Testicular cancer causes
According to the National Cancer Institute, 94 percent of all testicular tumors are found in germ cells, the sperm-forming cells inside the testicles. These tumors are divided into two types: seminoma and nonseminoma.

Seminomas, which consist of immature germ cells, account for 30 percent to 40 percent of all testicular cancers and are generally slow growing. Nonseminoma tumors can appear in one or all of four basic germ cell types: embryonal carcinoma, yolk sacs, teratoma, and choriocarcinoma. These cells are more mature than seminoma cells and consequently more aggressive. According to the American Cancer Society, 60 percent to 70 percent
of patients with nonseminoma tumors have cancer that has spread from the testicles to the abdominal lymph nodes.

Risk factors and prevention
Testicular cancer discriminates, mainly affecting males between the ages of 15 and 40. It’s also 4.5 times more common among white men than black men.

The main physiological risk factor is cryptorchidism, or an undescended testicle or testicles. The American Cancer Society reports that this condition affects about 3 percent of men, and accounts for about 14 percent of all testicular cancer cases. Most cancers develop in the undescended testicle.

Those with a family history of testicular cancer may be at higher risk, and men who have had cancer in one testicle have a 3 percent chance of developing cancer in the other testicle.

Some studies have found that diet and exercise have effects on testicular cancer. High meat, fat, and milk intakes, coupled with lower intakes of fruits, vegetables, and fiber, can increase testicular cancer risk. A Norwegian study of 1,276 testicular cancer survivors compared with 20,391 healthy men in the same age range found that 43 percent of the cancer survivors exercised, compared to 37 percent of the general population.

Symptoms and diagnosis
Testicular cancer is often discovered through self exams (see “How To Perform a Self-Exam”). Symptoms include the following.
• Pain or discomfort in the testicle
• A painless lump, swelling, enlargement, or shrinking in the testicle
• A feeling of heaviness in the scrotum
• A sudden collection of fluid in the scrotum
• A dull ache in the lower abdomen, back, or groin

A urologist can conduct blood tests for tumor markers such as beta-human chorionic gonadotropin, a compound found in the blood of pregnant women and in people with certain cancers, including testicular cancer. Other tumor markers include alpha-fetoprotein and lactase dehydrogenase. A doctor can also attempt to diagnose a tumor through ultrasound or a sonogram, but the only sure way to determine if a tumor is present is to remove the testicle and the spermatic cord through an incision in the groin, and then examine the tissue under a microscope. This procedure is known as an inguinal orchiectomy.

The next step is to determine the extent of the cancer, either through computed tomography (C.T.) further blood tests, ultrasound, chest scans, X-rays, or biopsy. There are three stages of testicular cancer:
• Stage 1: The cancer is confined to the testicle (98 percent to 99 percent survival rate, according to The Testicular Cancer Resource Center [TCRC]).
• Stage 2: The cancer has spread to the retroperitoneal lymph nodes, located below the diaphragm and between the kidneys (90 percent survival rate, according to TCRC).
• Stage 3: The cancer has spread to other areas of the body (70 percent survival rate, according to the National Cancer Institute).

Treatment and side effects
Stage 1 cancer is generally cured by orchiectomy. For men with stage 2 testicular cancer, there are several options. If the cancer is confined to the lymph nodes in the abdomen, they can be removed by a procedure known as retroperitoneal lymph-node dissection, or RPLND. According to TCRC, this surgery is usually performed on patients with nonseminoma cancer to help stop it from spreading beyond the lymph nodes; those with seminomas generally opt for radiation treatment rather than surgery, because the cancer cells are less aggressive and therefore unlikely to spread. Nonseminomas are much less sensitive to radiation.

While removing a testicle generally doesn’t cause impotency or sterility, RPLND surgery may cause infertility because it can interfere with the nerves involved in ejaculation.

Radiation can cause fatigue, nausea, and diarrhea as the body works to repair healthy tissues injured by the treatment. It can also interfere with sperm production during the treatment, according to TCRC.

Chemotherapy is used in some cases of stage 2 and 3 cancer. Chemo-therapy used to treat germ-cell based testicular cancer includes a combination of three drugs: Platinol (cisplatin), VePesid or VP-16 (etoposide), and Blenoxane (bleomycin). Clinical trials show that side effects for this drug combination, known as PEB, include nausea, a reduction in blood cells, kidney disease, nervous system disorders, hearing problems, fertility problems, cardiovascular disease, chromosome disorders, brain function disorders, and tissue death.

Natural remedies
Complementary and alternative medical therapies (CAM) for cancer are gaining popularity. A 2001 Florida study reports that 80 percent of 100 cancer patients surveyed used some type of CAM. The most common herbal remedies used were green tea (Camelliae sinensis), Echinacea (Echinacea spp.), shark cartilage, grape seed extract, and milk thistle (Silybum marianum). But although there has been extensive research on herbal remedies and supplements to treat many types of cancer, CAM studies on testicular cancer are minimal. Because testicular cancer is rare, “there’s not as high or as compelling an interest from a research point of view,” says Mark Blumenthal, executive director of the American Botanical Council. Consequently, Blumenthal says, “I’ve not seen any reliable herbal remedy for testicular cancer.”

John Boik, author of Natural Compounds in Cancer Therapy (Oregon Medical Press, 2001) and Cancer and Natural Medicine: A Textbook of Basic Scientific and Clinical Research (Oregon Medical Press, 1996), agrees. “I don’t know of any compounds from herbal or food material that I think would have a magic bullet effect on cancer,” he says. However, he notes that there are about 20 relatively mild compounds whose combined effect reduces the chances of toxic reactions to cancer. These compounds include flavonoids; genistein, an isoflavone found in soybeans; fish oil; curcumin, found in turmeric; and bioswellic acid, found in frankincense.

Clinical studies show that vinca alkaloids from the Madagascar periwinkle (Catharanthus roseus) and paclitaxel from the Pacific yew (Taxus brevifolia) treehave anticancer agents. Shark cartilage has been found to have anticancer compounds in numerous studies.

How to perform a self-exam

The most reliable way to discover testicular tumors is by a monthly self-examination after a bath or shower, because heat relaxes the scrotum, making it easier to spot abnormalities. The National Cancer Institute recommends the following steps.

one) Stand in front of a mirror and check for swelling in the scrotum. Remember that it’s normal if one testicle is slightly larger than the other.

two) Place the index and middle fingers under the testicle and the thumb on top. Roll the testicle gently and check for pea-sized lumps, which are usually found on the sides. Don’t mistake the epididymis, the soft, tubelike structure behind the testicle that stores and transports sperm, for a lump.

three) If you find a lump, contact your doctor. The lump could be due to infection, but could also be a tumor.