Testicular Cancer

Cancer of the testicles accounts for only about 1 percent of all cancers in men, but it is the most common type of cancer in males ages 16 to 35, and it can occur anytime after age 15.

Often, only one testicle is affected. The cause of testicular cancer is still unknown. Risk factors, however, have been found. These include:

Uncorrected undescended testicles in infants and young children. (Parents should make sure that their infant boys are checked at birth for undescended testicles.)

A family history of testicular cancer. (If you don’t know, ask.)

Having an identical twin with testicular cancer.

Injury to the scrotum or to a testicle.

It’s five times more common among white than black males.

By doing a Testicular Self-Exam (TSE) monthly, you can find a potential tumor early. Testicular cancer is highly curable, especially when detected and treated early.

What is Testicular Self-Exam? (TSE)

The TSE is a method for men to check their testicles to make sure there aren't any unusual bumps or lumps, which may be the first sign of testicular cancer. Sometimes cancer of the testicles will spread, so it’s very important to detect it early so that the cancer doesn't become more serious. The Tour de France winner and great cyclist Lance Armstrong beat testicular cancer, but he ignored symptoms for a long time and nearly died from it since it spread so much.

Warning Signs of a Problem

In the early stages, testicular cancer may have no symptoms. In general about 70 or 80 percent of men will have some painless swelling or firmness to the testicle. It is either noticed by the man or by his sexual partner. Because it's painless, many patients may think it is harmless, and there can be a long delay before they actually seek medical attention. When there are symptoms, they include:

Small, painless lump in a testicle
Enlarged testicle
Feeling of heaviness in the testicle or groin
Pain in the testicle
A change in the way the testicle feels
Enlarged male breasts and nipples
Blood or fluid that accumulates suddenly in the scrotum.

What Tests Are Usually Done for a Diagnosis?

The first part of the process is a physical examination, checking the scrotum and the testes to see what the abnormality is. There are two blood tests that are used to look for what are called tumor markers.

These are two markers that are normally not present in adult males, but in men with testicular cancer they may be elevated.

Sometimes a scrotum ultrasound is done to see what's happening inside the scrotum also.

When is a Biopsy Recommended?

If there is a suspicious mass in the testicle, or if the ultrasound shows a mass within the testicle, then the proper approach is to explore this through an incision in the groin. A biopsy through the scrotum is generally not performed because of the risk of "spilling" some tumor cells into the scrotum and lymph nodes.

What are the Treatments Besides Surgery?

The therapy for a testicular tumor really depends on the subtype of tumor. If it's seminoma and you've done the staging studies and there is no extensive disease, the standard therapy in the past has been radiation therapy to the lymph nodes and to the tissue that lines the perineum.

Is Treatment Generally Successful?

Testicular cancer has become one of the most curable solid malignancies for patients with low-stage disease; the cure rate approaches 100 percent. Even for patients with intermediate or early-advanced disease, the cure rates are better than 85 percent. This really is because of the development of effective chemotherapy and effective surgical approaches, as well as radiation for selected patients.

Can Sexual Function and Fertility Be Affected by Treatments?

Fertility certainly can be affected by treatment. Chemotherapy also adversely affects sperm production. Approximately half of the patients will recover fertility within approximately 2 years. Prior to chemotherapy, semen can be "donated" and frozen for use later on in life. (Lance Armstrong did that.)

The surgery can have some impact on ejaculations. There are certain nerves in the surgical area that control ejaculation, and with the techniques utilized nowadays that spare nerves, 95 to 100 percent of men will retain ejaculation. Erectile problems are usually spared.

How Do I Do a TSE?

Check yourself right after a hot shower. The skin of the scrotum is then relaxed and soft.
Become familiar with the normal size, shape and weight of your testicles.
Using both hands, gently roll each testicle between your fingers.
Identify the epididymis. This is a rope-like structure on the top and back of each testicle. This structure is not an abnormal lump.
Be on the alert for a tiny lump under the skin, in front or along the sides of either testicle. A lump may remind you of a piece of uncooked rice or a small cooked pea.
Report any swelling to your health care provider. If you have any lumps or swelling, it does not necessarily mean you have cancer, but you must be checked.