Testicular Cancer Types & How It Spreads to Lymph Nodes

Testicular cancer is the most common cancer in young men aged 15 to 35. While it usually starts in the testicles, it can spread to other parts of the body and often first to the abdominal lymph nodes. Understanding how this process works and what you can do to catch it early can empower you to take charge of your health.

What is Testicular Cancer?

Testicular cancer is a disease where abnormal cells start growing in the testicles. The testicles (also known as testes) are two small, oval-shaped glands located inside the scrotum, the pouch of skin beneath the penis. Their job is to make sperm (for reproduction) and testosterone (the main male hormone).

Main Types of Testicular Cancer:

Testicular cancers are mainly classified as germ cell tumors because they start in the cells that make sperm. The two major types that can spread to the lymph nodes in the abdomen are:

Seminomas Seminomas usually grow more slowly and are more sensitive to radiation therapy. They often spread first to the lymph nodes in the back of the abdomen (retroperitoneal lymph nodes).

Non-Seminomatous Germ Cell Tumors (NSGCTs) These grow and spread faster than seminomas. They usually spread to the same abdominal lymph nodes, but they can also spread to the lungs or other organs earlier. This category includes several subtypes (like embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma), but they’re usually grouped together for treatment decisions because they behave similarly.

Embryonal Carcinoma is an aggressive and fast-growing type of testicular cancer that often looks like early embryonic tissue under a microscope. It can spread quickly to lymph nodes, lungs, liver, or other organs, and is often mixed with other types of testicular tumors like teratomas or yolk sac tumors. Because of its aggressive nature, embryonal carcinoma usually requires a combination of surgery and chemotherapy.

Yolk sac tumor is also known as endodermal sinus tumor, it is most common in infants and young children but can also occur in adults. This tumor produces alpha-fetoprotein (AFP), a protein that can be measured in the blood to help diagnose and monitor the cancer. AFP is a protein that the liver makes when its cells are growing and dividing to make new cells. Yolk sac tumors are typically treated with surgery and chemotherapy.

Choriocarcinoma is a rare but extremely aggressive type of testicular cancer that originates from cells that would normally form the placenta during pregnancy, but in this case, grow in the testicle. It tends to spread rapidly through the bloodstream to organs like the lungs, liver, and brain. Choriocarcinomas produce high levels of human chorionic gonadotropin (hCG), another tumor marker measured in the blood. Due to its rapid spread, it typically requires intensive chemotherapy.

Teratoma is a tumor made up of several types of tissue from like hair, muscle, or bone because it arises from primitive germ cells. Teratomas can be classified as mature (often benign) or immature (more likely to be malignant). In adults, even mature teratomas can behave aggressively or transform into cancer over time. Teratomas often do not respond well to chemotherapy, so surgery is the mainstay of treatment.

Where Does It Spread First?

Testicular cancer often spreads through the lymphatic system, a network of small vessels that drain fluid and help fight infections. The first stop for many testicular cancers is the retroperitoneal lymph nodes in the abdomen, which are located near the back of the abdominal cavity.

Step-by-Step: How Does Testicular Cancer Spread?

Step 1: You Notice a Lump or Swelling in Your Testicle

You might notice a small, painless lump or swelling in one of your testicles during a self-exam, while showering, or putting on clothes. Sometimes you might feel a dull ache in the groin or lower abdomen.

Step 2: Tumor Forms in the Testicle Inside the Body

Cancer cells begin to grow in the testicular tissue, forming a small tumor. These cells multiply and can invade nearby structures.

Step 3: Cancer Cells Break Away:

Some of these cancer cells detach from the main tumor and enter the lymphatic vessels, which act like highways for fluid and immune cells in the body.

Step 4: Cancer Cells Travel Through Lymphatic Vessels

The cancer cells move along the lymphatic vessels, following a path toward the abdominal lymph nodes. These lymph nodes filter fluids and can trap cancer cells.

Step 5: Cancer Cells Reach the Abdominal Lymph Nodes

The cancer cells settle in the retroperitoneal lymph nodes. These are clusters of nodes located behind the abdominal organs and along the aorta.

Step 6: You Might Feel Abdominal Fullness or Pain

At this stage, you might start to feel a sense of fullness, discomfort, or dull pain in your abdomen or lower back. However, many people don’t feel anything at all, which is why follow up testing is so important.

Step 7: Doctor Confirms the Diagnosis

If your doctor suspects the cancer has spread, they might order imaging tests like a CT scan or MRI to look at your abdominal lymph nodes. Blood tests measuring tumor markers like AFP, hCG, and LDH can also help confirm the spread.

Step 8: Treatment Planning

Based on the results, your doctor will discuss the best treatment options. These might include surgery to remove affected lymph nodes, chemotherapy, or radiation therapy, depending on the type of testicular cancer.

Why Does This Matter?

Understanding these different types of testicular cancer and how they spread is critical for doctors to determine the most effective treatment and for patients to understand the importance of early detection and follow-up care.

Something To Think About:

Self exams are a simple, proactive way to catch testicular cancer early. If you notice any swelling, lumps, or unusual discomfort, see your doctor as soon as possible. Understanding how cancer spreads helps you understand why follow up tests are important. Knowing how it moves through the lymphatic system can make sense of why your doctor may order abdominal imaging, even if your only symptom is a small lump in your testicle.

Sources:

American Cancer Society. (2023). Testicular Cancer. Retrieved from https://www.cancer.org/cancer/types/testicular-cancer.html

Mayo Clinic. (2023). Testicular Cancer. Retrieved from https://www.mayoclinic.org/diseases-conditions/testicular-cancer/symptoms-causes/syc-20352986

National Cancer Institute. (2023). Testicular Cancer Treatment (PDQ®)–Patient Version. Retrieved from https://www.cancer.gov/types/testicular/patient/testicular-treatment-pdq