Testicular cancer develops in the testicles, the male reproductive glands located in the scrotum. It is relatively uncommon, accounting for 1% of cancers in men. It tends to affect younger men, especially those between the ages of 15 and 49.
Despite its rarity, testicular cancer is highly treatable, particularly when diagnosed early. Early detection and treatment are crucial for effective management and successful recovery.
Common symptoms of testicular cancer
The most common early symptom of testicular cancer is a painless lump or swelling in one of the testicles. However, symptoms can vary and may include:
- Painless Lump or Swelling: The most prominent sign, often discovered during a self-examination or routine physical check-up.
- Ache in the Scrotum: Some men experience a dull ache or discomfort in the scrotum or lower abdomen.
- Heaviness in the Scrotum: A feeling of unusual heaviness in the scrotum is another common symptom.
- Changes in Testicle Size or Shape: Any noticeable changes in the size, shape, or texture of the testicles should be examined by a healthcare professional.
Severe symptoms or complications
In more advanced cases, testicular cancer can cause severe symptoms or complications, including:
- Sudden Fluid Build-Up: Rapid accumulation of fluid in the scrotum.
- Pain or Discomfort: While early stages are usually painless, advanced cancer can cause significant pain or discomfort in the testicle or scrotum.
- Lower Back or Abdominal Pain: This can occur if the cancer has spread to the lymph nodes or other areas.
- Gynecomastia: Enlargement or tenderness of the breasts, caused by hormonal changes due to the cancer.
- Respiratory Issues: If the cancer spreads to the lungs, it may cause shortness of breath, chest pain, or a persistent cough.
What causes testicular cancer?
The exact cause of testicular cancer is unknown, but several factors may increase the risk:
- Undescended Testicle (Cryptorchidism): Men with a history of undescended testicles have a higher risk of developing testicular cancer.
- Family History: A family history of testicular cancer or other cancers can increase risk.
- Previous Testicular Cancer: Men who have had testicular cancer are at a higher risk of developing it in the other testicle.
- Abnormal Testicle Development: Conditions such as Klinefelter syndrome can increase the risk.
- Age: Testicular cancer primarily affects younger men, particularly those aged 15 to 49.
- Race and Ethnicity: White men are at a higher risk compared to men of other races.
How testicular cancer is diagnosed
Diagnosing testicular cancer involves a series of steps and tests to confirm the presence and extent of the disease:
- Physical Examination: A thorough examination by a healthcare provider to check for lumps, swelling, or changes in the testicles.
- Ultrasound Scan: A non-invasive scan of the scrotum that uses sound waves to create an image of the inside of the testicles. This helps determine if a lump is solid (potentially cancerous) or fluid-filled (likely benign).
- Blood Tests: Tumour marker tests measure the levels of certain substances in the blood that are often elevated in the presence of testicular cancer, such as alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH).
- Inguinal Orchidectomy: If cancer is suspected, the affected testicle is surgically removed through an inguinal incision to prevent the spread of cancer cells. This procedure provides a tissue sample for histopathological examination, confirming the diagnosis and type of cancer.
- Additional Imaging: CT scans and X-rays may be used to determine if the cancer has spread to other parts of the body.
Treatments for testicular cancer
The treatment plan for testicular cancer depends on the type, stage, and spread of the cancer. Common treatments include:
Surgery
- Inguinal Orchidectomy: The primary treatment for testicular cancer involves the removal of the affected testicle. This surgery not only helps in diagnosis but also in preventing the spread of cancer.
- Retroperitoneal Lymph Node Dissection (RPLND): In some cases, surgery to remove lymph nodes in the abdomen may be necessary, especially if there is a risk of cancer spread.
Radiotherapy
High-energy radiation is used to target and kill cancer cells. This treatment is often used for seminoma, a type of testicular cancer that is sensitive to radiation. Radiotherapy can be used after surgery to prevent recurrence.
Chemotherapy
Chemotherapy involves the use of powerful drugs to destroy cancer cells throughout the body. This treatment is particularly effective for non-seminoma types of testicular cancer and in cases where the cancer has spread beyond the testicles.
Surveillance
For early-stage cancer, especially if it is low risk, close monitoring with regular follow-up appointments and tests may be recommended instead of immediate additional treatment.
Stem Cell Transplant
In rare cases, a stem cell transplant may be necessary for testicular cancer that has recurred or is resistant to other treatments. This involves high-dose chemotherapy followed by a transplant of the patient’s own stem cells to restore bone marrow function.
Can testicular cancer be prevented?
While it is not always possible to prevent testicular cancer, certain measures can help in early detection and potentially reduce the risk:
- Regular Self-Examinations: Men should perform monthly testicular self-examinations to detect any changes early. The best time to do this is after a warm bath or shower when the scrotal skin is relaxed.
- Prompt Medical Attention: Seek medical advice immediately if any unusual lumps, swelling, or changes in the testicles are noticed.
- Awareness of Risk Factors: Being aware of personal risk factors, such as a family history of testicular cancer or a history of undescended testicles, can help in taking proactive measures.
- Healthy Lifestyle: Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can contribute to overall well-being and potentially reduce cancer risk.
Frequently asked questions
How often should I perform a testicular self-exam?
It is recommended that men perform a testicular self-examination once a month. The ideal time to do this is after a warm bath or shower when the scrotal skin is relaxed, making it easier to feel any abnormalities. To perform the exam, follow these steps:
- Stand in front of a mirror and look for any swelling on the scrotum.
- Gently roll each testicle between your fingers and thumbs of both hands, feeling for any lumps, changes in size, or irregularities. It’s normal for one testicle to be slightly larger than the other and for one to hang lower.
- If you detect any unusual lumps, swelling, or changes, contact your healthcare provider promptly for further evaluation.
Does losing a testicle affect fertility or sexual function?
Losing one testicle typically does not affect a man’s fertility or sexual function. The remaining testicle generally compensates by producing sufficient sperm and testosterone to maintain normal sexual function and fertility. However, some men may experience psychological effects or concerns about their body image after the loss of a testicle. In such cases, options like testicular prosthesis (implants) are available to restore the appearance of the scrotum.
Can testicular cancer come back after treatment?
While treatment for testicular cancer is often successful, there is a possibility of recurrence, especially within the first few years after treatment. Regular follow-up appointments are essential to monitor for any signs of recurrence.
Is testicular cancer hereditary?
A family history of testicular cancer can increase an individual’s risk, suggesting a potential hereditary component. If you have close relatives (such as a father or brother) who have had testicular cancer, your risk may be higher.
Genetic conditions, such as Klinefelter syndrome, can also increase the risk. However, most cases of testicular cancer occur without a family history. It’s important to inform your healthcare provider about any family history of cancer so they can advise you on appropriate monitoring and preventive measures.
What are the survival rates for testicular cancer?
The survival rates for testicular cancer are very high, particularly when the cancer is detected and treated early. The overall five-year survival rate is around 95%, and for localised cases (where the cancer has not spread beyond the testicle), the survival rate can be as high as 99%. Even in cases where the cancer has spread to nearby lymph nodes or other organs, advances in treatment have significantly improved outcomes.
