• Testicular Tumors in Children and Teens

    A testicular tumor is a growth on the testicles. These are germ-cell tumors that can present as either benign (non-cancerous) or malignant (cancerous).

    Germ cell tumors are masses of tissue formed by immature cells that normally would have developed into mature eggs (in a female) or sperm (in a male). Ninety percent of germ cell tumors are gonadal, which means they begin in the reproductive cells of the testes or ovaries.

    Many testicular tumors are benign. While they may grow in their original location, they do not often spread to other parts of the body. However, some testicular tumors can grow aggressively and metastasize (spread) to other parts of the body, most commonly to the lymph nodes, lungs, liver and central nervous system, including the brain and spinal cord.

    Testicular tumor treatment at Dana-Farber/Boston Children's

    Children, teens and young adults with testicular tumors are treated at Dana-Farber/Boston Children's through our Solid Tumor Center. Our treatment team includes medical oncologists, surgical oncologists, and pediatric subspecialists, including urologists, who have specialized expertise in treating all types of germ cell tumors, including testicular tumors.

    Because of their unique expertise in treating these types of tumors, our urologists can help identify and, when possible, avoid potential side effects – such as infertility, sexual dysfunction or incontinence – that may result from cancer treatment. We also offer procedures that can help preserve fertility, including harvesting stem cells.

    How are testicular tumors classified?

    Successfully treating your son's testicular tumor depends on its size and whether it is benign or malignant. Doctors at Dana-Farber/Boston Children's will classify your son's tumor as one of the following types:

    • Benign. Many testicular tumors are non-cancerous, and though they do not spread, they often require surgical removal.
    • Malignant. A malignant testicular tumor is a cancerous tumor that has the ability to spread to other parts of the body.

    What are the symptoms and causes of testicular tumors?

    Testicular tumors are often noticed when a growth develops on one of the testes. Keep in mind that the symptoms of a testicular tumor may resemble other more common conditions or medical problems. It is important to consult your child's physician for a diagnosis.

    Testicular tumor symptoms may include:

    • Swelling in the affected testicle.
    • A hardened mass on the affected testicle.
    • Abnormal shape of the testicle, or irregularity in size between testicles.
    • Testicular pain (though some tumors are painless).

    As a parent, you undoubtedly want to know what may have caused your child’s tumor. Doctors do not completely understand the cause of most testicular tumors. There’s nothing that you could have done or avoided doing that would have prevented the tumor from developing. It’s important to understand that these and other tumors most often occur with no known cause.

    Scientists do know that certain germ-cell tumors can be associated with a number of other inherited defects of the central nervous system, genitourinary tract and lower spine. And boys with undescended testicles have an increased risk of developing certain germ cell tumors.

    How are testicular tumors diagnosed?

    The first step in treating your child is forming an accurate and complete diagnosis. Most testicular tumors are first noticed by the patient himself, his parent or his physician as a non-tender swelling in the scrotum.

    Most of these scrotal masses, though, result from much more common problems like hernia, hydrocele, testicular torsion or inflammation of the epididymis. Your child's doctor will usually be able to distinguish a testicular tumor from these more common conditions through an examination.

    In addition, your child’s physician may perform or order a number of different tests including:

    • A complete medical history.
    • Ultrasound/sonography, an imaging technique that 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. An ultrasound will confirm whether it is a tumor or another condition.

    If it is determined to be a tumor, your child will receive these additional tests:

    • A complete blood count, an analysis of your child's blood that involves measuring the size, number and maturity of different blood cells within a set volume of blood.
    • Additional blood tests may include blood chemistries, genetic testing and an evaluation of liver and kidney function.
    • Magnetic resonance imaging (MRI), a diagnostic procedure that produces detailed images by using a combination of large magnets, radiofrequencies and a computer to analyze organs and structures within the body. No x-rays or radiation are used.
    • 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, of the body from horizontal and vertical perspectives. CT scans are more detailed than general x-rays.

