Testicular Cancer
Testicular cancer is a malignant tumor that develops in one or both testicles, primarily affecting young men between ages 15-35. While the diagnosis can be frightening, testicular cancer has one of the highest cure rates of all cancers, with over 95% of cases being successfully treated when detected early. Regular self-examination and prompt medical attention for any testicular abnormalities are crucial for early detection.
Medical Disclaimer: This information is for educational purposes only and should not replace professional medical advice. If you discover any testicular lumps, swelling, or other concerning symptoms, seek immediate medical evaluation from a healthcare professional.
Overview
The testicles are two oval-shaped organs located in the scrotum that produce sperm and testosterone. Testicular cancer occurs when normal cells in the testicle undergo malignant transformation and begin to grow uncontrollably. This type of cancer is relatively rare, accounting for only about 1% of all cancers in men, but it's the most common cancer in young men aged 15-35.
There are two main types of testicular cancer: seminomas and non-seminomas. Seminomas tend to grow more slowly and are more responsive to radiation therapy, while non-seminomas are more aggressive but respond well to chemotherapy. The distinction between these types is important for determining the most appropriate treatment approach.
Approximately 9,000-10,000 new cases of testicular cancer are diagnosed annually in the United States, with the incidence having doubled over the past 40 years for reasons that are not fully understood. Despite this increase, deaths from testicular cancer have decreased significantly due to improved treatments, particularly the development of effective chemotherapy regimens in the 1970s.
The excellent prognosis for testicular cancer is one of the most encouraging aspects of this diagnosis. Even in cases where the cancer has spread to other parts of the body, cure rates remain very high with appropriate treatment. The key to maintaining these excellent outcomes is early detection through regular self-examination and prompt medical evaluation of any suspicious symptoms.
Symptoms
Early detection of testicular cancer significantly improves treatment outcomes. Many cases are discovered by men themselves during self-examination or by their partners. Understanding the signs and symptoms is crucial for early identification.
Primary Symptoms
- Mass in scrotum - painless lump or swelling in either testicle
- Testicular enlargement or change in size
- Change in testicular consistency or firmness
- Heaviness or aching in the lower abdomen or scrotum
- Sharp or dull pain in the testicle or scrotum
- Sudden collection of fluid in the scrotum (hydrocele)
Secondary Symptoms
- Anxiety and nervousness - psychological response to symptoms
- Back pain (if cancer has spread to lymph nodes)
- Shortness of breath or cough (if spread to lungs)
- Abdominal pain or mass (if spread to abdomen)
- Swelling in the legs (if lymph nodes are involved)
Advanced or Systemic Symptoms
- Diminished hearing - rare complication from certain chemotherapy drugs
- Fatigue and general malaise
- Weight loss (uncommon in early stages)
- Enlarged lymph nodes in the neck
- Breast enlargement or tenderness (gynecomastia)
- Headaches or confusion (if brain metastases, very rare)
Testicular Self-Examination
Monthly self-examination is recommended for all men, especially those at higher risk. The best time is after a warm shower when the scrotal skin is relaxed:
- Examine each testicle separately using both hands
- Roll the testicle gently between the thumb and fingers
- Look for any hard lumps, smooth rounded masses, or changes in size
- Feel for any pain or unusual tenderness
- Note any differences between the two testicles
- Remember that one testicle is normally slightly larger than the other
When Symptoms Are NOT Cancer
Many testicular symptoms have benign causes:
- Epididymitis (infection of the epididymis)
- Testicular torsion (twisted testicle)
- Hydrocele (fluid collection)
- Varicocele (enlarged veins)
- Spermatocele (cyst in epididymis)
- Inguinal hernia
Causes
The exact cause of testicular cancer is not fully understood, but research has identified several factors that may contribute to its development. Unlike many other cancers, lifestyle factors such as smoking, diet, and alcohol consumption do not appear to significantly increase testicular cancer risk.
