Testicular cancer
Published by BUPA's Health Information Team
February 2004
Testicular cancer is a rare disease in men caused by abnormal growth of cells of the testicle. The testicles (or testes) are located inside the scrotum, the loose bag of skin that hangs below the penis. Each testicle (or testis) produces sperm.
The male pelvis
Cancer
The building blocks of the body are tiny cells, which normally repair and reproduce in a controlled process. With cancer, this process goes wrong and cells can divide and grow in an uncontrolled way, causing a lump on or within the part of the body affected. If this tumour contains cells that are able to invade neighbouring tissues or organs, it is known as malignant. If the tumour does not do this, it is termed benign.
About testicular cancer
Cancer of the testicles is not a common cancer overall, and is responsible for less than one per cent of all cancer deaths. However, it is the most common cancer in men aged 20 to 34. It is important for men to be aware of the disease so that they can recognise the symptoms. If caught early, testicular cancer can usually be treated and cured.
Types of testicular cancer
The most common types of testicular cancer are seminoma and teratoma. Seminomas are made up of a single type of cell, whereas teratomas consist of more than one type of testicular cell. Occasionally, the cancer can be a combination of seminoma and teratoma. Other types of testicular cancer, such as lymphoma, arise from lymphatic tissue (tissue that forms part of the immune system) within the testicle. These are very rare.
What causes testicular cancer?
The causes of testicular cancer are unknown, but men born with an undescended testicle (one that remains in the abdominal cavity rather than descending into the scrotum) may be at greater risk of developing the disease.
Other factors that are thought to make testicular cancer more likely include:
having a brother who had testicular cancer
fertility problems
being from a wealthier social group
having a rare complication of mumps called mumps orchitis (painful swelling of the testis)
Symptoms of testicular cancer
The most common symptom of testicular cancer is a lump, irregularity or swelling in one testicle. Other symptoms that may be present are:
a pulling sensation or feeling of unusual heaviness in the scrotum
a dull ache in the groin or lower abdomen
pain or discomfort (which may come and go) in the testicle or scrotum
tenderness or enlargement of tissue in the breast area
a sudden collection of fluid in the scrotum (called a hydrocele).
Most lumps in the scrotum are not testicular cancer. However, anyone who notices one or more of the symptoms above should see their GP for advice.
Detecting testicular cancer
Testicular cancer can't be prevented. To help detect it early, you should be aware of how your testicles feel normally, so that you notice any unusual lumps, irregularities, enlargements or areas of firmness.
A good time to feel the testicles is when you are having a warm bath or shower, when the scrotal skin is relaxed. Feel each testicle by rolling it between thumb and forefinger.
You may notice that one testicle is slightly larger than the other, which is normal. Also, it is normal to feel the epididymis - a small, firm, tube-like structure at the back of the testicle. This stores and transports sperm.
Diagnosis
If you notice a lump or change in appearance of your testicles you should visit your GP. He or she will carry out a physical examination to rule out any other conditions or infections that can cause similar symptoms.
An ultrasound scan may be recommended to take a closer look at the testicles. This is a painless scan using sound waves. For more information please see the separate BUPA factsheet, Ultrasound.
You may be referred to a urologist, a surgeon who specialises in conditions affecting the urinary organs (such as the bladder and kidneys) and their surroundings.
In most cases, the specialist can tell from the scan whether a lump is due to cancer or to other causes. However, the only way to be certain that the lump is cancer is for the surgeon to examine the testicle during an operation. A biopsy may be needed to confirm the diagnosis. This is when a small piece of tissue is removed from the testis and examined to see if it is cancerous, and if so, to see what type of cancer it is.
Other tests may be carried out to see if the cancer has spread, and if so, how far. These may include:
more scans such as ultrasound or CT scans (please see the separate BUPA factsheet CT scan)
chest X-ray
blood tests
Assessing how far the cancer has spread is called "staging". The stages are:
stage I - cancer in the testicle only
stage II - cancer has spread to the lymph nodes nearby
stage III - there are cancer cells in the abdomen or above the collarbone
stage IV - cancer has spread to other parts of the body, often the lung
Treating testicular cancer
Several types of treatments are commonly used for testicular cancer. The type of treatment used depends on the type of cancer and how far it has spread, and is also tailored to each person's overall health.
Surgery
Surgical removal of the affected testis (orchidectomy) is the normal treatment for testicular cancer. If it has spread to the lymph nodes in the abdomen (also known as lymph glands), these may be removed as well.
The removal of one testicle does not affect a man's sex life or his ability to have erections or father children. An artificial testicle (called an implant or prosthesis) can be inserted into the scrotum to give a normal appearance if desired.
Chemotherapy and radiotherapy
Chemotherapy drugs are often given together with surgery, particularly if the cancer has spread beyond the testicles. Chemotherapy drugs may be taken by mouth or injection.
Radiotherapy may also be used, but unlike chemotherapy, radiation is focused to treat just the area of the cancer. Radiotherapy is a particularly effective treatment for seminomas.
Chemotherapy and radiotherapy may cause some short-term side effects such as nausea, vomiting and temporary hair loss, but these will get better after treatment has finished.
Chemotherapy and radiotherapy can temporarily interfere with sperm production and, therefore, fertility. As a precaution, many men store their sperm in a sperm bank before treatment.
The outcome of testicular cancer
Testicular cancer is one of the most curable cancers. After treatment for advanced testicular cancer, world-leading cyclist Lance Armstrong went on to win the Tour de France five times.
The earlier the stage at which your cancer is diagnosed, the better your chances for recovery. Stage I and II testicular cancer have a high cure rate of over 90 per cent. For stage III the cure rate is about 70 per cent.
Further information
Cancer BACUP
0808 800 1234
http://www.cancerbacup.org.uk
Cancer Research UK
020 7009 8820
http://www.cancerresearchuk.org