Testicular Cancer

What Is Testicular Cancer?

Testicular cancer is when unusual cells grow out of control in the tissue of one or both of your testicles. Also called testes, these are the two oval-shaped organs that hang from the base of a man’s torso. They’re a little smaller than a golf ball. They rest in a sac of skin known as the scrotum, beneath the penis. They make sperm as well as hormones such as testosterone.

Testicular cancer is generally rare, but it’s the most common form in males 15 to 34. It’s also one of the easiest cancers to cure.

Testicular Cancer Symptoms

Signs of this type of cancer include:

  • A change in how your testicle feels. One might be bigger or firmer than the other.
  • A painless lump on your testicle
  • Swelling or a feeling of weight in your scrotum, with or without pain
  • Fluid collecting in your testicles
  • Pain or a dull ache in your scrotum or groin
  • Soreness or changes in breast tissue
  • Early signs of puberty in a younger boy
  • Swelling in one or both legs
  • Blood clots that may travel to your lungs and cause shortness of breath

Testicular cancer that has spread may cause:

Some of the symptoms of testicular cancer are also signs of other conditions. Testicle changes or lumps could be:

  • A cyst in the epididymis, a small organ made up of tubes that carry sperm out of the testicle (spermatocele)
  • Swollen blood vessels (varicocele)
  • Buildup of fluid around the testicle (hydrocele)
  • An opening in your abdominal muscle (hernia)

Pain may be a sign of:

  • An infection of the testicle (orchitis) or the epididymis (epididymitis)
  • Injury
  • Twisting (torsion)

Talk to your doctor if you notice any changes in your testicles, especially if they last more than 2 weeks.

Testicular Cancer Types

Most testicular cancers are germ cell tumors, which start in the cells that make sperm. The two main types are seminomas and nonseminomas.

  • Seminomas grow and spread slowly. There are two subtypes:
    • Classical seminoma. This is the most common and usually happens in men ages 25 to 45.
    • Spermatocytic seminoma. Older men are most likely to get this kind. It doesn’t tend to spread.
  • Nonseminomas grow and spread more quickly. They’re usually made up of more than one type of cancer cell, including:
    • Embryonal carcinoma. Under a microscope, these cells look like tissues from embryos.
    • Yolk sac carcinoma. These cells look like the sac around an embryo. This is the most common form of testicular cancer in children.
    • Choriocarcinoma. This subtype is very rare and spreads around the body quickly.
    • Teratoma. These cells also look like those of an embryo.

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Germ cell cancer may start as another form called carcinoma in situ or intratubular germ cell neoplasia. This doesn’t always become invasive cancer. It doesn’t usually cause lumps or other symptoms, so it’s hard to diagnose.

Growths called stromal tumors are often harmless but can be cancerous. They make up about 5% of cases in men and about 20% of cases in boys. The two main types are:

  • Leydig cell tumor. This starts in the cells that make male sex hormones.
  • Sertoli cell tumor. This type forms in cells that support the germ cells.

Cancer that starts in another part of your body before spreading to your testicle is called secondary testicular cancer. Lymphoma is the most common one.

Testicular Cancer Causes and Risk Factors

Doctors aren’t sure what causes testicular cancer. Some things may make it more likely, including:

  • Age. About half of all cases are in men in their 20s and early 30s.
  • Race. White men are as much as five times more likely than African American or Asian American men to get testicular cancer.
  • Testes that didn’t descend the way they should (cryptorchidism). This risk might be lower if you have surgery to fix it before puberty.
  • Unusual testicle development because of a condition such as Klinefelter syndrome
  • Family history of testicular cancer, especially in a brother
  • HIV, the virus that causes AIDS. This causes slightly higher odds of seminoma.

Testicular Cancer Diagnosis

Testicular self-exam

You can often find a tumor by examining yourself. Aim for at least once a month. Do it during or after a warm bath or shower, when your skin is relaxed.

  • Stand up and hold your penis out of the way.
  • One at a time, gently but firmly roll each testicle between your thumb and fingers.
  • Look for hard lumps or changes in how your testicle feels.

Keep in mind that it’s normal for one of your testicles to be larger than the other. If you notice a small, hard lump, pain, or swelling, tell your doctor.

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You may feel a cordlike tube on top and in back of your testicle. This is called the epididymis. It’s about an inch long and is sensitive but shouldn’t be painful to touch. Check with your doctor if you have any questions about what you’re feeling.

