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Testicular Cancer
Director
: Prof. Pierre Blanchard
Contact
: Phone: +33 (0)1 42 11 47 99
Email
Understanding the Disease
Testicular cancer is a rare disease, but it is the most common cancer among young men, particularly those between the ages of 15 and 35. It accounts for about 1 to 2 percent of cancers in men, with just over 2,000 new cases each year in France. Thanks to advances in treatment, the prognosis is now very favorable, with a 5-year survival rate exceeding 95%.
In the vast majority of cases, this cancer develops from germ cells, which are responsible for sperm production. These are known as germ cell tumors, which account for more than 90% of testicular cancers.
There are two main types of germ cell tumors: seminomas, which generally progress more slowly and often occur at a slightly older age, and nonseminomatous tumors, which tend to grow more rapidly and affect younger men.
Testicular cancer occurs when a cell undergoes abnormalities and begins to multiply uncontrollably. This proliferation forms a tumor within the testicle, which can then spread to other parts of the body if left untreated.
In most cases, the disease is discovered following the appearance of a mass or lump in the testicle—often painless—detected by the patient himself or during a clinical examination.
What are the testicles?
The testicles are two organs of the male reproductive system located in a pouch of skin called the scrotum. They play an essential role in reproduction and the functioning of the male body.
Their primary function is twofold. First, they produce sperm, which are necessary for reproduction. Second, they secrete testosterone, the male hormone that plays a key role in the development of secondary sexual characteristics (voice, body hair, muscle mass).
These organs become active at puberty and function continuously throughout life. Their location outside the body helps maintain a slightly lower temperature, which is essential for sperm production.
Testicular Cancer by the Numbers
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2,300
new cases each year in France.
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85%
Men who have been diagnosed are between the ages of 15 and 49.
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1st
Cancer in men between the ages of 15 and 35.
A type of cancer that responds well to treatment
Testicular cancer is one of the most curable cancers, with a cure rate of over 90% across all stages. It is one of the few cancers that can be cured even when it has metastasized. This exceptional responsiveness to treatment is due to the nature of the cells that give rise to the tumor: germ cells. These reproductive cells have a high potential for differentiation and retain a very immature cellular program. This immaturity makes them particularly sensitive to chemotherapy.
Nevertheless, early diagnosis remains a major challenge: the earlier the tumor is detected, the less intensive the treatment will be, with fewer side effects. For this reason, it is essential that men aged 15 to 40 make it a habit to perform a testicular self-exam once a month and consult their primary care physician as soon as they detect any abnormalities.
Prevention and Risk Factors
Prevention of testicular cancer relies on regular self-examination. Men, particularly those aged 15 to 35, are encouraged to perform a testicular self-exam once a month to detect any abnormalities, such as a lump or painless swelling.
Family history and cryptorchidism (undescended testicle)—even when surgery has been performed—are risk factors for testicular cancer.
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Symptoms
Testicular cancer generally causes few clinical symptoms, which is why it is most often discovered incidentally during self-examination or a routine checkup.
While the causes of testicular tumors are not always identifiable, several risk factors that may contribute to the development of this type of cancer have been identified:
- Cryptorchidism, a congenital abnormality that affects 1 to 3% of male newborns.
- HIV infection.
- Testicular atrophy.
- A family history of testicular cancer.
- Having had cancer in one testicle increases the risk of developing cancer in the opposite testicle.
Furthermore, as testicular cancers have become increasingly common in recent decades, several studies are underway to shed light on the impact of exposure to certain modern chemical pollutants on the development of the disease.
Diagnosis
The diagnosis of testicular cancer begins with the detection of an abnormality during a self-exam or a medical examination. A doctor then performs a physical exam and may order a testicular ultrasound to assess the nature of the mass.
Blood tests to measure tumor markers (AFP, total hCG, and LDH) are also commonly used. If cancer is suspected, surgery is then performed to confirm the diagnosis and determine the type and stage of the cancer.
Coverage
The management (diagnosis and treatment) of testicular cancer requires the collaborative efforts of several physicians from various disciplines—medical oncologists, surgeons, radiation oncologists, radiologists, and pathologists—working in collaboration with primary care physicians. Every major decision is made during multidisciplinary team meetings (MDTs). In some cases, the patient’s presence at a meeting may be required.
Impact on Sexuality and Fertility
Testicular cancer generally has no impact on patients’ sexuality. In the vast majority of cases, the other testicle is healthy, which ensures sufficient testosterone production to support erections and a normal sex drive. However, if sexual dysfunction occurs, the patient may be referred to a urologist and/or an andrologist.
