Germ Cell Tumours start in the reproductive cells known as germ cells. Almost all testicular cancers start in the germ cells.
Germ cells refer to the sperm producing cells in the testes in men and the egg producing cells in women (ovaries). For information on germ cell tumours in women, visit our fact sheet on ovarian germ cell tumours.
There are two main types of testicular germ cell tumours:
- Seminomas- this type of tumour generally occurs in men between the ages of 25 and 55.
- Nonseminomas- Unlike seminomas, nonseminomas tend to grow and spread at a faster rate.
Teratomas are one type of nonseminoma. They can be either benign or malignant. Unlike other germ cell tumours they are not as sensitive to chemotherapy and therefore their main treatment is surgery.
Teratomas usually occur in men between the ages of 15 and 35.
Germ cell tumours can also occur in children and can found in other parts of the body including the abdomen, chest and brain.
What causes a testicular germ cell tumour?
The exact causes of testicular germ cell tumours are unknown. However, there are a few factors that increase the risk:
- Failed testicular descent: failure of the testes to descend into the scrotal sac (normally the testicles descend in the first year of a baby’s life).
- Having a family history of testicular germ cell tumours.
- Background- testicular germ cell tumours are more common in white men than African-Caribbean or Asian men.
What are the symptoms?
Some of the symptoms of a testicular germ cell tumour may include:
- A painless lump in the testicle
- Pain or discomfort in a testicle or in the scrotum
- Ache in the groin or abdomen
- Heavy feeling in scrotum
- Rarely, tender nipples may be caused by hormonal changes within the body.
TIP: If you have any of these symptoms you should have them checked by your doctor.
Although testicular germ cell tumours do not always produce early symptoms, self examination is recommended for people who are at a higher risk of developing a testicular germ cell tumour.
The best time to do this is after a warm bath or shower, when the scrotal skin is relaxed. Visit this link for more information and tips on how to conduct a testicular self-examination.
How is it diagnosed?
After visiting a GP a referral will probably be made to a hospital for some tests.
Firstly they will complete a physical examination followed by an ultrasound of the testicles to detect any abnormalities.
If these tests detect a possible testicular germ cell tumour further tests may include:
- Blood Tests- this can help to determine the exact type of tumour and at what stage the tumour is at.
- CT Scan
- Radical Orchiectomy- sometimes the removal of a testicle is required for further testing.
For more information check out our Tests page.
If the results of the test show testicular cancer, another referral will be made to a doctor who specialises in the treatment of the reproductive organs.
The stage of a cancer describes its size and whether it has spread beyond the area of the body where it started. A staging system commonly used is called the TNM system. It is described here:
- T: refers to the tumour size.
- N: refers to whether lymph nodes are affected.
- M: refers to whether cancer has spread to other parts of the body (metastases).
How is it treated?
A team of doctors and other staff at the hospital will plan treatment. It will depend on the type of tumour (seminoma or nonseminoma), the size of the tumour, where it is and the patients overall general health.
Treatment may be coordinated by an urologist (a surgeon who specialises in the treatment the urinary tract and male reproductive organs), an oncologist (a doctor who specialises in treating cancer with chemotherapy) and a radiologist (a doctor who specialises in treating cancer with radiation).
Treatments may involve:
Surgery for a testicular germ cell tumour
There are two different types of surgery that can be performed to treat a testicular germ cell tumour:
- Radical inguinal orchiectomy
Whether it is a seminoma or nonseminoma, the first form of treatment is generally always a radical inguinal orchiectomy. This is the removal of the affected testicle.
This is not only used as a form of treatment, but also to diagnose the stage of cancer.
This type of surgery should not affect the levels of testosterone in the patient as long as the other testicle is of regular size and is present.
- Retroperitoneal lymph node dissection (RPLND)
This is surgery to remove the lymph nodes at the back of the abdomen. This is performed in the advanced stages of non seminomas in patients that still have remnants of cancer after completing chemotherapy.
For more information check out our surgery fact sheet.
Chemotherapy for a testicular germ cell tumour
Chemotherapy is an effective form of treatment for patients that have a non seminoma germ cell tumour which has spread to other parts of the body. Generally it is used to treat patients in the later stages of cancer.
For more information check out our chemotherapy fact sheet.
Radiotherapy for a testicular germ cell tumour
This form of treatment is only used in specific circumstances to treat testicular germ cell tumours.
Radiotherapy is generally only used to treat seminomas as this form of treatment is not as effective in treating nonseminomas. Usually the radiation is directed at the lymph nodes located at the back of the abdomen.
For more information check out our radiotherapy fact sheet.
Rather than completing further treatment such as chemotherapy or radiotherapy after surgery, sometimes there is an option for the patient to simply be monitored in case the need arises for further treatment.
Depending on the type of testicular germ cell tumour, the frequency of check ups and tests will vary.
The advantage of active surveillance is not having to go through chemotherapy or radiotherapy unnecessarily; however it does require dedication on the part of the patient and doctor to maintain the surveillance schedule after surgery.