What is it?
The testicles are part of the male reproductive system. They produce sperm and the male hormone testosterone. They lie outside the body in the scrotum under the penis. They are soft and oval shaped, but they are not identical – one normally hangs a little lower than the other.

Testicular cancer develops from the cells within the testicles. If the cancer is not treated, cancer cells from the original site may break away and spread to nearby lymph nodes.

Most (up to 99%) of testicular cancers can be cured if caught at an early stage. Even when these tumours spread they can still be cured in approximately 95% of cases.
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Causes and risk factors
The causes of testicular cancer are not fully understood. Contrary to some people's belief, there is no evidence that an injury or a sporting strain increases the risk of developing testicular cancer. Hot baths, riding a bike, and having a vasectomy do not cause testicular cancer either.

But there are some factors that can put you at greater risk:

Cryptorchidism (undescended testicle) - The main risk factor appears to be having had an undescended testicle, where the testicle fails to reach its proper position within the scrotum naturally. Men with one or both undescended testes have a greatly increased risk - 10% of testicular cancer patients have a history of this condition. However, re-positioning of the testicle in a hospital before the age of 10 may eliminate this excess risk. Family history - Having a close relative who has had testicular cancer increases the risk of getting the disease. Inherited genetic factors may play a role in up to one in five testicular cancers. Previous testicular cancer - Having had testicular cancer before increases the risk of developing cancer in the other testicle. However, cancer in both testicles is rare. HIV/ AIDS - Infection with the human immunodeficiency virus (HIV), particularly if acquired immune deficiency syndrome (AIDS) has developed, increases the risk of developing testicular cancer. Race - Testicular cancer is seen more commonly in men with white skin than men with black skin, and also in those from more affluent backgrounds. The reason for this is not known. Klinefelter's syndrome - This is a sex chromosome disorder, which results in low levels of male hormones, sterility, breast enlargement, and small testes. People who have Klinefelter's syndrome are at greater risk of developing testicular cancer.

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Symptoms

The symptoms of testicular cancer may include:

 

A painless lump or swelling in either testicle. Hardness in part or all of the testicle. Enlargement of the testicle . A feeling of heaviness in the scrotum. A dull ache in the scrotum or the groin. A sudden collection of fluid in the scrotum. Pain or discomfort in the testicle or scrotum. Blood in the semen. A dull ache in the abdomen or groin. Enlargement or tenderness of the breasts.

 

These symptoms may all be caused by conditions other than cancer, such as a cyst or infection. Yet, it is important to contact a doctor if any symptoms occur. Testicular cancer is easier to treat successfully if detected early.
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Hold your scrotum in the palms of your hands. Each testicle should be gently rolled between the thumb and index finger to find any lumps or irregular areas. You may want to ask your partner to help you.
Note the size and weight of the testicles. It is common to have one testicle slightly larger, or which hangs lower than the other, but a noticeable increase in size or weight may indicate something is wrong.

Gently feel each testicle individually. You should feel a soft tube at the top and back of the testicle. This is the epididymis which carries and stores sperm. It may feel slightly tender. Don't confuse it with an abnormal lump.

You should be able to feel the firm, smooth tube of the spermatic cord, which runs up from the epididymis.

Feel the testicle itself. It should be smooth with no lumps or swellings. It is unusual to develop cancer in both testicles at the same time, so if you are wondering whether a testicle is feeling normal or not you can compare it with the other.

If you do find a lump or change in your testicle, make an appointment and have it checked by your doctor as soon as possible. Regular examination of the testicles can, in most instances, detect testicular cancer at an early stage but neglect can lead to presentation with advanced cancer. You may be more at risk of testicular cancer if you have an undescended testicle, a family history of the disease or a previous testicular tumour. In these situations, it is very important to carry out self-examination at least once a month, and report any changes to your GP.

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What do I do if I think I've got it?
Any lump or abnormality in the testicles or scrotum needs to be seen by your GP and, if appropriate, a hospital specialist. Remember, most lumps are not cancer!

Your GP may need to refer you to specialist, who will ask questions, perform an examination and arrange further tests.

