What to know about testicular cancer

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Symptoms of testicular cancer often appear at an early stage, but sometimes, they do not appear until much later.

The individual may notice a change, or a doctor will find it during a routine physical exam.

A common early symptom is a painless lump or swelling in a testicle. Changes occur in the testicles for many reasons. A lump does not always mean cancer, but anyone who notices a change should see a doctor.

There may also be:

• a sharp pain in the testicle or scrotum
• a heavy feeling in the scrotum
• a difference in size between the testicles

In some cases, hormonal changes will cause the breasts to grow and become sore.

In the later stages, as cancer spreads to other organs, a person may notice:

• lower back pain, if cancer spreads to the lymph nodes
• difficulty breathing, if it affects the lungs
• abdominal pain, if it affects the liver
• headaches and confusion, if it reaches the brain

What causes pain in the testicles? Learn more here.

Most testicular cancers start in the germ cells. These are the cells in the testicles that produce immature sperm.

Doctors do not know why testicular cells become cancerous, but some genetic factors may increase the risk.

Testicular cancer is more likely to occur in people with the following risk factors:

• cryptorchidism, or an undescended testicle
• a family history of testicular cancer
• being white, rather than black or Asian

Having HIV might increase the risk. Having a vasectomy does not increase the risk.

It is not possible to prevent testicular cancer, as doctors do not know what causes it, and because genetic factors may play a role. A person cannot change these factors.

What should a male consider before undergoing a vasectomy? Find out more.

Testicular cancer is highly treatable, especially in the early stages. Most males with a diagnosis of testicular cancer will live at least another 5 years following diagnosis.

Treatment will usually involve a combination of the following:

• surgery
• radiation therapy
• chemotherapy
• stem cell treatment
• surveillance

We cover these options in more detail in the sections below:

Surgery

A surgeon will remove one or both testicles to prevent the tumor from spreading.

The person will receive a general anesthetic. The surgeon will then make a small incision in the groin and remove the testicle through the incision.

Removing one testicle does not usually affect the person’s sex life or fertility, but removing both testicles means that the male will not be able to conceive naturally.

However, other fertility options are available. For example, the doctor might suggest banking sperm for future use, if necessary.

Other effects of removing the testicles may include:

• a loss of sex drive
• difficulty achieving an erection
• fatigue
• hot flashes
• loss of muscle mass

A doctor may prescribe testosterone supplements — as a gel, a patch, or an injection — to help with these issues.

It is also possible to restore the appearance of testicles by having a prosthesis. A surgeon will implant this in the scrotum. It is filled with salt water.

A person who has surgery in the early stages may not need any further treatment.

Lymph node surgery

If cancer has reached the lymph nodes, usually those around the large blood vessels at the back of the abdomen, a surgeon will need to remove these. A surgeon can do this as open or laparoscopic surgery.

This procedure will not impact fertility directly, but any nerve damage may affect ejaculation. This may mean that sperm does not come out through the urethra but goes to the bladder instead.

This is not dangerous, but a lower sperm count can affect fertility.

Radiation therapy

Radiation therapy damages the DNA inside the tumor cells and destroys their ability to reproduce. In this way, it can remove cancer and may prevent it from spreading or coming back.

A person who has surgery may need radiation therapy to ensure that treatment removes any remaining cancer cells. If cancer has spread to the lymph nodes, a doctor may also recommend radiation therapy.

The following temporary side effects may occur:

• tiredness
• rashes
• muscle and joint stiffness
• loss of appetite
• nausea

These symptoms should pass once the treatment is over.

Chemotherapy

Chemotherapy uses medication to destroy cancer cells and stop them from dividing and growing.

A doctor may recommend chemotherapy if a person has testicular cancer that has spread to other parts of the body. A doctor will give the treatment either orally or as an injection.

Chemotherapy attacks healthy cells as well as cancerous ones, which may lead to the following side effects:

• nausea and vomiting
• hair loss
• mouth sores
• tiredness and a general feeling of being unwell

These symptoms usually resolve after treatment finishes.

