Testicular Cancer

‍What is testicular cancer?

Testicular cancer is an uncommon cancer that commonly affects men aged between 15 and 49 and represents around 1% of all cancers in men.^1,2 It develops in the testicles, which are part of the male reproductive system responsible for producing sperm and testosterone.³

‍However, despite the greater emphasis on testicular cancer awareness over the years, the incidence of testicular cancer has continued to grow, doubling over the past 4 decades.⁴ Testicular cancer occurs when cells in one or both testicles start to grow and divide in an uncontrolled and abnormal manner, eventually forming a tumour.⁵

‍There are different types of testicular cancer depending on the type of cell in which the cancer originates.⁵ The most common form of testicular cancer, testicular germ-cell tumour, occurs in around 90% of cases and originates from the cells that make the sperm.⁵

Testicular germ-cell tumours can be further broken down into two subcategories: seminomas, which grow more slowly and are more sensitive to radiation therapy; and non-seminomas, which are more liable to spread or metastasize.^6,7 There are, however, other, less common forms of testicular cancer, such as Leydig cell tumours, Sertoli cell tumours, and yolk sac tumours, among others.²

Symptoms of testicular cancer

Knowing the symptoms of testicular cancer is crucial for early detection and successful treatment.² However, testicular cancer can be tricky to spot due to its symptoms being rather unspecific, making a testicular cancer diagnosis more difficult to obtain. 

Most patients would present with a painless lump or swelling in the testes, which is often discovered by accident.² These lumps may be the size of a pea or as large as a golf ball, and in 10% of cases, they may cause an individual to experience ongoing dull pain. Other more common symptoms of testicular cancer include: ⁸

• A change in shape, size, or texture of one or both testicles.
• A feeling of heaviness or fullness in the scrotum.
• A notable difference in appearance between the testicles.

Some men and people with testicles may not display any symptoms of testicular cancer until the cancer has spread.² If testicular cancer spreads to different parts of the body, the symptoms an individual may experience will be more generalised.

‍These include: ²

• Ongoing fatigue.
• Weight loss.
• Shortness of breath or cough.
• Enlarged lymph nodes.

Diagnosis of testicular cancer

If you notice any changes in how your testicles look or feel, we recommend you see a doctor as soon as possible. Your doctor will carry out a thorough history and perform a careful physical exam which includes feeling the testes and the area around the testes, to check if a firm lesion or mass is present.²

‍To confirm a diagnosis and to check the stage of testicular cancer, your doctor may refer you for some additional testing, which includes: ²

• Trans-scrotal ultrasound: an ultrasound is the primary imaging technique used to identify testicular cancer. This procedure is painless and involves manoeuvring a small device over the scrotum which then relays images of your testicles back to the doctor for examination.¹³
• Blood tests: certain cancers may release markers into the bloodstream which can be identified by a blood test. Some testicular cancers produce high levels of these markers, such as alpha-fetoprotein and human chorionic gonadotropin.¹⁴
• Biopsy: a biopsy involves removing and examining a part of a lump under a microscope. Though not routinely offered, a biopsy may be recommended depending on your symptoms and the stage of testicular cancer you may have.¹⁵
• Further imaging: you may be referred for a computerised tomography (CT) scan and chest x-ray to determine whether the cancer has spread.¹⁶
  

How to check for testicular cancer at home

Discovering testicular cancer early increases your chances of survival.² The best way to check yourself for any lumps or bumps is by carrying out a testicular self-examination around once a month. A testicular self-examination is a process whereby you check your testicles for any changes in size, colour, shape, or appearance.¹⁷ It is best for you to do this when in the shower or bath, as warm water helps relax your scrotum and makes it easier to examine.  

Below is a short step-by-step testicular self-examination guide for you to follow:

1. Hold your penis out of the way and examine each testicle separately.
2. Gentle roll each testicle between your thumb and fingers, feeling for any lumps, swelling, hardness, or changes in size. Do not be alarmed if you can feel your sperm ducts, as these naturally stick out of your testes.
3. Feel for any pain in either testicle.
4. Compare the testicles to one another. It is normal for one to be slightly larger or hang lower than the other. If this difference changes upon your next examination, you should get it checked out by your doctor.  

Testicular cancer risk factors stem from both genetic and environmental causes, though with advancements in both medicine and technology, we’re able to better evaluate signs of testicular cancer and manage the disease accordingly, making it one of the most curable cancers.² As it currently stands, testicular cancer prognosis is around 90%, with a greater than 95% 5-year survival rate.²

Treatment of testicular cancer

Testicular cancer is treated depending on the type of disease you have, the stage of the disease, and its clinical presentation.² The main treatment for testicular cancer is the surgical removal of the affected testicle, otherwise known as an orchidectomy.¹⁶ This is a minimally invasive procedure often carried out through a small cut in your groin.

Depending on the stage and type of disease you have, you may also require further treatment using chemotherapy, radiotherapy, or both.¹⁶ The best testicular cancer treatment for you will depend on several factors which your specialist will discuss with you to help you make an informed decision.¹⁶

Sperm bank

In the UK, you will also be given the opportunity to donate to a sperm bank prior to your surgery.^16,18 After undergoing the removal of one testicle, the impact on fertility can vary, affecting some individuals while leaving others unaffected.¹⁸ Additionally, certain treatments such as chemotherapy may too affect your sperm count, so you may want to consider sperm banking before your treatment.¹⁸

Testosterone replacement

Having one testicle removed should not alter the production of testosterone unless the remaining testicle is not functioning properly.¹⁸ In such cases, you may be provided with testosterone replacement therapy in the form of injections, skin patches, or gels.¹⁸