 Testicular Tumors
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Testicular tumors are benign and malignant growths on the testicle that can occur in boys. These are uncommon tumors that occur most often in boys less than 5 years of age and sometimes in boys who experience puberty early, although they can appear at any age. Most testicular tumors are benign and, though they do not spread, still do require an operation.
Malignant testicular tumors can spread (metastasize) to other parts of the body. The most common sites for metastasis are the lungs, liver, lymph nodes, and central nervous system.
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The cause of testicular tumors is unkown. What is known is that most of these tumors are of germ cell origin. Germ cells are the cells that develop in the embryo (fetus, or unborn baby) and become the cells that make up the reproductive system in males and females. These germ cells follow a midline path through the body after development and descend into the pelvis as ovarian cells or into the scrotal sac as testicular cells.
A number of inherited defects have been associated with an increased risk of developing germ cell tumors including some in the central nervous system and genitourinary tract malformations, and major malformations of the lower spine. Specifically, males with undescended testes (failure of the testes to descend into the scrotal sac) have an increased risk of developing testicular germ cell tumors.
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Symptoms can include:
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- Swelling
- Hardness
- Abnormal shape, or irregularity in, testicular size
- Testicular pain (although some tumors are painless)
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The symptoms of germ cell tumors may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.
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Most testicular tumors are first noticed by a parent or health care provider as a nontender swelling in a boy's scrotum. Most of these scrotal masses, however, are from far more common problems, such as a hernia, a hydrocele, infection of the epididymis, or twisting, or torsion of the testicle.
Your child's doctor will usually be able to distinguish a tumor from these more common conditions by the way the mass feels and if a light shines through it or not. In addition to a complete medical history and physical examination, your child's doctor may also want to perform some combination of the following tests:
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- ultrasound (also called sonography) - An ultrasound of the testicles is the best way to tell what the mass is and if more tests or an operation are needed. Ultrasound is a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
- computerized tomography scan (also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
- magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body
- biopsy - a sample of tissue removed from the tumor and examined under a microscope
- complete blood count (CBC) - a measurement of size, number, and maturity of different blood cells in a specific volume of blood
- additional blood tests - may include blood chemistries, evaluation of liver and kidney functions, and genetic studies
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Specific treatment for testicular tumors will be determined by your child's physician based on:
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- your child's age, overall health, and medical history
- extent of the disease
- your child's tolerance for specific medications, procedures, or therapies
- how your child's physician expects the disease to progress
- your opinion or preference
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Testicular tumors, whether benign or malignant, are usually removed along with the testicle on the affected side in a procedure known as orchiectomy. If the tumor is malignant, your son may need to receive more of the following treatments in addition to orchiectomy:
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- chemotherapy - a drug treatment that works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells and shrink tumors. Chemotherapy may be used alone for some types of cancer or in conjunction with other therapy such as radiation or surgery. Often, a combination of chemotherapy drugs is used to fight a specific cancer. Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat. While chemotherapy can be quite effective in treating certain cancers, the agents do not differentiate normal healthy cells from cancer cells. Because of this, there can be many adverse side effects during treatment. Being able to anticipate these side effects can help the care team, parents, and child prepare, and, in some cases, prevent these symptoms from occurring, if possible. Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells. Chemotherapy can be given:
- as a pill to swallow
- as an injection into the muscle or fat tissue
- intravenously (directly to the bloodstream; also called IV)
- intrathecally - chemotherapy given directly into the spinal column with a needle
- radiation therapy - using high-energy rays (radiation) from a specialized machine to damage or kill cancer cells an shrink tumors
- supportive care - any type of treatment to prevent and treat infections, side effects of treatments, and complications, and to keep your child comfortable during treatment
- continuous follow-up care - a schedule of follow-up care determined by your child's physician and other members of your care team to monitor ongoing response to treatment and possible late effects of treatment
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Prognosis for benign testicular tumors is usually very good, with minimal if any long-term complications. If one testis remains, fertility will be preserved.
Prognosis for malignant tumor can vary greatly from individual to individual and depends heavily on the extent of the disease. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a child diagnosed with a testicular tumor. Side effects of radiation and chemotherapy, as well as second malignancies, can occur. New methods are continually being discovered to improve treatment and to decrease side effects.
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