Developmental Factors
Abnormal Testicular Development
The most significant risk factor is abnormal testicular development during fetal life:
- Cryptorchidism: Undescended testicles increase cancer risk 3-5 times
- Testicular dysgenesis syndrome: A spectrum of male reproductive disorders
- Intersex conditions: Disorders of sexual development
- Maternal hormone exposure: In utero exposure to estrogens
Genetic Factors
- Chromosomal abnormalities, particularly involving chromosome 12
- Klinefelter syndrome (XXY chromosome pattern)
- Family history of testicular cancer
- Personal history of testicular cancer in the other testicle
Environmental and External Factors
Chemical Exposures
- Occupational exposure to certain chemicals
- Pesticide exposure during pregnancy
- Polyvinyl chloride (PVC) exposure
- Heavy metals exposure
Infectious Agents
- Human immunodeficiency virus (HIV) infection
- Prior history of orchitis (testicular inflammation)
- Epstein-Barr virus (possible association)
Hormonal Factors
- Exposure to diethylstilbestrol (DES) in utero
- Maternal use of oral contraceptives during pregnancy
- Testicular atrophy from any cause
- Previous testicular trauma with scarring
Cellular and Molecular Causes
Genetic Mutations
- Mutations in tumor suppressor genes
- Oncogene activation
- DNA repair mechanism defects
- Telomerase activity abnormalities
Precancerous Conditions
- Carcinoma in situ (CIS) of the testicle
- Testicular intraepithelial neoplasia (TIN)
- Gonadal dysgenesis
Risk Factors
Understanding risk factors helps identify men who may benefit from increased surveillance or preventive measures. However, many men with risk factors never develop testicular cancer, while some men with no known risk factors do develop the disease.
High-Risk Factors
- Undescended testicle (cryptorchidism): 3-5 times increased risk, even after surgical correction
- Personal history: Having cancer in one testicle increases risk in the other testicle by 25-fold
- Family history: Brothers of men with testicular cancer have 8-10 times increased risk
- Testicular dysgenesis syndrome: Constellation of male reproductive disorders
- Klinefelter syndrome: Genetic condition with XXY chromosomes
Moderate-Risk Factors
- Age: Peak incidence between 15-35 years, with secondary peak after 55
- Race/Ethnicity: White men have 4-5 times higher risk than Black men
- Tall stature: Men over 6 feet tall have slightly increased risk
- Testicular atrophy: From any cause, including mumps orchitis
- HIV infection: Moderately increased risk
Possible Risk Factors (Under Investigation)
- Maternal DES exposure during pregnancy
- Low birth weight
- Being a twin
- Occupational chemical exposures
- Testicular trauma
- Cannabis use (conflicting evidence)
Protective Factors
Some factors may reduce testicular cancer risk:
- African or Asian ancestry
- Regular physical activity
- Testicular cancer in family member (paradoxically protective in some studies)
Age Distribution
- 15-35 years: Primary peak incidence (non-seminomatous tumors)
- 35-45 years: Transition period
- Over 55 years: Secondary peak (seminomatous tumors)
- Under 15 years: Very rare, usually non-seminomatous
Diagnosis
Early and accurate diagnosis of testicular cancer is crucial for optimal treatment outcomes. The diagnostic process involves multiple steps to confirm the presence of cancer, determine its type, and assess its extent.
Initial Evaluation
Medical History and Physical Examination
- Detailed symptom history and timeline
- Family history of testicular or other cancers
- Personal medical history, including undescended testicles
- Physical examination of both testicles and surrounding areas
- Abdominal examination for enlarged lymph nodes
- Examination of the chest and neck for signs of spread
Laboratory Tests
Tumor Markers
Blood tests for specific proteins produced by testicular cancers:
- Alpha-fetoprotein (AFP): Elevated in 50-70% of non-seminomatous tumors
- Human chorionic gonadotropin (hCG): Elevated in 40-60% of non-seminomatous and 10-25% of seminomatous tumors
- Lactate dehydrogenase (LDH): General marker of cell damage, elevated in 80% of advanced cases
Additional Blood Tests
- Complete blood count (CBC)
- Comprehensive metabolic panel
- Liver function tests
- Kidney function tests
Imaging Studies
Scrotal Ultrasound
Usually the first imaging test performed:
- Distinguishes between solid masses and fluid collections
- Evaluates both testicles simultaneously
- Guides further diagnostic decisions
- Nearly 100% accurate in detecting testicular masses
Staging Imaging
- CT scan of chest, abdomen, and pelvis: Looks for spread to lymph nodes or other organs
- Chest X-ray: Initial screening for lung metastases
- Brain MRI: Only if symptoms suggest brain involvement
- PET scan: Sometimes used for specific situations
Definitive Diagnosis
Radical Inguinal Orchiectomy
Surgical removal of the affected testicle through a groin incision:
- Provides tissue for definitive pathological diagnosis
- Primary treatment for testicular cancer
- Performed as soon as cancer is suspected
- Avoids scrotal approach to prevent spread
Pathological Analysis
- Histological examination of tumor type
- Assessment of tumor size and local invasion
- Evaluation of blood vessel and lymphatic invasion
- Immunohistochemical staining for specific markers
Staging
Cancer staging determines the extent of disease spread:
Clinical Stage I
- Cancer confined to the testicle
- No evidence of spread to lymph nodes or other organs
- Normal or declining tumor markers after orchiectomy
Clinical Stage II
- Cancer has spread to retroperitoneal lymph nodes
- No evidence of spread beyond these lymph nodes
- Subdivided based on size of lymph node involvement
Clinical Stage III
- Cancer has spread beyond retroperitoneal lymph nodes
- May involve lungs, liver, brain, or other organs
- Significantly elevated tumor markers
Treatment
Testicular cancer treatment is highly effective, with cure rates exceeding 95% overall and approaching 100% for early-stage disease. Treatment plans are individualized based on cancer type, stage, and patient factors.
