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).
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.
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.
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.
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.
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.
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.
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 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.
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.