin levels. More often, teratomas are seen as parts of mixed germ cell tumors.
There are 3 main types of teratomas: Mature teratomas are tumors formed by cells similar to cells of adult tissues. Yolk sac carcinoma : These tumors are so named because their cells look like the yolk sac of an early human embryo. Other names for this cancer include yolk sac tumor, endodermal sinus tumor, infantile embryonal carcinoma, or orchidoblastoma. This is the most common form of testicular cancer in children especially in infants , but pure yolk sac carcinomas tumors that do not have other types of non-seminoma cells are rare in adults.
When they occur in children, these tumors usually are treated successfully. But they are of more concern when they occur in adults, especially if they are pure. Yolk sac carcinomas respond very well to chemotherapy, even if they have spread. This type of tumor almost always increases blood levels of AFP alpha-fetoprotein. Choriocarcinoma: This is a very rare and aggressive type of testicular cancer in adults. Pure choriocarcinoma is likely to spread rapidly to distant organs of the body, including the lungs, bones, and brain.
More often, choriocarcinoma cells are present with other types of non-seminoma cells in a mixed germ cell tumor. These mixed tumors tend to have a somewhat better outlook than pure choriocarcinomas, although the presence of choriocarcinoma is always a worrisome finding. This type of tumor increases blood levels of HCG human chorionic gonadotropin. Teratoma: Teratomas are germ cell tumors with areas that, under a microscope, look like each of the 3 layers of a developing embryo: the endoderm innermost layer , mesoderm middle layer , and ectoderm outer layer.
Pure teratomas of the testicles are rare and do not increase AFP alpha-fetoprotein or HCG human chorionic gonadotropin levels. More often, teratomas are seen as parts of mixed germ cell tumors. There are 3 main types of teratomas: Mature teratomas are tumors formed by cells similar to cells of adult tissues.
They rarely spread to nearby tissues and distant parts of the body. They can usually be cured with surgery, but some come back recur after treatment. Immature teratomas are less well-developed cancers with cells that look like those of an early embryo. This type is more likely than a mature teratoma to grow into invade surrounding tissues, to spread metastasize outside the testicle, and to come back recur years after treatment.
Teratomas with somatic type malignancy are very rare cancers. These cancers have some areas that look like mature teratomas but have other areas where the cells have become a type of cancer that normally develops outside the testicle such as a sarcoma, adenocarcinoma, or even leukemia. Carcinoma in situ of the testicle Testicular germ cell cancers can begin as a non-invasive form of the disease called carcinoma in situ CIS or intratubular germ cell neoplasia.
In testicular CIS, the cells look abnormal under the microscope, but they have not yet spread outside the walls of the seminiferous tubules where sperm cells are formed. It is hard to find CIS before it does become an invasive cancer because it generally does not cause symptoms and often does not form a lump that you or the doctor can feel. The only way to diagnose testicular CIS is to have a biopsy a procedure that removes a tissue sample and looks at it under a microscope.
Some cases are found incidentally by accident when a testicular biopsy is done for another reason, such as infertility. When CIS of the testicle becomes invasive, its cells are no longer just in the seminiferous tubules but have grown into other structures of the testicle. These cancer cells can then spread either to the lymph nodes small, bean-shaped collections of white blood cells through lymphatic channels fluid-filled vessels that connect the lymph nodes , or through the blood to other parts of the body.
Stromal tumors Tumors can also develop in the supportive and hormone-producing tissues, or stroma, of the testicles. These tumors are known as gonadal stromal tumors. The 2 main types are Leydig cell tumors and Sertoli cell tumors.
Leydig cell tumors These tumors develop from the Leydig cells in the testicle that normally make male sex hormones androgens like testosterone. Leydig cell tumors can develop in both adults and children. These tumors often make androgens male hormones but sometimes produce estrogens female sex hormones.
Most Leydig cell tumors are benign. They usually do not spread beyond the testicle and are cured with surgery. But a small portion of Leydig cell tumors spread to other parts of the body and tend to have a poor outlook because they usually do not respond well to chemotherapy or radiation therapy. Sertoli cell tumors These tumors develop from normal Sertoli cells, which support and nourish the sperm-making germ cells.
Like the Leydig cell tumors, these tumors are usually benign. Secondary testicular cancers Cancers that start in another organ and then spread to the testicle are called secondary testicular cancers. These are not true testicular cancers — they are named and treated based on where they started.
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