Testicular cancer develops in the testicles (testes), the male reproductive glands. The testicles are located in the membranous pouch below the penis (scrotum) and are suspended from the body by the spermatic cord. They produce male reproductive cells (sperm) and testosterone. Testicular cancer is treated successfully in more than 95% of cases. While testicular cancer is uncommon, it usually affects males who are young (age 20 to 40) and can therefore be very devastating.
Undescended testicles (cryptorchidism) – The testicles normally move down from inside the abdomen into the scrotum before birth. In males with a testicle that fails to descend into the scrotum, the risk of developing testicular cancer is increased. This risk does not change even after surgery to relocate the testicles down. The increased risk applies to both testicles.
Congenital abnormalities – Men born with abnormal development of the testicles may be at increased risk.
Family history of testicular cancer – The risk for testicular cancer is greater with a family member having the disease.
History of testicular cancer – Men with history of testicular cancer are at increased risk of developing cancer in the other testicle.
Signs and Symptoms
Testicular cancer does not always produce symptoms. A mass or lump in the testicle is usually the first sign of the disease. The mass may or may not be painful. Other symptoms include testicular swelling, hardness, and a feeling of heaviness or aching in the scrotum or lower abdomen.
Some types of testicular cancer produce high levels of hormones. Increased levels of HCG (human chorionic gonadotropin ) may cause breast tenderness and breast enlargement. Increased levels of estrogen may cause a loss of libido (sexual desire) and increased levels of testosterone may cause premature growth of facial and body hair in boys.
Testicular cancer that has metastasized (spread to other organs) may cause low back pain, shortness of breath, chest pain and cough.
A lump may be detected in your testicle during a routine physical exam. To determine whether a lump is testicular cancer, your doctor may recommend:
- Ultrasound – During a testicular ultrasound , a hand-held probe is moved over the scrotum and sound waves help create an image of the scrotum and testicles. The test enables the doctor to determine the nature of any testicular lumps, such as if the lumps are solid or fluid filled, inside or outside of the testicle, and whether it is likely to be testicular cancer.
- Blood tests – The levels of certain tumour markers may be elevated in testicular cancer.
- Biopsy – The testicle is removed during surgery and the testicular tissue is examined under a microscope to determine if the lump is cancerous and, if so, what type of cancer. The type of testicular cancer will determine treatment and prognosis.
TYPES OF TESTICULAR CANCER
There are two main types of testicular cancer: seminomas and nonseminomas.
- Seminoma – This is a slow-growing form of testicular cancer usually found in men in their 30s and 40s. They are very sensitive to radiation therapy.
- Nonseminoma – This type of testicular cancer tends to develop earlier in life. They grow and spread more rapidly than seminomas. There are different types of nonseminoma tumours: including choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumour. Nonseminomas are less sensitive to radiation therapy than seminomas. Chemotherapy is often very effective for nonseminomas, even if the cancer has spread.
Sometimes both types of cancer are present in a tumor. In that case, the cancer is treated as though it is a nonseminoma.
Treatment for testicular cancer depends on the stage of the disease. Surgery to remove the testicle is sometimes combined with radiation and/or chemotherapy. Some patients choose to store frozen sperm in a sperm bank before treatment to ensure fertility.