Lymphoma can affect the testes in a few ways. A lymphoma may start in the testes, in which case it is referred to as primary testicular lymphoma, or a lymphoma may involve the testes as part of a widespread disease that involves many other sites.
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Prevalence
Types
Lymphoma of the testes is almost always atype of non-Hodgkin’s lymphoma (NHL). The most common type isdiffuse large B-cell lymphoma.Other types are immunoblastic lymphoma,Burkitt lymphoma(in children), andfollicular lymphoma.
There are a few terms you may hear if you are diagnosed with testicular lymphoma. One is “extranodal presentation.“Primary extranodal lymphoma simply means that the lymphoma is first found (originated) outside of the lymphatic system, in other words, it is found in the testes first rather than in a lymph node, the spleen, the bone marrow, or thymus. The testes (along with the central nervous system) are also referred to assanctuary sites,which areareas to which it is difficult to get chemotherapy drugs.
Causes
It’s not known what the causes of testicular lymphoma are, but there are several general risk factors for non-Hodgkin lymphoma. There is an association with viral infections, particularlyEBV (the Epstein-Barr virus which causes mono),CMV (cytomegalovirus infection), parvovirus B19 (the virus that causes “fifths” disease, a common rash associated viral infection in children), and HIV.
Signs and Symptoms
The common symptom is the enlargement of one of the two testes.There is usually little or no pain associated with this. The testis may feel heavy. If the lymphoma has spread to other parts of the body, there may be symptoms related to the parts affected. There may be one or more of theB-symptomsof lymphoma—fever, weight loss or sweating at night.
Diagnosis
An enlarged testicle can have many causes, and your healthcare provider can easily identify some common and simple conditions. If there is a suspicion of a tumor, an ultrasound or CT scan of the testes will be recommended as a first test.Some blood tests for tumor markers are done in order to identify germ cell tumors, the more common type of testicular cancer.
The best way to find out the exact type of tumor is to remove the testis with a simple surgery. A needle test or a biopsy is usually not recommended because of the risk of tumor “seeding” (spreading cancer cells around the area where the needle is inserted). The removed testicle tissue is then viewed under a microscope, and a final diagnosis is made.
Tests After Diagnosis
If the testicular tumor is a lymphoma, a set of tests is required before treatment can start. This usually always includes CT scans of the abdomen and the chest and abone marrow test. Testicular lymphoma can also spread into the cerebrospinal fluid (CSF) that flows inside the brain and spinal cord. A lumbar puncture (spinal tap) may be performed to remove a small amount of this fluid from the spine in the lower back and test it for lymphoma cells.
Treatments
The treatment oftesticular cancerusually involves removing the tumor, but more treatment is required to prevent cancer from coming back in the other testicle, central nervous system, and other extranodal sites.
Surgery: Removing the testicle (orchiectomy) is the first part of treatment and often gets done as a part of the diagnosis.
Chemotherapy: Thechemotherapy regimen CHOPis often given along with Rituxan (rituximab).CHOP stands for Cytoxan (cyclophosphamide), Adriamycin (hydroxydaunorubicin), Oncovin (vincristine), and prednisone.
Targeted therapy: Rituxan is a monoclonal antibody that is usually given along with chemotherapy.Our bodies make antibodies to fight off bacteria and viruses. Rituxan is essentially a man-made antibody designed to fight lymphoma cells.
Radiation: Radiation is often done to the pelvic region, especially to decrease the likelihood of cancer recurring in the other testicle.
Central nervous system prophylaxis: Central nervous system prophylaxis is usually included as part of treatment to prevent this lymphoma from spreading or recurring in the central nervous system.
Immunotherapy:Chimeric antigen receptor (CAR) T-cell therapyis an immunotherapy treatment that modifies a patients' own T-cells to help destroy the cancer cells in their body. Yescarta (axicabtagene ciloleucel) and Kymriah (tisagenlecleucel) are two CAR T-cell therapies approved for certain patients with testicular lymphoma.
Preserving Fertility
Often only one testicle needs to be removed, but both chemotherapy and radiation therapy can result in infertility.Thankfully sperm banking is a viable option for many men. Make sure to talk with your healthcare provider about preserving fertility during cancer treatment so you are aware of all of your options before you begin treatment.
Coping and Support
If you’ve been diagnosed with testicular lymphoma you may be feeling overwhelmed. Since this is an uncommon tumor you may feel very alone, and wonder who you can talk to. Reach out to family and friends. Consider connecting with the cancer community online. We live in an age when you can find others with testicular lymphoma all around the world, and can even find support and people to bounce thoughts off of 24/7.
Research and learn about your disease, and take an active part in your care. The treatment of this disease is aggressive, but unlike many cancers offers a good chance for long-term control of the disease.
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Cheah, C., Wirth, A., and J. Saymour.Primary testicular lymphoma.Blood. 2014;123(4):486-93. doi:10.1182/blood-2013-10-530659Chapuy, B., Roemer, M., Steward, C. et al.Targetable genetic features of primary testicular and primary central nervous system lymphomas.Blood. 2016;127(7):869-81. doi:10.1182/blood-2015-10-673236Yousif, L., Hammer, G., Blettner, M., and H. Zeeb.Testicular cancer and viral infections: a systematic literature review and meta-analysis.Journal of Medical Virology. 2013;85(12):2165-75. doi:10.1002/jmv.23704Vitolo, U., Chiappella, A., Ferreri, A. et al.First-line treatment for primary testicular diffuse large B-cell lymphoma with rituximab-CHOPD, CNS prophylaxis, and contralateral testis irradiation: final results of an international phase II trials.Journal of Clinical Oncology. 2011;29(20):2766-72. doi:10.1200/JCO.2010.31.4187Leukemia and Lymphoma Society.Chimeric Antigen Receptor (CAR) T-Cell Therapy.
Cheah, C., Wirth, A., and J. Saymour.Primary testicular lymphoma.Blood. 2014;123(4):486-93. doi:10.1182/blood-2013-10-530659
Chapuy, B., Roemer, M., Steward, C. et al.Targetable genetic features of primary testicular and primary central nervous system lymphomas.Blood. 2016;127(7):869-81. doi:10.1182/blood-2015-10-673236
Yousif, L., Hammer, G., Blettner, M., and H. Zeeb.Testicular cancer and viral infections: a systematic literature review and meta-analysis.Journal of Medical Virology. 2013;85(12):2165-75. doi:10.1002/jmv.23704
Vitolo, U., Chiappella, A., Ferreri, A. et al.First-line treatment for primary testicular diffuse large B-cell lymphoma with rituximab-CHOPD, CNS prophylaxis, and contralateral testis irradiation: final results of an international phase II trials.Journal of Clinical Oncology. 2011;29(20):2766-72. doi:10.1200/JCO.2010.31.4187
Leukemia and Lymphoma Society.Chimeric Antigen Receptor (CAR) T-Cell Therapy.
Huang, Y., Zhang, Z., Tashkin, D., Feng, B., Straif, K., and M. Hashibe.An epidemiologic review of marijuana and cancer: an update.Cancer Epidemiology Biomarkers and Prevention. 2015;24(1):15-31. doi:10.1158/1055-9965.EPI-14-1026
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