Testicular cancer

by | Cancer Care, Men's Health

Cancer that develops in a testicle is called testicular cancer. It usually starts as a painless lump or swelling just in one testicle. If diagnosed early, testicular cancer has a very high cure rate (around 90-95%) because the cancer is localised within the testicle. However, if left untreated, the cancer may spread to other parts of the body where it may be more difficult to treat. So you should see a doctor as soon as possible if you notice any changes in your testicles.

Symptoms of testicular cancer

Testicular cancer often causes no symptoms except for the awareness of a painless swelling or lump in the testicle. Because of the lack of other symptoms, any new lump or swelling in the testis should be reviewed by your doctor

However it can cause a variety of other signs and symptoms that include:

  • A feeling of heaviness in the testicle or the groin;
  • A dull ache in the lower abdomen or the groin;
  • Pain or tenderness in the testicle or scrotum; or
  • A change in the way a testicle feels.

If the cancer has spread beyond the testicle, there may be symptoms in other parts of the body, such as:

  • Enlarged or tender breasts or nipples;
  • Back pain, breathlessness or coughing; or
  • Reduced appetite and weight loss.

These symptoms are not specific for testicular cancer, and can be caused by a many other conditions. Speak with your doctor if any of these symptoms last for around 2 weeks or more. All illnesses should be diagnosed and treated as soon as possible. This is particularly important for testicular cancer, because the sooner the cancer is diagnosed and treated, the better the chances of a complete recovery.

How common is testicular cancer?

Testicular cancer accounts for approximately 1% of all cancers in men, and around 700 Australian men are diagnosed each year. Unlike some cancers which increase with age, testicular cancer mainly affects men between the ages of 20 and 40.

There are a number of types of testicular cancer. The most common type is called a seminoma and is usually found in men aged 25-50 years. The next most common type is called a non-seminoma and is usually found in younger men (e.g. in their 20s).

Risk factors for testicular cancer

Like many cancers, the exact cause of testicular cancer is not known. However, a number of factors can increase the risk of developing testicular cancer, including:

  • Undescended testicles as a young child – where one or both testicles remain in the abdomen or don’t descend fully into the scrotum. This condition increases the risk of testicular cancer by about 10 times. The risk of cancer is reduced if surgery to correct the undescended testicle/s is carried out before the child is 1 year old.;
  • A history of testicular cancer in one testicle increases the risk of cancer in the other testicle;
  • A history of male infertility (particularly due to undescended testicles);
  • Having a mother who took a hormone called DES (diethylstilbestrol) during pregnancy to prevent miscarriage. This hormone may cause changes in the testicles, but it is not yet clear whether exposure to DES causes testicular cancer;
  • Having Down syndrome may increase the risk of developing several types of cancer, including testicular cancer;
  • A family history of testicular cancer (such as having a father, brother or uncle with the condition) slightly increases your risk; and

How is testicular cancer diagnosed?

Your doctor will ask you about your symptoms and perform a physical examination.

Your doctor may request a number of tests, including:

  • An ultrasound of the scrotum to examine the testicles;
  • Blood tests to look for particular substances that may indicate the presence of cancer.

Sometimes, lumps or swellings in the scrotum turn out to be cysts that are filled with fluid and which are not cancerous. So the tests your doctor orders help to work out what is causing the changes in the scrotum or testicles. If testicular cancer is suspected, your doctor will refer you to a specialist doctor (called a urologist) who is an expert in diseases of the genital organs and urinary tract.

To confirm the diagnosis, a sample of tissue from the affected testicle is needed for examination under a microscope. Unfortunately, a tissue sample cannot be taken from the testicle while it is in place. This is because if the symptoms are caused by cancer, cutting into the testicle may accidentally allow cancer cells to spread to other parts of the body. The only way to safely obtain a tissue sample is to surgically remove the testicle under a general anaesthetic. The affected testicle is removed through the groin in an operation called an inguinal orchiectomy. The surgeon may also remove the lymph nodes deep in the abdomen to test for cancer cells.

More than 70% of men with testicular cancer are diagnosed at an early stage of the disease, which generally responds very well to treatment.

If tissue samples from the testicle confirm the diagnosis of testicular cancer, further tests will be recommended. A chest X-ray or a CT scan of the chest, abdomen and pelvis will be needed to check whether the cancer has spread to other parts of the body.

