What is Testicular Cancer?

With timely diagnosis, testicular cancer is most likely treatable and most often curable. It is the most common cancer in men 15 to 34 years old. Still, it is fairly rare. About 8,850 men will be diagnosed with testicular cancer in the U.S. this year. The risk of death from testicular cancer is small. About 410 men will die of testicular cancer in the U.S. this year.

The Testicles

Male Reproductive Organs
Male Reproductive System
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

The testicles (also known as testes or testis) are part of the male reproductive system. These 2 golf ball size glands are held in a sac (scrotum) below the penis. The testicles have a firm, slightly spongy feel. At the top and outside edge is a rubbery, tube-like structure called the epididymis. The firmness of the testicle should be the same throughout. The size of the testicles should also be about the same.

The testicles are where sperm mature before being delivered to the vas deferens and ejaculated. The testicles also make male hormones such as testosterone. This hormone controls the sex drive in men. It also triggers the development of male traits.



What are the Symptoms of Testicular Cancer?

Signs of a testicular tumor are:

  • a painless lump in the testicle (the most common sign)
  • a feeling of weight in the scrotum
  • swelling of the testicle.(with or without pain)
  • pain or a dull ache in the testicle, scrotum or groin.

Until proven otherwise, any lump or firm part of the testicle should be considered a potential tumor. Of the many men who are found to have testicular cancer, 75 out of 100 complain of painless swelling of the testicle and about 17 out of 100 may have pain.

Unfortunately, it is common for men to put off telling their health care provider about these signs (for up to an average of 5 months). Since the tumor can spread during that time, it is vital to reach out to a urologist right away when you have a symptom, especially if it lasts for more than 2 weeks. The urologist must rule out other issues such as:

  • epididymitis (swelling of the epididymis)
  • testicular torsion (twisting of the testicles)
  • inguinal hernia (when a section of intestine pokes through a weak part of the stomach muscles near the groin)
  • hydrocele (atypical fluid in the scrotum, may happen in 10 out of every 100 cases).


What Causes Testicular Cancer?

A History of Undescended Testes

How the testicles descend into the scrotum during pregnancy
How the testicles descend into the scrotum during pregnancy
Image © 2003 Fairman Studios, LLC.

The only risk factor linked to testicular tumors is a history of undescended testicles (cryptorchidism). This means that a testicle did not drop from the abdomen (where it forms in fetal development) down into the scrotum by birth. Testicular cancer may develop in about 8 out of every 100 patients who have had an undescended testicle fixed with surgery. The cancer can grow in the undescended testicle or in the opposite testicle. In fact, in adults there is a 2 to 3% incidence of a bilateral tumor (on the opposite side) occurring at the same time or right after the first tumor. Testicular self-exams are important in these men since a tumor can grow in either testicle.

Other Risk Factors

Men whose father or brother had testicular cancer are also at greater risk. They should also do a self-exam each month. Younger men above all, those who are 15 to 34 years old are at risk for testicular cancer. Testicular cancer is also more common in white men than in black men.



How is Testicular Cancer Diagnosed?

  • Health record and physical exam: Your urologist will look for lumps, firmness or signs of swelling, and ask about a history of undescended testicles.
  • Ultrasound: Your urologist may call for an ultrasound (a noninvasive radiological test) to check any suspicious lump.
  • Blood test: A blood sample can be checked for tumor markers (proteins made by most testicular malignancies) that show up if cancer is present.

Unlike many other cancers, testicular cancer is not diagnosed by taking a biopsy (tissue sample). Doing a biopsy could cause the cancer to spread.

If your urologist finds cancer, he or she wll want to determine how serious it is, how far it has spread or its stage.



What are the Stages of Testicular Cancer?

Stages of Testicular Cancer and where it can spread throughout the body
Stages of Testicular Cancer and where it can spread throughout the body
Image © 2003 Fairman Studios, LLC.