Ultrasound Scan - The first test is usually an ultrasound scan (sound waves transmitted through the testicles showing what they look like on the inside). This scan can usually tell the difference between cancerous lumps and benign (non-cancerous) lumps. Blood Test - Some cancers of the testicle produce chemicals and release them into the blood stream. These chemicals are called tumour markers. You may have a test to see if these chemicals are present in your blood. Biopsy - As with many cancers, the best way to diagnose testicular cancer is with an operation. You will have a general anaesthetic and a surgeon called a urologist will look at the testicle through a small cut (incision) in the groin. They may take and examine a small tissue sample (biopsy). If the tests do confirm cancer, then other special tests are needed to see if it has spread. You may have a chest X-ray to look at the lungs and a computerised tomography (CT) scan to look at the lymph glands in the abdomen and chest. It will take about 1-2 weeks to get all the results and to see the specialist for advice on treatment.

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Getting Treated
Treatment for testicular cancer may include:

Surgery - The most common surgical operation to treat testicular cancer is removing the testicle completely (orchidectomy). The surgeon removes the whole testicle, rather than just some of it, to avoid the risk of spreading the disease. As long as only one testicle is removed, surgery will not affect fertility. Radiotherapy - Doctors may choose radiotherapy (exposure of affected areas to gamma rays or X-rays) to prevent the disease coming back after surgery, or to treat the disease if it has spread to the lymph glands. Radiotherapy will successfully treat almost all men with slow-growing testicular cancer. Chemotherapy - There are two main types of testicular cancer, "seminomas" and "teratomas". Teratomas respond very well to radiotherapy, whereas seminomas respond best to chemotherapy (anti-cancer drugs). Sometimes a combination of radiotherapy and chemotherapy is used to treat testicular cancer and prevent it from coming back.

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FAQs
How common is testicular cancer?
Testicular cancer is the most common form of cancer in young men, mostly between the ages of 20 and 35, although it can develop in boys as young as 15. Incidence has almost doubled in the last twenty years, with about 2,000 cases a year in the UK. Compared to other male cancers, this is still a low number – testicular cancer accounts for about 1-2% of all cancers in men.

Is there anything I can do to reduce the risk of developing testicular cancer?
The causes of testicular cancer are not yet known and there are no known treatments that could prevent it. The most important thing is to check your testicles regularly to detect any changes in their shape or size. The most significant risk factor is undescended testes at birth with 10% of patients having a history of this condition. Testicular cancer can have a strong genetic component, with brothers, fathers or sons of testicular cancer patients having up to a 10-fold increased risk of developing the disease.

How is testicular cancer diagnosed?
Testicular cancer can be diagnosed through regular self-checking of the normal size and shape of your testicles. If these have altered in some way, it is important to consult with your doctor. Note that most lumps are benign (non-cancerous) and no operation is necessary!

How is testicular cancer treated?
Testicular cancer can be treated by surgery, by radiotherapy or by chemotherapy. In some cases these treatments are combined. The most straightforward and safest way of dealing with a cancerous lump is to remove the testicle.

Can a man diagnosed with testicular cancer make a full recovery?
99% of testicular cancers can be cured if caught at an early stage. Even when the tumour spreads, the cure rate is around 95%. Treatment may be very intensive, but most patients cured will have no long-term side effects from treatment. A small proportion of patients will become infertile after chemotherapy treatment. Other side effects of treatment are uncommon but may include damage to the nerve endings, hearing and poor circulation. There may be a slightly increased risk of developing other cancers. The risks of these problems are lessened if the cancer is treated early.

Will the operation affect my sex drive and will I still be able to father children?
Once you have recovered from the immediate effects of the operation (you can be sore for a few days afterwards) you should be able to have sex as normal. In most circumstances, one testicle is sufficient to produce sperm to father children. If additional treatment is required following surgery, your fertility can be affected and you will always be offered sperm banking before this treatment commences. Being diagnosed with cancer can be stressful and this can affect the level of performance for some men. If this is the case, please consult with your doctor.

How will it look, after the operation?
Following the surgery you may not look very different to how you were before the operation especially if you have a prosthetic testicle inserted. You will have a small scar in your groin, although the scrotal area itself will be little changed.

Will I lose my masculinity?
This is a common worry for men with testicular cancer. Masculinity is due to the testosterone hormone that is produced by the testicles. In the majority of men one testicle can produce enough testosterone to support your masculinity. Occasionally if the remaining testicle has been damaged, your doctor can recommend replacement testosterone therapy to maintain this aspect of your life.
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