Non-Seminoma Carcinoma of the Testis

What is non-seminoma carcinoma of the testis?
Non-seminoma carcinoma of the testis is a type of testicular cancer that forms in specialized sex cells called germ cells. Non-seminomas include mixed germ cell tumors (the most common), embryonal carcinoma, teratoma, choriocarcinoma, and yolk sac tumors. About 60 percent of the 8,500 testicular cancers diagnosed each year are non-seminomas. Non-seminoma carcinoma can occur in one or both testicles. The cure rate is 70 to 95 percent, depending upon how extensively the cancer has spread. Nearly 140,000 men in the United States have survived testicular cancer, according to the American Cancer Society.

Who is likely to have non-seminoma carcinoma of the testis?
Testicular cancer is the most common form of cancer among young men. It can occur in boys as well but rarely. White-American men have about five times the risk of testicular cancer as African-American men and about twice the risk of Asian-American men. The occurrence of this cancer among white men also has doubled over the past 40 years. The reasons for this increased occurrence are unknown.

Risk factors include a medical history of undescended testicles, abnormal testicular development, Klinefelter’s syndrome (a sex chromosome disorder), or previous testicular cancer. Other possible risk factors include human immunodeficiency virus (HIV) infection and a family history of testicular cancer.

What characterizes non-seminoma carcinoma of the testis?
These tumors are usually confined to the testicles. In some cases, the cancer spreads to the lymph nodes and beyond. Symptoms include:

  • A painless lump or swelling in either testicle
  • A change in how the testicle feels
  • An ache in the lower abdomen or groin
  • A sudden build-up of fluid in the scrotum
  • Pain, discomfort or a feeling of heaviness in the scrotum

Sometimes, no symptoms occur.

How does the pathologist make the diagnosis?
You or your primary care doctor may discover an unusual, firm mass within the testicle. Your physician may hold a flashlight to the scrotum to see if light passes through the mass. If light does not pass through, your physician may order a scrotal ultrasound for the radiologist to examine to confirm a solid mass.

Your physician also may order a blood test. The pathologist will search your blood sample for tumor markers associated with non-seminoma carcinoma of the testis including alpha-fetoprotein (AFP) and human chorionic gonadotrophin (beta HCG). These blood marker tests also can monitor the response to treatment.

What else does the pathologist look for?
If the initial tests point toward cancer, a surgeon will remove the testicle containing the unusual mass to obtain an orchiectomy (testis removal) specimen for the pathologist to examine. The surgeon also may gather lymph nodes from the abdominal area for the pathologist to examine to determine if the cancer has spread. Your pathologist also may review a chest X-ray or CT scan results to see if the cancer has spread beyond the lymph nodes. With the results of the biopsy and all tests, the pathologist can determine the type and stage of the cancer. Stage 1 cancers are confined to the testicle, stage 2 to the lymph nodes in the abdomen, and stage 3 beyond the lymph nodes.

How do doctors determine what treatment will be necessary?
The pathologist consults with your primary care physician or specialist after reviewing the test results and determining the stage of the cancer. Together, using their combined experience and knowledge, they determine treatment options most appropriate for your condition. It’s important to learn as much as you can about your treatment options and make the decision that’s right for you.

What kinds of treatments are available for non-seminoma carcinoma of the testis?
In addition to surgically removing the cancerous testicle, physicians may recommend chemotherapy. In this treatment, physicians deliver drugs such as cisplatin, bleomycin, and etoposide throughout the body to slow the cancer’s progression. Physicians use this treatment if the cancer has spread.

Testicular cancer treatments may cause permanent infertility. For this reason, men who wish to father children may consider sperm banking before treatment begins. This process freezes sperm and stores it for later use.

Unlike some other forms of testicular cancer and because non-seminoma cells are resistant to radiation therapy, this treatment is rarely used. Radiation therapy uses pinpointed high-energy beams to shrink tumors or destroy cancer cells.

Also, follow-up testing is very important because of the risk of testicular cancer returning.

Clinical trails of new treatments for non-seminoma carcinoma of the testis may be found at www.cancer.gov in the clinical trials section of the website. These treatments are experimental in nature but may be the best option for advanced cancers.

For more information, go to www.cancer.gov (National Cancer Institute) or www.nlm.nih.gov/medlineplus (US Library of Medicine). Type the keywords: testicular cancer or non-seminoma carcinoma of the testis into the search box.

What kinds of questions should I ask my doctors?
Ask any question you want. There are no questions you should be reluctant to ask. Here are a few to consider:

  • Please describe the type of cancer I have and what treatment options are available.
  • What is the stage of my cancer?
  • What are the chances for full remission?
  • What treatment options do you recommend? Why do you believe these are the best treatments?
  • What are the pros and cons of these treatment options?
  • What are the side effects?
  • Is your medical team experienced in treating the type of cancer I have?
  • Can you provide me with information about the physicians and others on the medical team?
  • If I want a second opinion, could you provide me with the names of physicians and/or institutions that you would recommend?

DEFINITION OF TERMS


Germ cell: Cells that produce sperm. Ninety percent of testicular cancers start here.

Testicle: The male reproductive organ that produces sperm and the hormone testosterone.

Scrotum: A sack of loose skin holding the testicles, located directly below the penis.

Malignant: Cancerous and capable of spreading.

Pathologist: A physician who examines tissues and fluids to diagnose disease to assist in making treatment decisions.

 

Images

Embryonal carcinoma, a component of a mixed germ cell tumor.  NORMAL

Non-Seminoma Carcinoma
Normal tissue
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This information was developed by the College of American Pathologists’ Public Affairs Committee in conjunction with the College’s Cancer Committee and Council on Scientific Affairs. The College is providing this information to help you better understand your health. Ultimately any decisions you make about your health, however, should be between you and your doctor.

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