    There may be other diagnostic tests that your doctor will discuss with you depending on your child's individual situation. After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child's condition. Then we will meet with you and your family to discuss the results and outline the best possible treatment options.

    What are the treatments for testicular tumors?

    Your child's physician will determine a specific course of treatment based on several factors, including your son's age, overall health and medical history as well as the size and malignancy of the tumor.

    Testicular tumors, whether benign or malignant, are usually removed. Your child's treatment will almost always include:

    • Surgery. A pediatric urologic surgeon will surgically remove the tumor. If the tumor is malignant, the entire affected testicle may need to be removed through a procedure known as orchiectomy.

    If your son's testicular tumor is malignant, treatment may also include:

    • Additional surgery. When testicular cancer spreads, it first spreads to the lymph nodes at the back of the abdomen behind the intestines. Additional surgery is sometimes considered to remove these lymph nodes. This surgery can potentially be performed using minimally invasive techniques, typically robotic surgery. Depending on the findings, additional chemotherapy may be required. Surgery is also occasionally performed after chemotherapy.
    • Chemotherapy. Chemotherapy is a drug that interferes with the cancer cell's ability to grow or reproduce. Chemotherapy before surgery may help shrink the tumor, making it possible to remove; used after surgery it can help fight a cancer's recurrence. Different groups of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors. Your child may receive chemotherapy orally, as a pill to swallow; intramuscularly, as an injection into the muscle or fat tissue; intravenously, as a direct injection into the bloodstream, or IV; or intrathecally, as a direct injection into the spinal column through a needle.
    • Supportive care. Throughout your child's treatment, our doctors use supportive care to prevent and treat infections, minimize side effects of treatment, respond to complications and keep your child comfortable.

    It is important to note that treatment for testicular tumors may affect fertility. Before your son begins treatment, talk with your doctors about whether his fertility is likely to be impacted – and if so, whether fertility preservation options, such as sperm banking, should be considered.

    What is the latest research on testicular tumors?

    Various germ cell tumor research studies are underway to help build our understanding of how treatment types and dosages can be modified according to the tumor sub-type, stage, location on the body and the age and gender of the child – to provide the best possible outcome.

    Due to the rarity of germ cell tumors in children, however, statistically meaningful data with multivariate analysis is difficult to achieve. To address that, the Malignant Germ Cell International Collaborative (MaGIC) was formed. This consortium, led by A. Lindsay Frazier, MD, a pediatric oncologist at Dana-Farber/Boston Children’s, is a collaboration of the world’s experts in germ cell tumors, including pediatric, gynecologic and genito-urinary oncologists.

    Clinical Trials
    For many children with rare or hard-to-treat conditions, including testicular germ cell tumors, clinical trials – research studies evaluating new treatment approaches – provide new options.

    Participation in any clinical trial is completely voluntary. We will take care to fully explain all elements of the treatment plan prior to the start of the trial, and you may remove your child from the medical study at any time.

    What is the long-term outlook for testicular tumors?

    The prognosis for benign testicular tumors is usually very good, with minimal if any long-term complications. If one testicle remains, fertility will be preserved, so your son will still be able to father children.

    The prognosis for a 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. Continual follow-up care is equally essential to monitor for side effects of radiation and chemotherapy, as well as second malignancies.

    Children treated for a testicular tumor should visit a cancer survivorship clinic every year to manage disease complications, screen for recurrence and manage late treatment side effects. A typical follow-up visit is likely to include a physical exam, laboratory testing and imaging scans.

    The David B. Perini, Jr. Quality of Life Clinic at Dana-Farber provides care and advocacy for survivors of childhood cancer, conducting research on the long-term effects of cancer treatments, and offering education and support for survivors of cancer. In addition to meeting with your pediatric oncologists, your child may see one of our endocrinologists, cardiologists, neurologists, neuro-psychologists or alternative/complementary therapy specialists. We also offer patient and family education, psychosocial assessment, genetic counseling, reproductive and fertility evaluation and counseling and opportunities to speak with other childhood cancer survivors.