Cancer of the testicle: signs, causes and treatment

Medically reviewed: 5, December 2023

Read Time:5 Minute

Testicular cancer

Cancer of the testicle (also called testis) accounts for 1%2% of all cancers in men. There are approximately 2000 new cases per year in the United States.

It occurs predominantly in younger men and is the biggest cause of cancer-related death in male 15 to 35-year-olds. The number of cases has trebled in the last 20 years and is still rising, but with early detection and new improved treatments the chances of a cure are good.

Symptoms of the testicular cancer

The testicles lie outside the body in a sac of loose skin under the penis called the scrotum. They are soft, oval and not identical. one normally hangs a little lower than the other.

The most common symptom of testicular cancer is a painless swelling or lump in one of the testicles; rarely (in about 2% of cases) it can occur in both at the same time.

The swelling may be noticed by the man or by his partner and is often assumed to be caused by exercise or some minor injury.

However, any lump in the scrotum or testicles should be examined by a doctor.

Other symptoms that can be associated with testicular cancer include:

  • Pain or a ‘dragging’ sensation in the testicles or groins
  • Hardness in part or all of the testicle
  • Fluid accumulation within the scrotum
  • Blood seen at ejaculation within the semen (sperm)
  • Backache and abdominal (stomach) pains (because of the spread of cancer).

Rarely, some men experience tenderness and/or swelling in the area around their breast and nipples. This may be due to the release of hormones that are produced by some testicular tumors, or because the cancer has spread to the chest area.

Causes of a cancer of the testicle

The causes of testicular cancer are not fully understood. The main risk factor is having had an undescended testicle, where the testicle fails to reach its proper position within the scrotum naturally. All testicles are formed in the abdomen and descend into the scrotum at birth or in the first year of life.

Some young boys have an operation to help their testicles descend if they do not come down naturally.

Testicular cancer is seen more commonly in whites than in blacks, and also in those from more affluent backgrounds. Men who have a brother or father with testicular cancer have a higher risk of developing it (although the risk is still small).

A particular gene has been found to be present in many men with testicular cancer and may account for its running in families, just as breast cancer runs in families.

Hot baths, sporting injuries and having a vasectomy do not cause testicular cancer.

How to diagnose a testicular cancer?

Any lump or abnormality in the testicles or scrotum needs to be seen by a family doctor and, if appropriate, by a hospital specialist – remember, most lumps are not cancer.

A specialist will ask questions, perform an examination and organize tests. The first test is usually an ultrasound scan (sound waves transmitted through the testicles showing what they look like on the inside). This scan can usually distinguish cancer lumps from other, benign (non-cancerous) lumps.

Some cancers of the testicle produce chemicals and release them into the blood stream.

These chemicals are called tumor markers, the main ones being alpha fetoprotein (AFP) and beta human chorionic gonadotrophin (BHCG). If present, they can help detect cancer spread, the effect of treatment and, later on, whether or not the cancer has come back.

As with many cancers, the best way to diagnose testicular cancer is with an operation. With the patient under a general anesthetic, a surgeon called a urologist will look at the testicle through an incision in the groin (as for a hernia).

If the testicle looks as though it has cancer, or if a small tissue sample is removed (biopsy), looked at under a microscope and confirmed to be cancer, the testicle is removed.

This operation is called an orchidectomy.

A fake testicle called a prosthesis or implant, similar to the one removed, can be inserted in the same operation. A pathologist then examines the removed testicle under a microscope to see what type of cancer cells it has. There are two major types of testicular cancers, seminomas (more common in 25-55 year olds, and teratomas (usually affecting younger men. It is important for treatment to know what kind they are.

If the operation confirms cancer, then other special tests are needed to look for spread.

A chest X-ray to look at the lungs and a computerized tomography scan (CT scan) to look at the lymph glands in the abdomen and chest are performed. It is likely to take a week or two to get all the results and to see the specialist for advice on treatment.

Treatment of testicular cancer

Treatment is easier and more likely to be successful if testicular cancers are found early.

The treatment after surgical removal depends on the type and on whether or not it has spread:

  • Seminomas

are treated best by giving radiotherapy (x-rays) to the lymph glands within the abdomen, even if they look normal on the CT scan. Chemotherapy (anti-cancer drugs) may also be recommended if there are signs of spread.

  • Teratomas

do not respond to radiotherapy, but modern chemotherapy is very effective. A short course of chemotherapy is used when there is no spread (to prevent the cancer coming back), or longer courses if there is evidence of spread. If any cancer remains in the abdomen or chest after chemotherapy, it can be removed surgically by an operation called lymphadenectomy.

Having only one testicle does not affect your fertility or sexuality, as the remaining testicle produces enough sperm and testosterone.

Chemotherapy, however, can reduce sperm counts permanently, causing fertility problems. Before starting chemotherapy, your sperm can be tested and, if suitable, stored and used after treatment has finished. This procedure is called sperm banking.

Men who undergo lymphadenectomy may sometimes experience ejaculation problems afterwards and are also candidates for sperm banking.

Prevention of cancer of the testicle

All men should examine their testicles once a month.

The best place is in or after a warm bath when relaxed. Using both hands, each testicle should be gently rolled between the thumb and index finger and any irregularities or lumps identified.

All men have a lumpy tubular structure on the back of the testicle called the epididymis (where sperm is stored) and a small firm tube which passes from the testicle into the groin called the vas deferens (where sperm is transported). With repeated examinations these will become familiar and not be mistaken for abnormalities.

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