Testicular Cancer

What is testicular cancer?

Testicular cancer starts in the cells that make up your testicle. It is one of the most curable forms of cancer.

When cancer spreads, it’s called metastasis. The more cancer spreads (metastasizes), the harder it is to treat.

How common is testicular cancer?

According to the American Cancer Society, Testicular cancer is not common. Only about one of every 250 males will develop testicular cancer at some point during their lifetime.

Overview

The testicles are the male sex glands and are part of the male reproductive system. Testicles are also called testes or gonads. They're inside a pouch of skin (scrotum) under the penis.

The testicles produce sperm. The testicles also make male hormones, including testosterone.

These hormones control the development of the reproductive organs. They also control other things, such as body and facial hair and a lower voice.

Testicular cancer and its treatment may affect your fertility, the way your scrotum looks and your interest in sex. Talk about this before starting treatment.

Symptoms

What are testicular cancer symptoms?

If you have testicular cancer, you may notice certain warning signs. But you can also have testicular cancer without having any symptoms.

These are some of the possible symptoms:

• A lump on your testicle (the lump is often painless, but it can be uncomfortable)
• Swelling of a testicle or a change in how it feels
• Sudden fluid buildup in the scrotum
• A feeling of heaviness or aching in the scrotum or lower belly (abdomen)
• Swelling in your breasts (this is rare but can be caused by hormone changes linked to the cancer)
• Pain in your lower back, which can be a sign that testicular cancer may have spread to your lymph nodes
• Shortness of breath, chest pain, or a cough, which can be signs that testicular cancer may have spread to your lungs
• In rare cases, you may have no symptoms other than infertility tests. A test to find out why you are infertile may lead to diagnosing testicular cancer

Risk Factors

The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change.

The risk factors for testicular cancer include:

• Being in your 20s or 30s, though it can happen at any age
• Being white
• History of cancer in the other testicle
• Undescended testicle
• A family history of testicular cancer, which can put you at a higher risk
• HIV infection

Prevention

How to prevent testicular cancer

Researchers don’t yet know how to prevent this type of cancer.

Are there screening tests for testicular cancer?

No blood tests are used to screen for testicular cancer in men without symptoms. But regularly doing a testicular self-exam (TSE) may help you find cancer early. Some health care providers advise a TSE once a month after puberty. The American Cancer Society doesn't advise how often it should be done.

How to check for testicular cancer?

Get to know the normal size, shape, and weight of your testicles. This will help you notice any changes over time. It's normal for one testicle to be lower or slightly larger than the other.

Health care providers advise that males do the exam during or after showering. This is because your scrotal skin is softer and more relaxed at this time. This makes it easier to feel any changes.

Follow these steps to do a self-exam:

• Using both hands, gently roll each testicle between your fingers.
• Find the epididymis. This is a stringlike structure on the top and back of each testicle. This is a normal part of the testicles.
• Feel for firm areas or lumps under the skin, in the front or along the sides of either testicle. A lump may feel like a kernel of uncooked rice or a small, hard pea.
• Have your healthcare provider check any swollen areas or lumps you find.

Changes in the testicles can have causes other than cancer. But it's important to see your health care provider if you need clarification on anything you see or feel. Also, ask your health care provider about testicular exams during your regular checkups.

Diagnosis

How is testicular cancer diagnosed?

If your health care provider thinks you might have testicular cancer, you will need certain exams and tests to be sure. The process starts with your health care provider asking you questions. You'll be asked about your health history, symptoms, risk factors and family history of disease.

A physical exam will be done. It will include checking your testicles for swelling, sore areas or lumps. If there is a lump, your health care provider will note its size and location.

Your provider may also look carefully at your belly (abdomen), groin and other parts of your body. This is to look for signs that tumors may have spread to other parts of the body. 

What tests might I need?

You may have one or more of these tests:

Ultrasound
An ultrasound is often the first test done if you have a lump on or near your testicle. This test uses sound waves to make images of the inside of your body. It can show if the lump is filled with fluid or is a solid mass. Solid lumps are more likely to be cancerous.

Blood tests
Blood levels of certain proteins tend to change if you have testicular cancer. These proteins are called tumor markers. The main tumor markers for testicular cancer are alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). Another marker is an enzyme called lactate dehydrogenase (LDH).

Your health care providers may be able to tell what kind of testicular cancer you have based on these marker levels. These blood tests might be repeated during treatment to see how well the treatment is working. They can also be checked after treatment for signs of cancer returning.

Other blood tests will be done to get an idea of your overall health. They can also show how well organs like your kidney and liver are working.

Surgery to remove the testicle
If a testicular tumor is found and the health care provider thinks it's cancer, a surgeon will most likely try to remove it. This is often done by removing the entire testicle and spermatic cord. This surgery is called a radical inguinal orchiectomy.

The testicle and cord are removed through an incision above your pubic area. This surgery is not done through the scrotum. This is because if you have cancer, the surgery could spread the cancer cells to your scrotum or your other testicle.

The removed testicle and spermatic cord are sent to a lab for testing. A doctor called a pathologist will look at the removed tissues under the microscope to check for cancer cells.

What does the stage of a cancer mean?
Testicular cancer staging is how much and how far the cancer has spread in your body. Your health care provider uses exams and tests to determine the cancer’s size and location. They can also see if the cancer has spread. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

Treatment

How is testicular cancer treated?

The goal of testicular cancer treatment is to do one or more of these things:

• Remove the testicle with cancer in it
• Remove or destroy tumors in other parts of the body
• Kill cancer cells or keep them from growing and spreading
• Keep the cancer from coming back or delaying its return

Ease symptoms from the cancer, such as pain or pressure on organs.

What are some common testicular cancer treatments?

Testicular cancer treatment may include:

• Surgery. This is almost always the first treatment for testicular cancer. The goal is to remove the entire tumor along with the testicle. Sometimes lymph nodes in the lower belly (abdomen) are removed. Depending on the stage of the cancer, surgery may be the only treatment. But sometimes other treatments are needed after surgery.
• Chemotherapy.This is the use of strong medicines to treat cancer. The goal is to kill any cancer cells still in the body after surgery to help keep the cancer from coming back. When used after surgery, this is called adjuvant chemotherapy.
• Radiation therapy. The goal of radiation therapy is to kill cancer cells. It's mainly used to treat a type of testicular cancer called a seminoma. It might be used after surgery to treat lymph nodes in the lower back of the abdomen. When it's used after surgery, it is called adjuvant radiation therapy. In this case, the goal is to reduce the chance that the cancer will come back. Radiation can also be used to treat testicular cancer that has spread to other parts of the body, such as the brain. (This is rare.)

Is testicular cancer curable?

Yes. Survivability largely depends on the stage of cancer. Because testicular cancer can typically be diagnosed and treated early, the testicular cancer survival rate is high. The American Cancer Society reports the risk of dying from testicular cancer at one in 5,000.