Primary Treatment
Radical Inguinal Orchiectomy
Surgical removal of the affected testicle is the primary treatment for all testicular cancers:
- Performed through a groin incision to avoid spread
- Entire testicle and spermatic cord removed
- Provides immediate local control
- Tissue sent for pathological analysis
- Can be combined with prosthetic implant placement
Stage-Specific Treatment
Stage I Seminoma
- Surveillance: Regular monitoring with physical exams, tumor markers, and imaging
- Radiation therapy: Low-dose radiation to para-aortic lymph nodes
- Chemotherapy: Single-cycle carboplatin for high-risk patients
Stage I Non-Seminoma
- Surveillance: For low-risk patients with close monitoring
- Retroperitoneal lymph node dissection (RPLND): Surgical removal of lymph nodes
- Chemotherapy: One or two cycles of BEP (bleomycin, etoposide, cisplatin)
Advanced Stage Disease
- Combination chemotherapy: BEP or EP (etoposide, cisplatin) regimens
- High-dose chemotherapy: For very high-risk or relapsed cases
- Surgical resection: Of residual masses after chemotherapy
Chemotherapy Regimens
Standard Regimens
- BEP: Bleomycin, etoposide, and cisplatin (3-4 cycles)
- EP: Etoposide and cisplatin (4 cycles, for patients who cannot receive bleomycin)
- Carboplatin: Single agent for low-risk stage I seminoma
Salvage Chemotherapy
- VeIP: Vinblastine, ifosfamide, and cisplatin
- TIP: Paclitaxel, ifosfamide, and cisplatin
- High-dose chemotherapy with stem cell rescue
Radiation Therapy
- Primarily used for stage I and II seminomas
- External beam radiation to para-aortic and pelvic lymph nodes
- Highly effective for seminomatous tumors
- Lower doses than traditionally used to reduce side effects
Surgery
Retroperitoneal Lymph Node Dissection (RPLND)
- Removal of lymph nodes in the back of the abdomen
- Used for staging and treatment of non-seminomas
- Can be primary treatment or after chemotherapy
- Nerve-sparing techniques preserve ejaculatory function
Resection of Residual Masses
- Removal of masses remaining after chemotherapy
- May contain viable cancer, scar tissue, or mature teratoma
- Important for complete cure in some patients
Fertility Preservation
- Sperm banking before treatment (strongly recommended)
- Testicular sperm extraction if needed
- Counseling about fertility effects of treatment
- Hormone replacement if both testicles removed
Prevention
Unlike many other cancers, testicular cancer cannot be effectively prevented through lifestyle modifications, as most risk factors are present from birth or are not modifiable. However, early detection through self-examination and awareness can significantly improve outcomes.
Early Detection Strategies
Monthly Self-Examination
Regular testicular self-examination is the most important prevention strategy:
- Perform monthly, preferably after a warm shower
- Examine each testicle separately using both hands
- Roll the testicle between thumb and fingers
- Feel for any hard lumps, nodules, or changes in size
- Learn what's normal for you
- Report any changes to a healthcare provider immediately
Professional Screening
- Regular physical examinations by healthcare providers
- Testicular examination as part of routine check-ups
- Increased surveillance for high-risk individuals
- Partner awareness and involvement in detection
Risk Reduction for High-Risk Individuals
Undescended Testicle Management
- Early surgical correction (orchiopexy) before age 2
- Lifelong surveillance even after surgical correction
- Consider prophylactic removal in certain high-risk cases
- Genetic counseling for families with multiple affected members
Family History Considerations
- Increased awareness and vigilance
- Earlier and more frequent examinations
- Genetic counseling if multiple family members affected
- Education about signs and symptoms
General Health Measures
- Maintain overall good health and fitness
- Avoid unnecessary radiation exposure
- Practice safe sex to prevent HIV and other infections
- Seek prompt treatment for testicular injuries or infections
- Be aware of workplace chemical exposures
Education and Awareness
- Learn about testicular cancer signs and symptoms
- Understand your personal risk factors
- Educate partners and family members
- Participate in awareness campaigns
- Support research and advocacy efforts
Occupational and Environmental Considerations
- Use appropriate protective equipment if exposed to chemicals
- Follow workplace safety guidelines
- Be aware of potential environmental exposures
- Advocate for safer working conditions
When to See a Doctor
Given the excellent cure rates for testicular cancer when detected early, it's crucial to seek medical attention promptly for any concerning testicular symptoms. Early evaluation can be life-saving and fertility-preserving.
