About testicular cancer
Testicular cancer can spread to the lymph nodes (also known as glands), for example in your abdomen (tummy), or form tumours in the lungs or other organs. The spread of cancer is called metastasis.
About the testicles
The testicles are located inside the scrotum, the loose bag of skin that hangs below the penis. From the start of puberty, each testicle produces sperm and the hormone testosterone.
The position of the testicles and surrounding structures
Types of testicular cancer
There are two main types of testicular cancer: seminoma and non-seminoma (including teratoma). The names refer to the type of cell that makes up the tumour.
Very rarely, another type of cancer, called a lymphoma, can occur in the testicles. This is cancer of the lymphatic tissue (which forms part of the immune system). It's the most common testicular cancer in men over 50.
Symptoms of testicular cancer
The most common symptom of testicular cancer is swelling or a hard, pea-sized lump on one testicle. Other symptoms include:
- 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
- collection of fluid in the scrotum (called a hydrocele)
- feeling unwell and tired
Very rarely, if the cancer is at a later stage, symptoms can include breast tenderness, back pain, shortness of breath and coughing up blood.
These symptoms don't always mean you have testicular cancer, but see your doctor if you're concerned.
Causes of testicular cancer
The causes of testicular cancer are unknown. However, the number of men who develop it is increasing and research is being done to find out why.
The greatest risk is for men born with an undescended testicle (one that remains in the abdominal cavity rather than descending into the scrotum). Boys who don't have the condition corrected by the age of 11 may be up to 32 times more likely to develop testicular cancer later.
Other risk factors include:
- having a brother or father who had testicular cancer
- fertility problems
- being from a wealthier social group
- being white
- having a rare complication of mumps called orchitis (painful swelling of the testicles)
A vasectomy or injury to the testicles doesn't cause testicular cancer.
Diagnosis of testicular cancer
Most lumps in the scrotum aren't cancer - less than one in 25. However, if you're worried, visit your GP or a sexual health clinic. Your GP will ask about your symptoms and examine you. He or she will also ask you about your medical history.
You may be referred to a specialist. An ultrasound scan can help diagnose cancer. You will also have blood tests to assess the levels of 'tumour markers' - proteins produced by a tumour.
The only way to confirm testicular cancer is with a biopsy. In other types of cancer this involves removing a small sample of tissue, but for testicular cancer the affected testicle will be removed completely. This is called an orchidectomy. If a biopsy is done in the usual way, the risk of cancer spreading is high. Removing one testicle won't affect your fertility or ability to have erections.
You may be offered other tests including a CT or MRI scan or a chest X-ray to see if the cancer has spread.
Assessing how far the cancer has spread is called staging. The stages are:
- stage 1 - cancer in the testicle only
- stage 2 - cancer has spread to the lymph nodes in the abdomen
- stage 3 - there are cancer cells in the lymph nodes in the chest or above the collarbone
- stage 4 - cancer has spread to other organs
Treatment of testicular cancer
Treatment for testicular cancer is usually very successful. The type you have depends on the cancer and how far it has spread.
Surgery
Removing the affected testicle through surgery is the main treatment. If the cancer has spread, you may need to have chemotherapy before or after surgery.
Your doctor will talk to you about how inserting an artificial testicle in your scrotum will give it a normal appearance.
After surgery, you will be referred to a team of specialists including an oncologist - a doctor specialising in cancer care - to decide on further treatment. If the cancer is more advanced, you may need to have the lymph nodes in your abdomen removed. The reason for this and the potential side-effects will be explained to you.
Chemotherapy
Chemotherapy uses medicines to destroy cancer cells. If there are lots of cancer cells in the lymph nodes in your abdomen, or if the cancer has spread beyond these, you will have chemotherapy. Chemotherapy may also be given after surgery to reduce the chance of the cancer returning in the future. This is known as adjuvant chemotherapy.
Sometimes chemotherapy is used to shrink a large tumour before surgery, making it easier to remove. This is neo-adjuvant chemotherapy.
Radiotherapy
Radiotherapy uses radiation to kill cancer cells. You may have radiotherapy after surgery to prevent the cancer coming back or to treat any cancer cells that have spread to the lymph nodes at the back of the abdomen.
After treatment
If you're diagnosed with testicular cancer, your doctor will talk to you about the effects it may have on your sex life and body image. About a third of men treated for testicular cancer find they have a reduced libido or problems with sexual function. The cause for this is usually psychological rather than physical.
Your doctor will talk to you about the effects of treatment on fertility. You will be offered the opportunity to store your sperm before treatment.
Rarely, cancer can affect both testicles. You may need a biopsy of your other testicle during surgery or after treatment to check. Any cancer cells can be killed with radiotherapy or chemotherapy.
You will need to have regular check-ups so your doctor can examine your remaining testicle. You may also have further tests such as blood tests, X-rays or scans.
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