Testicular Cancer

What are the testes?

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 epidermis is the vars defer ens. You can feel each vars deference 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 defer ens carries the sperm to the penis.) Some people confuse the normal epidermis or vas deference with an abnormal lump.

What is testicular cancer?

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.

What causes testicular cancer?

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 descended 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.)

What is cancer?

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.)

What is the prognosis (outlook)?

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.

Detecting testicular cancer early

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.)

Further help and information

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