If the other testicle is healthy, sperm production continues normally in most cases. Many men remain fertile after a unilateral orchiectomy. However, some forms of testicular cancer are associated with reduced fertility, even before surgery. Chemotherapy can also temporarily or permanently impair sperm production. It is therefore recommended to have a semen analysis and to consider sperm preservation before any surgery or additional treatment. Sperm preservation is a quick procedure and is covered by Social Security.
Treatments and Clinical Trials
Treatment for testicular cancer primarily involves surgery. In most cases, an orchiectomy is performed, which involves removing the affected testicle through an incision in the groin. This procedure is most often performed on an outpatient basis. A testicular prosthesis, made of silicone or soft gel, may be inserted during or after the procedure, depending on the patient’s preference, to preserve body image.
Before treatment begins, the patient may be advised to freeze a sperm sample to address any potential impact on fertility.
Depending on the stage and characteristics of the disease, additional treatments may be necessary. In cases of localized disease with a risk of recurrence, platinum-based chemotherapy may be recommended after surgery. This chemotherapy may also be used when the disease is more advanced, with or without metastases.
In some situations, chemotherapy does not completely eliminate the lesions. Further surgical intervention may then be considered, particularly to perform a lymph node dissection or remove residual masses, such as those in the lungs.
Radiation therapy may also be recommended for certain tumor subtypes.
Once treatment is complete, regular follow-up is initiated. This includes clinical examinations, an ultrasound of the remaining testicle, as well as imaging studies and tumor marker tests, the frequency of which gradually decreases over time.
Search
Research into testicular cancer continues with a focus on personalized care. At Gustave Roussy, several studies are currently underway, including:
- De-escalation protocols designed to reduce the burden of current treatments while maintaining the same level of efficacy in cases with a very favorable prognosis, notably the EDEN study, which evaluates early de-escalation with multimodal therapy including reduced-dose chemotherapy and radiation therapy for stage II seminomas.
- Intensification protocols for patients with advanced germ cell tumors with an unfavorable prognosis, notably the VAPOR protocol, which includes a dedicated arm for patients with primary mediastinal germ cell tumors.
- Studies aimed at optimizing quality of life during and after treatment, including the GIG-T studies, which evaluate the benefits of preventive treatment for thrombosis (blood clots), and the STARTER study, which assesses whether adapted physical activity can reduce the side effects of chemotherapy in testicular cancer.
Join a clinical trial
Many clinical trials are open to patients with cancer. Participating in a clinical trial provides access to innovative treatments while contributing to the development of new therapies.
Contact
Chair of the Genitourinary Oncology Committee:
Prof. Pierre Blanchard
Contact:
Tel.: +33 (0)1 42 11 47 99
Appointments and Second Opinions
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Questions to Ask If I'm Told I Have Testicular Cancer
With just under 3,000 new cases per year in France, testicular cancer is a rare tumor, though it remains the most common cancer among young men. Thanks to advances in treatment, this cancer is now curable in more than nine out of ten cases. Early detection of the disease, aided by testicular self-examination, remains a key priority, however, in order to minimize the side effects of treatment. To mark Men’s Health Month, Dr. Macarena Rey-Cardenas, a medical oncologist on the genitourinary committee at Gustave Roussy, provides an update.
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Cancers in Men
Men are the group most affected by cancer. Each year, approximately 240,000 men are diagnosed with cancer, and 90,000 die from it. These figures make cancer the leading cause of premature death among men.
Frequently Asked Questions
The main risk factor is cryptorchidism, which is when a testicle does not descend properly into the scrotum before birth. Other factors may be involved, such as a family history of the condition or a previous history of testicular cancer. In most cases, no specific cause is identified.
The most common symptom is the appearance of a lump or mass in the testicle, which is usually painless. Other symptoms may include a feeling of heaviness, pain in the testicle or lower abdomen, or a change in the size of the testicle. If you experience these symptoms, you should see a doctor.
The diagnosis is initially based on a clinical examination, often followed by a testicular ultrasound. Additional tests, such as blood tests or a CT scan, are then used to confirm the diagnosis and assess the extent of the disease.
Treatment almost always begins with surgery to remove the affected testicle. Depending on the case, this procedure may be followed by chemotherapy, radiation therapy, or additional surgical procedures. The choice of treatment depends on the type of tumor and its stage.
Yes, it is one of the most treatable forms of cancer. When detected early, the cure rate exceeds 95 percent.
Treatments can affect fertility, but this is not always the case. Sperm preservation is generally recommended before treatment begins in order to preserve the possibility of having children later on.
Yes. A single healthy testicle is generally sufficient to ensure the production of sperm and testosterone. Most men return to a normal life after treatment.