If your urologist finds cancer through these exams, he or she will want to learn the exact cancer cell-type and if it has spread. This is called “staging.” This process helps the doctor learn which treatments are best.
Unlike other cancers, your doctor does not take a tissue sample (biopsy) before surgery. With testicular cancer, cells are looked at after surgery is done to remove the cancerous tissue.”
- Stage 0: This is also called “Germ Cell Neoplasia In Situ (GCNIS)”. This is not really cancer, but a warning that cancer could grow. GCNIS may be found in the seminal tubules and nowhere else.
- Stage I (IA, IB, IS): Cancer is found only in the testicle. It has not spread to nearby lymph nodes.
- Stage II (IIA, IIB, IIC): Cancer has spread to one or more lymph nodes in the abdomen (belly). It has not spread to other parts of the body.
- Stage III (IIIA, IIIB, IIIC): Cancer has spread beyond the lymph nodes in the abdomen. Cancer may be found far from the testicles, like in distant lymph nodes or the lungs. Tumor marker levels are high.
More than 90% of testicular cancers start in cells known as germ cells. These are the cells that make sperm. The main types of germ cell tumors (GCTs) in the testicles are either seminomas or non-seminomas:
- Seminoma – The most common cell type of testicular cancer. They grow slowly and react well to chemotherapy and radiation. Pure seminomas can raise HCG levels but never AFP levels. In addition to surgery, this type of cancer reacts well to radiation and chemotherapy treatment. Active surveillance (monitoring) is often used for low-stage seminomas.
- Non-seminomas – There are a few types of non-seminomas: choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumors. These cells grow more quickly and are less responsive to radiation and chemotherapy. Non-seminomas often raise AFP and/or HCG levels. Treatment for this type of cancer can involve surveillance and surgery. Later stages may be treated with chemotherapy. Sometimes more surgery is needed.
There are also rare testicular cancers from cells that support other roles. Leydig cell tumors form from the Leydig cells that make testosterone. Sertoli cell tumors come from the Sertoli cells that support normal sperm growth.
Testicular cancer may involve more than one cell-type. The best treatment will depend on the diagnosis (such as stage and risk of the cancer coming back after treatment) and whether the disease has spread.