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Lymphoma of the Testes

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Updated December 10, 2007

Lymphoma can affect the testes (testicles) in men. The testes may be the first organs affected (called primary testicular lymphoma), or they may get affected as a part of widespread disease that involves many other sites.

Is Testicular Lymphoma Common?

The testes are not a common site for lymphoma. In fact, the testes are far more commonly affected by another cancer called germ cell tumors. Less than 5% of individuals with cancer in the testes actually have lymphoma. But germ cell tumors are rare in people over 60 years of age, and lymphoma is the most common cancer affecting the testes in this group.

Type of Lymphoma of the Testes

Lymphoma of the testes is almost always a non-Hodgkin's lymphoma (NHL). The most common type is diffuse large B-cell lymphoma. Other types are immunoblastic lymphoma, Burkitt lymphoma (in children), and follicular lymphoma.

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 the B-symptoms -- fever, weight loss or sweating at night.

Diagnosis

An enlarged testicle can have many causes, and the doctor 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 conducted. Some blood tests for tumor markers are required to identify germ cell tumors, the more common type of testis cancer. The best way to find out the exact type of tumor is to remove the testis with simple surgery. A needle test or a biopsy is usually not recommended. 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 a bone marrow test. Testicular NHL can also spread into the cerebrospinal fluid (CSF) that flows inside the brain and spinal cord. A lumbar puncture may be performed to remove a small amount of this fluid from the spine in the lower back and test it for lymphoma cells.

Treatment and Results

Removing the testicle (orchiectomy) is the first part of treatment and often gets done as a part of diagnosis. Even if no other part of the body is affected, there is more treatment required. This may include chemotherapy and radiation to the scrotum. The chemo drugs used depend on the type of lymphoma that's being treated. As CSF spread can occur, some hospitals will also inject high doses of chemo drugs that can reach the CSF (all drugs don't). Radiation is given to the scrotum as well as the lymph nodes in the abdomen, if they are affected. This treatment usually results in long term disease control in 80 to 90% of individuals.

Source:

Cancer: Principles and Practice of Oncology 7th Edition. Editors: DeVita VT, Hellman S, Rosenberg SA. Lipincott Williams & Wilkins 2005.

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