Treatment for testicular cancer

The first step in treatment is to surgically remove the affected testicle. Any additional treatment depends on the type of cancer found, what stage it is at (e.g. early or more advanced), and whether it has spread beyond the testicle.

The most common treatments following the removal of the affected testicle are:

  • Careful monitoring with no further treatment – this is an option for some types of cancer that has not spread beyond the testicle;
  • Chemotherapy – medicines that kill cancer cells that may have spread to other parts of the body; and
  • Radiotherapy – using targeted x-rays to kill or slow the growth of cancer cells in other parts of the body.

Fortunately, testicular cancer cells are very sensitive to chemotherapy and radiotherapy.

Possible side effects of treatment

Most of the side effects of chemotherapy and radiotherapy are temporary or can be managed. Importantly, not everyone will get these side effects.

  • Chemotherapy side effects may include temporary hair loss, kidney problems, hearing problems, numbness in the hands or feet, bone marrow problems, or inflammation of the gums and mouth (lung problems may develop but only with a particular type of chemotherapy);
  • Radiotherapy side effects may include temporary hair loss, changes to bowel movements or diarrhoea.

Both radiotherapy and chemotherapy can cause infertility, but if men are concerned about their fertility, sperm can be donated before treatment and frozen for later use.

Surgical removal of a testicle does not affect sexual performance. However, if both testicles are removed, men may need long-term testosterone therapy to replace levels of this important hormone that is partly produced in the testicles.

The emotional impact of testicular cancer

Like all cancers, a diagnosis of testicular cancer can have a big impact on men and their families. Apart from the diagnosis, men also need to deal with the emotional impact of having the affected testicle (or testicles) surgically removed. Your doctor can provide information and support, and can also refer you to a psychologist, counsellor or support group for further help.

Ongoing follow-up

Men who have been treated for testicular cancer should have regular check-ups with their GP and specialist over the next 10 years or so to make sure the cancer does not come back. Check-ups may include X-rays, scans or blood tests.

Can testicular cancer be prevented?

As the cause of testicular cancer is not known, there is no way to prevent it. But early diagnosis can allow the cancer to be treated before it spreads to other parts of the body. So it’s important for men to be alert for any changes in their testicles and to speak to a doctor if something seems abnormal.

Self-examination of the testicles

Regular self-examination of the testicles is easy to do and may help identify any changes. The examination is easier after a warm shower or bath when the skin of the scrotum is relaxed. It’s quite normal to have different sized testicles, and the left testicle often hangs lower than the right testicle.

To examine your testicles, support your scrotum in the palm of your hand and gently roll one testicle between your thumb and fingers to feel for any changes in or on the surface (such as lumps, swelling or hard areas). Healthy testicles should feel firm and have a smooth surface. The epididymis (the coiled tube at the back of the testicle that carries sperm) should feel soft, with no swellings. Then repeat the process with the other testicle.

The Cancer Council Australia says that it is sensible for men from puberty onwards to become familiar with the usual level of lumpiness of their testicles and to see their doctor if they notice a change. Men with a family history of testicular cancer (father or brother) or a personal history of absent or undescended testicles in particular should regularly check for lumps or swellings on the surface of the testicles.

The testicles or testes are located beneath the penis and contained within the scrotum. They should be about equal size and feel smooth, rubbery and egg-shaped. The left testicle occasionally hangs lower than the right.

Self-examination of the testes is best done when the scrotum is relaxed, after a warm bath or shower. This will also allow the testicles to drop down completely.

What to do if you find a lump in your testicle

If you find a lump or any other abnormality you should contact your doctor immediately. The lump may be due to an infection, cyst or other non-cancerous swelling. Your doctor may recommend an ultrasound to determine the precise nature of the swelling.

Don’t worry: the great majority of lumps detected by TSE are not cancer. For the rare ones that are, testicular cancer is highly curable, especially when detected and treated early. Testicular cancer generally occurs in only one testicle, and the other testicle is all that is needed for full sexual function and fertility.

Outlook for men with testicular cancer

Testicular cancer generally has a good outcome, with around 90-95% of men completely cured after surgical removal of the testicle (perhaps with chemotherapy and/or radiotherapy). However, the outlook depends greatly on the type of cancer, its size and whether it has spread to other parts of the body.

The earlier testicular cancer is detected and treated, the better the outlook. So see your doctor as soon as possible if you notice any changes in your testicles.