Testicular Cancer

Testicular cancer is a common early symptom is a painless swelling that develops in the testicles. Treatment involves surgery to remove the affected testicle. When diagnosed with chemotherapy and / or radiotherapy depending on the stage of the cancer and the type of advice can be given. Treatment for Testicular cancer that has spread is often even better works. Testicular cancer can be cured with almost 9 out of 10 men.

Male Reproductive OrgansCross-section diagram of a testis
The testes hang down behind the penis and make sperm. It is normal for one testis to be slightly bigger than the other, and for one to hang slightly lower than the other. The testes themselves feel like smooth, soft balls inside the baggy scrotum. At the top and to the back of each testis is the epididymis (this stores the sperm). This feels like a soft swelling attached to the testis, and can be quite tender if you press it firmly.

Leading from the epididymis is the vas deferens. You can feel each vas deferens at each side at the back and top of the scrotum. They feel like soft, narrow tubes which pass up and into the groin. (The vas deferens carries the sperm to the penis.) Some people confuse the normal epididymis or vas deferens with an abnormal lump.

Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are many different types of cell in the body, and there are many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and multiply out of control.

A malignant tumour is a lump or growth of tissue made up from cancer cells which continue to multiply. Malignant tumours invade into nearby tissues and organs, which can cause damage. Malignant tumours may also spread to other parts of the body. This happens if some cells break off from the first (primary) tumour and are carried in the bloodstream or lymph channels to other parts of the body. These small groups of cells may then multiply to form secondary tumours (metastases) in one or more parts of the body. These secondary tumours may then grow, invade and damage nearby tissues, and spread again.

Some cancers are more serious than others. Some are more easily treated than others (particularly if diagnosed at an early stage). Some have a better outlook (prognosis) than others. So, cancer is not just one condition. In each case it is important to know what type of cancer has developed, how large it has become, and whether it has spread. This will enable you to get reliable information on treatment options and outlook. (See leaflet called 'Cancer - What are Cancer and Tumours?' for details about cancer in general.)
Testicular cancer is a cancer that arises from a testis. Around half of all cases occur in men under 35 but testicular cancer rarely occurs before puberty. It is the most common cancer in men aged 15-44 years. There are about 2,000 new cases in the UK each year.

Almost all testicular cancers are classed as germ cell cancers as the cells which become cancerous are those involved with making sperm. Germ cell testicular cancers are divided into two main types (depending on the exact type of cell causing the cancer):
  • Seminomas which occur in about half of cases. They most commonly occur in men aged between 25 and 55 years.
  • Non-seminomas (sometimes called non-seminomatous germ cell tumours or NSGCTs). Non-seminomas usually affect men aged between 15 and 35 years.
Non-germ cell testicular cancers are rare. The rest of this leaflet deals only with germ cell testicular cancers.
A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply out of control. (See separate leaflet called 'Cancer - What Causes Cancer?' for more detail.)

In many cases, testicular cancer develops for no apparent reason. However, certain risk factors increase the chance that testicular cancer may develop. These include:
  • Geography. The highest rate of testicular cancer occurs in white men in northern Europe. So, some genetic or environmental factor may be involved.
  • Family history. Brothers and sons of affected men have an increased risk.
  • Undescended testes. The testes develop in the abdomen and usually descend into the scrotum before birth. Some babies are born with one or both testes which have not come down into the scrotum. This can be fixed by a small operation. There is a large increased risk in men who have not had their undescended testis surgically fixed. There is still some increased risk in men who had an undescended testis fixed when they were a baby.
  • Infertility. Infertile men with an abnormal sperm count have a slight increased risk.
  • Klinefelter's syndrome.
  • HIV/AIDS. Men who have HIV or AIDS have an increased risk.
Vasectomy does not increase the risk of testicular cancer. (Several years ago there was a scare linking vasectomy with testicular cancer. Studies have ruled out this link.)

Lump on a testis

In most cases, the first symptom noticed is a lump that develops on one testis. The lump is often painless but some people notice some pain or discomfort coming from the affected testis. (Note: most swellings and lumps in the scrotum are not due to cancer. There are various other causes. However, you should always tell a doctor if you discover a swelling or lump in one of your testes. It needs checking out as soon as possible.)

Other testicular cancer symptoms

Sometimes there is general swelling in one of the testes. If the cancer is not treated and spreads to other parts of the body then various other symptoms can develop. These may include back pain or shortness of breath.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. Again, your doctor will advise if radiotherapy is needed in addition to having the affected testis removed.

When chemotherapy or radiotherapy are used in addition to surgery it is known as adjuvant chemotherapy or adjuvant radiotherapy.

Follow-up after treatment

You will normally be followed up for several years following successful treatment to check that the cancer has not come back. This may include regular blood tests which check for marker chemicals (see above). You may also have regular chest X-rays or other scans or tests to check that you are free of any recurrence.

Studies have shown that people who are successfully treated for testicular cancer have an increased risk of cardiovascular diseases. Therefore not smoking and other ways to prevent cardiovascular diseases are particularly important. See the separate leaflet called 'Preventing Cardiovascular Diseases'.
The outlook is usually very good. Treatment for testicular cancer is usually successful. During the last 40 years, testicular cancer has become a curable cancer in over 95% of cases.
  • If your testicular cancer is diagnosed and treated at an early stage, you can expect to be cured. Most testicular cancers are diagnosed at an early stage.
  • Even if the cancer has spread to other parts of the body, there is still a good chance of a cure. For testicular cancer that has spread to other parts of the body, the chance of being cured is much higher than for many other types of cancers which have spread. This is because the cancerous cells of testicular cancer often respond well to chemotherapy.
The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. You should ask the specialist who knows your case about your particular outlook.
Young men and teenage boys should get to know how their testes normally feel. Report any changes or lumps to your doctor. (See separate leaflet called 'Testes - Get To Know Yours' for more detail on how to check for testicular cancer.)

Macmillan Cancer Support

Tel: 0808 800 1234 Web: www.macmillan.org.uk
They provide information and support to anyone affected by cancer.

CancerHelp UK

Web: http://cancerhelp.cancerresearchuk.org/ provides facts about cancer, including treatment choices.

Orchid

A charity that focuses entirely on the male-specific cancers: prostate, penile and testicular.
Website: www.orchid-cancer.org.uk