Stem cell treatment

In some cases, stem cell therapy can enable a person to receive higher doses of chemotherapy that would otherwise be too dangerous to administer.

During the weeks before treatment, a special machine will harvest stem cells from the person’s blood. Healthcare professionals will freeze and store these cells.

The person receives a high dose of chemotherapy, and they will then receive the stem cells into a vein as in a transfusion.

These cells establish themselves in the bone marrow and start making new blood cells. This enables the person’s body to recover from higher doses of chemotherapy.

Disadvantages of this type of therapy include:

• Due to the high dose of chemotherapy, it is risky and may involve life threatening adverse effects.
• It can involve a long stay in the hospital.
• It can be expensive, and medical insurance may not cover it.

Learn more here about stem cells and their uses in research and medicine.

Surveillance

A doctor will carry out surveillance after a person has had treatment for testicular cancer, to check for any signs that the cancer has come back.

Surveillance does not involve active treatment, but the individual will attend regular appointments and undergo tests.

Why does cancer develop? Learn more here.

To diagnose testicular cancer, a doctor will recommend:

Blood tests: These can measure levels of alpha-fetoprotein, human chorionic gonadotrophin, and lactate dehydrogenase. These are substances that may suggest the presence of a tumor.

Ultrasound: This can reveal the presence and size of a tumor.

Biopsy: The doctor takes a small tissue sample from the testicle for investigation using a microscope. A biopsy can determine whether cancer is present or not.

Types of testicular cancer

If tests show that testicular cancer is present, a doctor will also need to know what type of cancer it is and what stage it is at before discussing a treatment plan with the individual.

There are two main types of testicular cancer:

Seminoma: This type grows slowly and contains only seminoma cells. There are two subtypes: classic and spermatocytic.

Nonseminoma: This can involve various kinds of cancer cell. There are several subtypes, including embryonal carcinoma, yolk sac carcinoma, chiorcarcinoma, and teratoma.

Other tumors that are not cancerous include stromal tumors, Leydig cell tumors, and Sertoli cell tumors.

Staging the cancer

The stage of the cancer will also affect treatment options:

Locaiized: The cancer is only in the testis and has not spread.

Regional: The cancer has reached the lymph nodes in the abdomen.

Distant: The cancer has spread to other parts of the body, such as the lungs, liver, brain, and bones.

The best time to check for testicular cancer is when the scrotal skin is relaxed, usually after a warm shower or bath.

To perform a self-exam:

1. Gently hold the scrotum in the palms of both hands. Stand in front of a mirror and look for any swelling on the skin of the scrotum.

2. Feel the size and weight of the testicles first.

3. Press around the testicles with the fingers and thumbs, and be aware of any lumps or unusual swellings.

4. Feel each testicle individually. Place the index and middle fingers under one testicle with the thumbs on the top. Gently roll the testicle between the thumbs and the fingers. It should be smooth, oval shaped, and somewhat firm, with no lumps or swellings. The top and back of each testicle should have a tube-like section, called the epididymis, where sperm is stored.

Repeat this process once each month, checking for changes in the size, weight, or feel of the testicles.

Many males have one testicle that hangs lower than the other or one testicle that is bigger than the other, but as long as these proportions do not change over time, it is not a cause for concern.

Cancer can also affect the penis. Learn more here.

It is not currently possible to prevent testicular cancer, because there are no known lifestyle risk factors. However, if there is a family history, genetic testing may help detect iyt early, if it happens. Regular self-exams may also lead to an early diagnosis.

The outlook for someone with early stage testicular cancer is excellent, with 95% of people surviving at least another 5 years after diagnosis.

Around 11% of people receive a diagnosis after the cancer has spread to other organs. According to the American Society of Clinical Oncology, 74% of these people will live at least another 5 years.

Being aware of any changes can make it easier to spot testicular cancer in the early stages. With prompt treatment, there is an excellent outlook for this type of cancer.