Medical exam

Your doctor will examine your testes during a routine physical exam. If they think something doesn’t seem right, they may order tests to rule out other conditions or confirm a diagnosis. These include:

  • Ultrasound. This uses sound waves to make a picture of your testicles. It can tell whether growths are more likely to be cancer or something harmless. For this painless test, you’ll lie on your back on an exam table. A technician spreads a clear gel over your scrotum and then moves an ultrasound device over your scrotum.
  • Blood test. Your doctor might want to test your blood. Testicular cancers often make proteins or enzymes that can be found in your blood. If you have cancer, the tests might tell your doctor which type you have and whether it’s likely to have spread.
  • Biopsy. Your doctor may remove a bit of tissue from your testicle to check it for cancer. This is called a biopsy. There’s a chance that it could cause cancer to spread, so your doctor might do it only in the operating room. A technician will look at the tissue right away, and if it’s cancerous, your doctor will take out your testicle.

Often, your doctor will remove the whole testicle instead of doing a biopsy.

If your doctor finds a tumor, they’ll do more tests like X-rays and other scans to make sure cancer hasn’t spread.

If your child has a testicular tumor, their doctor will probably do a procedure called inguinal exploration. They make a cut just above the pubic bone and take the testicle out of the scrotum. The doctor can get a close look at it and decide on the next steps to take.

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Testicular Cancer Stages

A cancer diagnosis usually includes a number, called a stage, that’s based on whether it’s spread and how far.

  • In Stage 0, the cancer is found only in small tubes inside your testicle called seminiferous tubules.
  • In Stage I, cancer is limited to your testicle and tissues close to it.
  • In Stage II, it’s spread to the lymph nodes in your abdomen.
  • In Stage III, cancer has spread to distant lymph nodes or other organs like your lungs, liver, or brain. This is called metastasis.

Testicular Cancer Treatment

Your treatment will depend on several things including your diagnosis, your overall health, and whether you want to have children later on. Talk with your doctor about what might work best for you.

Surveillance

If your cancer is in the earliest stages, your doctor might suggest simply keeping an eye on it for growth or other changes.

In the later stages, you could have one or more of these forms of treatment:

Surgery

  • Orchiectomy. Most men with testicular cancer have surgery to take out a testicle. Your doctor can replace it with a prosthetic if you choose.
  • Testes-sparing surgery (TSS). Your doctor removes the tumor and leaves the testicle in place. This procedure is usually for men who have small tumors that aren’t cancer (called benign).
  • Retroperitoneal lymph node dissection. This is a long, complex surgery to take out the lymph nodes in the back of your belly. Your doctor will take care to limit damage to nearby nerves.

Radiation therapy

This kills cancer cells on your testicle or in your lymph nodes. Your doctor will use a machine to send radiation into certain spots on your body.

Chemotherapy

Some drugs can kill cancer cells throughout your body or stop them from dividing. You take these medicines by mouth or through a shot in a vein or muscle.

These drugs may also kill healthy cells, including those that make blood.

If you have chemotherapy, you may follow it up with a stem cell treatment. You’ll get stem cells that will grow into healthy blood cells. They could be your own, or they could come from another person.

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Testicular Cancer Complications

Chemotherapy can cause problems with your lungs, kidneys, heart, blood vessels, nerves, or hearing. It may also damage the cells that make testosterone. Talk to your doctor about how to manage these risks.

Testicular Cancer Outlook

Testicular cancer is one of the most curable forms. Your results will depend on several things, including the cancer’s type and stage. Overall, 95% of men who have testicular cancer live at least 5 years after diagnosis.

Nearly all men whose cancers haven’t spread beyond their testicles live at least 5 more years. In those whose cancer has moved into the lymph nodes at the back of their abdomen, the 5-year survival rate is 96%. If it’s spread to other areas, the rate is 73%.

Sex life and fertility

Removal of one testicle probably won’t affect your sex life or your fertility, but testicular cancer can raise your risk of infertility and low testosterone. You might choose to bank your sperm before treatment. Your testosterone levels will rise again over time.

Cancer recurrence

About 3% to 4% of men who’ve been treated for cancer in one testicle will get it in the other. Have regular checkups, and watch for changes in your body.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on July 02, 2020

Sources

SOURCES:

National Cancer Institute: “General Information About Testicular Cancer,” “SEER Stat Fact Sheets: Testis Cancer,” “Testicular Cancer Screening,” “Testicular Cancer Treatment (PDQ) – Patient Version.”

National Center for Biotechnology Information, “Glossary Database.”

American Cancer Society, “What Is Testicular Cancer?” “How is testicular cancer diagnosed?” “Risk Factors for Testicular Cancer,” “Tests for Testicular Cancer,” “Testicular Cancer.”

Urology Care Foundation, “How Do You Do a Testicular Self-Exam?”

National Library of Medicine.

Urology Care Foundation: “What is Testicular Cancer?”

National Organization for Rare Disorders: “Testicular Cancer.”

Mayo Clinic: “Testicular cancer.”

American Society of Clinical Oncology: “Testicular Cancer: Follow-Up Care,” “Testicular Cancer.”

Mount Sinai: “Testicular cancer.”

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