Immediate Medical Attention
Seek emergency care if you experience:
- Sudden, severe testicular pain
- Testicular trauma with persistent pain or swelling
- Signs of testicular torsion (twisted testicle)
- Fever with testicular pain and swelling
- Inability to urinate normally
- Severe abdominal pain with testicular symptoms
Schedule Medical Consultation
See your healthcare provider within days if you notice:
- Any new lump or mass in the testicle
- Change in testicle size, shape, or consistency
- Persistent testicular pain or discomfort
- Heaviness or aching in the scrotum
- Sudden collection of fluid in the scrotum
- Change in the way a testicle feels
- Any abnormality discovered during self-examination
Routine Screening Discussions
Discuss testicular cancer screening with your doctor if you have:
- History of undescended testicle
- Family history of testicular cancer
- Previous testicular cancer
- Klinefelter syndrome or other genetic conditions
- HIV infection
- Concerns about your risk level
Follow-up Care
Regular follow-up is essential for:
- Monitoring after testicular cancer treatment
- Surveillance of the remaining testicle
- Managing long-term effects of treatment
- Fertility counseling and planning
- Psychological support and counseling
Specialist Referrals
Your primary care doctor may refer you to:
- Urologist: For evaluation of testicular masses or symptoms
- Oncologist: For cancer treatment planning and management
- Radiation oncologist: If radiation therapy is recommended
- Fertility specialist: For reproductive counseling and preservation
- Genetic counselor: For family history assessment
Preparing for Your Appointment
- Write down all symptoms and when they started
- List all medications and supplements
- Prepare family history information
- Bring a list of questions
- Consider bringing a support person
Frequently Asked Questions
Can testicular cancer be cured?
Yes, testicular cancer has one of the highest cure rates of all cancers. Overall cure rates exceed 95%, and approach 100% for early-stage disease. Even advanced testicular cancer can be cured in about 80-90% of cases with appropriate treatment.
Will I be able to have children after testicular cancer?
Many men can father children after testicular cancer treatment. Sperm banking before treatment is strongly recommended. Even if fertility is affected, assisted reproductive technologies can often help couples conceive. Discuss fertility preservation options with your doctor before starting treatment.
How often should I perform testicular self-examination?
Monthly testicular self-examination is recommended, especially for men between ages 15-35. The best time is after a warm shower when the scrotal skin is relaxed. Consistent monthly examination helps you learn what's normal and detect any changes early.
Does removing one testicle affect hormone production?
Usually not significantly. One healthy testicle can produce adequate testosterone and sperm for normal function. However, some men may experience slight decreases in testosterone levels. Your doctor will monitor hormone levels and provide replacement therapy if needed.
What are the long-term effects of testicular cancer treatment?
Most men experience no long-term effects. Possible effects include fertility problems, hearing loss from certain chemotherapy drugs, increased risk of heart disease, and slightly elevated risk of secondary cancers. Regular follow-up care helps monitor and manage any long-term effects.
Can testicular cancer spread to other parts of the body?
Yes, testicular cancer can spread to lymph nodes in the abdomen, chest, and neck, as well as to the lungs, liver, brain, and bones. However, even when it has spread, testicular cancer remains highly curable with appropriate treatment.
Is testicular cancer painful?
Testicular cancer is often painless in its early stages, which is why regular self-examination is so important. Some men may experience a dull ache, heaviness, or sharp pain. However, the absence of pain doesn't rule out cancer, so any testicular abnormality should be evaluated.
Can lifestyle changes prevent testicular cancer?
Unlike many other cancers, testicular cancer cannot be prevented through lifestyle modifications, as most risk factors are developmental or genetic. The best approach is early detection through regular self-examination and awareness of symptoms.