  • Stage 1: Cancer is found only in the testicle.
  • Stage 2: Cancer has spread to the lymph nodes in the belly.
  • Stage 3: Cancer has spread beyond the lymph nodes in the belly. There may be cancer in parts of the body far away from the testicles such as the lungs and liver.


How are Testicular Tumors Treated?

Surgery

Suspicious tumors are first treated by removing the testicle through a small groin incision (orchiectomy). In some cases a testicular prosthesis may be placed for cosmetic reasons.

Further Treatment

Later treatment depends on the tumor, since testicular cancers are categorized by cell type. The cell type determines how the tumors act biologically and respond to treatment.

Seminoma

The most common cell type is seminoma. This type responds to radiation and chemotherapy. Active surveillance (monitoring) is often used for low stage seminomas, but you may need radiation or chemotherapy.

Nonseminomatous Tumors

Treatment can involve observation, surgery or chemotherapy. The treatment depends on the type of cell and spread of disease. A urologist will use imaging tools such as chest x-rays and computerized tomography (CT), along with blood tumor markers, to stage the cancer.

Advanced Testicular Cancer or Aggressive Tumors

Your doctor will need to gauge how far the cancer has spread. Some cases may call for surgical removal of lymph nodes in the abdomen from the area behind the peritoneum. If the disease is advanced, you may be put on chemotherapy. Often specialists prescribe a drug "cocktail," made of 2 or 3 drugs such as cisplatin, etoposide and bleomycin, to be delivered in 3 or 4, 3-week cycles. Sometimes residual tumors may need to be removed surgically after chemotherapy is completed.



What Can You Expect after Treatment?

Potency and Fertility

Removal of 1 testicle should not impair your sexual potency or fertility. Still, there is a chance of

  • a brief decrease in sperm production
  • a change in ability to ejaculate (after surgery to remove lymph nodes)

But the other gland should compensate and make enough testosterone. Also, with today's surgical techniques, this problem is rare. Some drugs may also help reverse ejaculation problems. Most men are able to have a normal erection after surgery. But because ejaculation can be impaired with surgery and because chemotherapy can lower sperm counts (usually only temporarily), you may wish to bank sperm before treatment.

Follow-up

If you have been diagnosed with a testicular tumor, you can expect to be followed for at least 5 years with:

  • periodic x-rays
  • CT scans
  • blood tests for tumor markers

Also, since there is an increased risk (about 2%) of a second tumor, it is important to continue monthly testicular self-exams.



More Information

Frequently Asked Questions

How common are testicular tumors?

Testicular tumors are uncommon. Testicular tumors develop in about 3 in 100,000 men each year. But while those numbers are low, testicular cancer is the most common cancer in men age 15 to 34. Also, testicular cancers are increasing in incidence worldwide. Awareness of the disease has grown since Olympic gold medalist figure skater Scott Hamilton and cyclist Lance Armstrong have had testicular tumors.

What is the cure rate for testicular tumors?

The good news is that a strategy using surgery, chemotherapy or radiation (alone or combined) has resulted in cure rates of almost 100% for low stage or early disease, and more than 85% for more advanced tumors.

How do I perform a testicular self-exam?

Monthly testicular self-exams are the most important way to detect a tumor early. The best time to examine the testicles is right after a hot bath or shower. The scrotal skin is most relaxed at this time and the testicles can be felt more easily. The exam should be done while standing and it only takes a few minutes.

  • Look for swelling in the scrotum or any changes in appearance.
  • Gently feel the scrotal sac to find a testicle.
  • Examine the testicles one at a time. Firmly and gently roll each testicle between the thumb and fingers of both hands to feel the whole surface.
  • Note that it is normal for one testicle to be slightly larger than the other. It is also normal to feel a cord-like structure (the epididymis) on the top and back of each testicle.
  • If you find a lump, swelling, pain or other change, get it checked out right away. Changes are not always cancer. If it is cancer and you catch it early, you have the best chance for a cure.