What to know about testicular lymphoma

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Testicular lymphoma is usually a type of non-Hodgkin lymphoma (NHL).

NHL is a type of cancer that occurs in the lymphatic system, which is part of the immune system and comprises a network of vessels and glands that spread throughout the body.

NHL affects lymphocytes, white blood cells that fight infection in the clear fluid that flows through lymphatic vessels. NHL causes the lymphocytes to multiply and collect abnormally within the system, such as in the lymph nodes. This causes the lymphocytes to lose their infection-fighting abilities, leaving a person vulnerable to infection.

The most common type of NHL testicular lymphoma is diffuse large B-cell lymphoma, which affects white blood cells called B-cell lymphocytes.

Testicular lymphoma usually presents as a swelling or mass in the testes.

Experts do not know the precise causes of testicular lymphoma, but several viral infections have associations with the disease. These include:

• HIV
• Epstein-Barr virus, which causes mono
• parvovirus B19, which causes erythema infectiosum, or fifth disease
• cytomegalovirus infection

The most common symptom of testicular lymphoma is an enlarged testicle. The swelling does not cause pain, but in some cases, people can experience a sharp pain along with the swelling, and the testes may feel heavier than usual.

Depending on whether the lymphoma has spread, a person may experience other symptoms relating to its affected areas. A person may also experience B symptoms, such as night sweats, weight loss, and fever.

Risk factors for testicular lymphoma include:

• Age: People over the age of 60 years who have testes are much more likely to develop this type of cancer than younger individuals.
• Infection of certain other viruses: These include Epstein-Barr virus, HIV, parvovirus B19, and cytomegalovirus
• Exposure to cancer-causing chemicals and radiation

There are many possible reasons why a testicle may be swollen or enlarged, and this does not necessarily mean a person has testicular cancer. A doctor can identify other common or simple conditions and rule them out.

If they suspect a tumor, they may perform a testicular ultrasound. They may also order blood tests to test for tumor markers.

Healthcare professionals will typically avoid a biopsy, which may increase the risk of spreading the cancer. Instead, if they find a tumor, they may perform a simple surgery to remove the testis to identify the kind of tumor. After the doctor has examined the testicle tissue, they can make a diagnosis.

A doctor will also stage the cancer according to the size and location of the tumor and whether it has spread to other organs. At this point, they will order CT scans of the chest, abdomen, and pelvis, but they will shield the testicles during these tests. The doctor will consider the stage and type of lymphoma when developing a treatment plan and estimating the outlook.

Doctors will usually treat testicular cancer by surgically removing the tumor and using techniques to prevent the cancer from recurring in the other testicle and other sites in the body. These treatments may involve:

• Surgery: Doctors may perform an orchiectomy on the affected testicle. This is also a part of the diagnosis of the type of cancer.
• Chemotherapy: Doctors typically suggest a chemotherapy regimen, which they refer to as R-CHOP, involving a targeted therapy called rituximab (Rituxan) along with:
  • cyclophosphamide (Cytoxan)
  • hydroxydaunorubicin (Adriamycin)
  • vincristine (Oncovin)
  • prednisone
• Radiation: Doctors may perform radiation therapy on the pelvic area, which can help reduce the risk of cancer reoccurring in the other testicle.
• Central nervous system prophylaxis: This involves the injection of chemotherapy directly into the space between thin layers of tissue that cover the spinal cord and brain. Alternatively, they will inject high doses of chemotherapy directly into a vein to kill cancer cells in the central nervous system.
• Immunotherapy: Doctors call this treatment chimeric antigen receptor (CAR) T-cell therapy. It is a therapy that modifies the patient’s T cells to help fight and destroy cancer cells in the body. Approved CAR T therapies for testicular lymphoma include Kymriah (tisagenlecleucel) and Yescarta (axicabtagene ciloleucel).

Testicular lymphoma is an aggressive cancer and has a higher 5-year survival rate if a doctor diagnoses it at an early stage and the person receives appropriate treatment.

An individual’s outlook depends on several factors, including:

• the size of the tumor
• the stage of the cancer at diagnosis
• their age
• the presence of other symptoms
• the spread of cancer to other sites
• which testicle the lymphoma occurs in — lymphoma in the left testicle may worsen the outlook

Testicular lymphoma is usually a type of non-Hodgkin lymphoma, which affects white blood cells called lymphocytes in the lymphatic system. This prevents the blood cells from protecting the body, leaving it open to infection.

A lymphoma can start in the testes, which healthcare professionals call primary testicular lymphoma. Alternatively, it may start in another organ and spread to the testes and other parts of the body, which doctors call secondary testicular lymphoma.

The most common symptom of testicular lymphoma is a swollen or enlarged testis. A doctor may diagnose the cancer by performing blood tests, CT scans, ultrasounds, and by removing the testicle and examining the tissue.

Treatment for testicular lymphoma may involve surgery, chemotherapy, radiation, central nervous system prophylaxis, and immunotherapy. Testicular lymphoma is an aggressive malignant cancer. However, the outlook for this cancer improves with early diagnosis and treatment.