Types and Stages of Testicular Cancer

Testicular cancer is the most common type of cancer in young men, with the vast majority being diagnosed in their 20s or 30s. Fortunately, it is also one of the most treatable types of cancer, with a high survival rate (around 95%) if symptoms are noticed and investigated early.

There are different types of testicular cancer, and they can all be at various different stages. Type refers to the tumour itself, whereas the stage refers to the degree of which a cancer has spread from its site of origin.

Types of testicular cancer

The two main types of testicular cancer are called germ cell tumours and stromal tumours. Treatment can vary depending on what type of tumour you have. Germ cell tumours account for around 95% of all testicular cancer cases. Stromal tumours are much less common in adults, but more commonly found in minors.

Germ cell tumours

Germ cells are the cells that create sperm. Germ cell tumours are either seminomas or non-seminomas. However, it is possible for germ cell tumours to have both seminoma and non-seminoma cells.

A seminoma tumour translates as ‘semen tumour.’ These tend to spread slowly and can be treated with surgery, and chemotherapy or radiotherapy. Classic seminomas are usually found in younger males (from 20s to 50s), whereas spermatocytic seminomas are much rarer and are usually found in older men.

Non-seminoma tumours are found in younger men and they tend to grow more quickly in comparison. Most contain a mixture of different types of cancer cells, rather than just one singular type. This makes them easier to treat too.

The different types of cancer cells may include:

• Embryonal carcinoma (aggressive form of cancer cell)
• Yolk sac carcinoma (more commonly found in young children)
• Choriocarcinoma (very rare and aggressive form of cancer)
• Teratoma (extremely rare and don’t respond to radiotherapy or chemotherapy)
• Seminoma (can often be a component of non-seminoma tumours)

They are also known as ‘carcinomas’ – which refers to cancers that start within skin cells or tissues lining your internal organs.

Stromal tumours

Stromal tumours account for around 5% of all cases in adults, and are more common in children. One in five childhood cases of testicular cancer are stromal tumours. These are often benign (not harmful), respond well to treatment, and also less likely to spread to other areas of the body.

The two main types of stromal tumours are called ‘Leydig cell tumours’ and ‘Sertoli cell tumours.’ The former affects the cells that make male hormones like testosterone. The latter affects cells that allow germ cells to make sperm.

Stages of testicular cancer

The stage of testicular cancer refers to the way we measure how severe the cancer is and how much it may have spread to other areas of the body. The higher the stage, the more advanced the cancer is.

The 3 main stages of testicular cancer are:

• Stage 1 – Localised (no spread)
• Stage 2 – Regional (spread to lymph nodes only)
• Stage 3 – Distant spread (spread to areas away from the site of origin)

This is determined by an investigation of the tumour itself and the lymph nodes in your lower abdomen. It is also determined by metastases (if it has spread to other areas of the body) and the levels of tumour markers in your blood.

(Read our blog ‘What to Expect from Scans and Tests: Blood Tests’ for more information on tumour markers.)Top of Form

Stage 1 – Localised

The cancer is found in the testicle but has not spread. For this you may just require surgery and then post-surgery surveillance. However, in some cases chemotherapy and surgery to remove lymph nodes may also be necessary.

• Stage 1A is limited to the testicle, so there is no sign of spread anywhere else in the body. Surgery is usually all that is required for this stage of cancer and the risk of reoccurrence is low.
• Stage 1B spreads locally but is confined to the scrotum. Again, there is no sign of cancer elsewhere at this stage. Surgery is usually all that is required but there is a higher risk of reoccurrence.
• Stage 1S means your tumour markers are still abnormal following surgery. This could mean there is cancer elsewhere in the body and more treatment is needed.

Stage 2 – Regional

The cancer has spread to nearby lymph nodes in your abdomen, but no further than that. Tumour markers may or may not be elevated at this stage. Treatment may include surgery, radiotherapy, chemotherapy or a combination of all three – depending on the type of testicular cancer you have.

• Stage 2A tumours are 2cms or less
• Stage 2B tumours are 2 to 5cms
• Stage 2C tumours are bigger than 5cms

Stage 3 – Distant

The cancer has spread beyond the lymph nodes in the abdomen to other areas of your body. Treatment will usually involve surgery and chemotherapy.

• Stage 3A cancer has spread to the lungs or lymph nodes away from the abdomen. Tumour markers may or may not be slightly elevated.
• Stage 3B cancer may or may not have spread to the lungs or lymph nodes away from the abdomen, but tumour markers are moderately elevated.
• Stage 3C cancer has spread to other organs of the body like the liver or brain, or to your lungs and distant lymph nodes and your tumour markers are very high.

Do your part! Check your nuts!

If you check your balls frequently and see a doctor if you do find something unusual, then statistics suggest you will be absolutely fine, even if you do find something. Check regularly! Do not put off calling the doctor if you find a lump! You could potentially save your life!