Can testicular cancer spread? Here’s what you should know.

Testicular cancer is one of the most highly treatable, curable cancers. But what if it spreads?

Like almost any cancer, testicular cancer can spread to other parts of the body. But how likely it is to spread and where depend in part on what type of testicular cancer you have in the first place.

Here’s what you need to know about where testicular cancer can spread and what it could mean for your treatment.

When testicular cancer spreads: the basics

Testicular cancer that spreads to other parts of the body is referred to by doctors as metastatic testicular cancer. (Metastasis is a word originally meaning “change” or “transition” and is used to describe any cancer that has spread.)

It’s not uncommon for cancer to spread beyond the testicles. In fact, about 1 in 3 people with testicular cancer already have some spread at the time they’re diagnosed, according to data from the National Cancer Institute in the US.

Don’t panic, though. Testicular cancer is still very treatable, even when it has spread. It’s also important to remember that when cancer spreads from the testicles to other parts of the body, it’s still testicular cancer. For example, if it spreads to the lungs (more on where it can spread below), it’s not the same thing as having lung cancer. Those are testicular cancer cells in your lungs, not lung cancer cells.

Doctors measure the spread of cancerous cells by stages. When it comes to testicular cancer, there are three main stages to know about:

• Stage 1: localized cancer
  This means the cancer has not spread beyond the testicle itself.

• Stage 2: regional spread
  This means the cancer has spread to nearby tissues and/or lymph nodes. In some cases, the affected lymph nodes can be removed during a procedure called a retroperitoneal lymph node dissection (RPLND).

• Stage 3: distant spread
  This means the cancer has spread from the testicles and surrounding tissues to other tissues and/or organs in the body.

Survival rates are still good for testicular cancer that has spread. For example, stage 3 testicular cancer—the most advanced stage—has a 5-year survival rate of 73%.

All that’s well and good, but what parts of the body can be affected by the spread of testicular cancer?

Where testicular cancer can spread: the usual suspects

Lymph nodes are by far the most common place for testicular cancer to spread—but not where you might think. These lymph nodes aren’t near the testicles but in a part of your abdomen called the retroperitoneum—specifically, near the aorta and vena cava (the biggest artery and vein in the abdomen) and the kidneys. This is because the testicles form near the kidneys and “descend” to the scrotum around the eighth month of pregnancy. As a result, all the blood supply, muscles, nerves, and lymphatic drainage for the testicles originate near the kidneys.

Around 1 in 5 people have some regional spread to their lymph nodes at the time of diagnosis. Again, this is what doctors categorize as stage 2 testicular cancer.

In around 1 in 8 cases, the cancer will have spread to other parts of the body:

• The lungs are the second most common place for testicular cancer to spread. Guys with testicular cancer in theirs lungs can still have a good prognosis—that is, a strong likelihood of recovery.

• Other less common places for testicular cancer to spread include:
  - Bones
  - Liver
  - Brain

Testicular cancer spread by type

Where the cancer spreads depends in part on what type you have.

Most testicular cancers are either seminoma tumors (slightly more than half of all cases) or non-seminoma tumors (a little less than half of all cases).

Seminoma tumors: where they can spread

In general, this type grows relatively slowly and is less likely to spread than other forms of testicular cancer. In some cases, seminoma can grow quickly and spread to these parts of the body:

• Lymph nodes

• Lungs

• Brain (this is less common)

Non-seminoma tumors: where they can spread

In general, this is a faster-growing form of testicular cancer, and it can spread more easily to other parts of the body, including the following:

• Lymph nodes

• Brain

• Liver

• The area between the lungs (called the mediastinum)

• The area behind the stomach and diaphragm (called the retrocrural space)

How do you know if your testicular cancer has spread?

If you’ve just been diagnosed with testicular cancer, one of the first things your doctor will do is check to see whether it has spread anywhere beyond the testicles. There are a number of medical tests your care team can run to look for any signs of spread, including:

• Chest x-rays or CT scan to look for testicular cancer cells in the lungs

• CT or CAT scan, using powerful x-rays to look for signs of spread in other parts of the body (most commonly the chest or abdomen)

• MRI scan, using a magnetic field that provides a detailed scan of the body

• PET scan using a specialized camera to look for cancer hot spots (not commonly used for testicular cancer)

• Biopsy to remove tissue for testing (rarely recommended)

With testicular cancer, there is a small risk that performing a biopsy might cause the cancerous cells to spread. Fortunately, modern needle biopsy techniques have dramatically lowered that risk. Performing a biopsy of a metastatic site (like a lymph node or lung nodule) is rare, but if your doctor determines it’s necessary in your case, normally it will be done during surgery to remove the cancer (an orchiectomy or removal of a lymph node or lung nodule), in order to minimize the risk of any spread.

How is metastatic testicular cancer treated?

Remember, testicular cancer is still very treatable, even if it has metastasized—that is, spread to other parts of the body.

If your testicular cancer has spread, your care team may opt for one or more of the following treatments:

• Surgery to remove the affected lymph nodes, to see if any cancer has spread there

• Chemotherapy, which can be used to fight cancer throughout your body

• Radiation therapy (or radiotherapy), which is sometimes used to treat cancer that has spread to your lymph nodes, spinal cord or brain.

The bottom line: testicular cancer that spreads to other parts of the body is still testicular cancer, and it’s still very treatable.

If you’re experiencing fear or anxiety over the spread of your cancer, it’s important to talk to someone. Reach out to your medical care team or a counselor. Testicular cancer can affect your mental and emotional well being, not just your physical health, so it’s important to make sure you get the support you need.