Testicular Cancer: First Signs of Testicular Cancer & Typical Prognosis with Treatment
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Testicular cancer occurs in the testicles, two egg-shaped glands located beneath the penis. Signs of testicular cancer include a lump in the testicle, a change in how the testicle feels, aching in the lower abdomen of the groin, swelling of the scrotum, and pain in the scrotum.
What is testicular cancer?
The testicles, or the male sex glands, are two egg-shaped glands located in a sac of skin (scrotum) beneath the penis. Most testicular cancers originate in the germ cells of the testicles, which produce immature sperm that then matures in order to fertilize a female egg and start a pregnancy.
Signs and symptoms of testicular cancer include a lump in the testicle, a change in how the testicle feels, aching in the lower abdomen of the groin, swelling of the scrotum, and pain in the scrotum.
Treatment for testicular cancer typically includes surgical removal of the affected testicle (orchiectomy). It may also include radiation or chemotherapy. Since treatment for testicular cancer can lead to infertility, sperm banking early in treatment is important to preserving fertility options for the future.
You should visit your primary care physician who will coordinate care with a cancer surgery specialist (surgical oncologist). Testicular cancer responds well to surgical treatment.
Symptoms of testicular cancer
Testicular cancer is the most common solid cancer in men aged 15 to 35 but is often curable.
The first sign of testicular cancer may be any of the following changes:
- A lump in either testicle
- Enlargement of the testicle
- Heaviness in the scrotum
- An aching feeling in the lower abdomen or groin
- Swelling of the scrotum
- Pain or discomfort of the testicle or scrotum
- Back pain
Causes of testicular cancer
The testicles are primarily responsible for producing male hormones, such as testosterone, as well as sperm. The exact cause of testicular cancer is unknown. However, several risk factors have been identified that increase chances of developing the condition. These include:
- An undescended testicle (cryptorchidism): This increases risk three- to six-fold. The risk is highest if surgical correction (orchiopexy) is delayed until after puberty.
- Abnormal testicles: This includes small testicles that do not fully function.
- Whites, Hispanics, and American Indian/Alaska Natives: These groups have an elevated risk when compared to other ethnic groups.
- A family history of testicular cancer: In the immediate family the risk is raised 3.8- to 9.6-fold.
- Klinefelter syndrome: This is a genetic condition in males associated with having more than one X chromosome, learning difficulties, a lack of body hair, and small testicles.
Germ cell tumors
These tumors originate from the cells that produce sperm (>90 percent of all testicular cancer).
- Seminomas: These grow more slowly than non-seminomas. They can increase the level of a protein in the blood called HCG.
- Nonseminomas: Although there are four main types, most tumors are a mix of several different types. One type is an embryonal carcinoma, which under a microscope may look like the tissue of early embryos. They tend to grow rapidly and spread outside the testicle. They can also increase levels of AFP (another protein) and HCG in the blood. Another type is yolk sac carcinoma, which is the most common form of testicular cancer in children but is rare in adults. They also increase AFP in the blood. Choriocarcinoma is a rare type but grows very rapidly in adults. It is likely to spread elsewhere in the body, such as the lungs, bones, and brain, and increases HCG in the blood. Another type, teratomas, contain multiple layers of a developing embryo when examined under a microscope.
Non-germ cell tumors
Also known as stromal tumors, these originate from other cells in the testicles (<10 percent of all testicular cancers).
- Leydig cell tumors: These originate from cells that make male hormones, such as testosterone. Most Leydig tumors are benign, but if they spread outside the testicle, treatment options are limited.
- Sertoli cell tumors: These form in cells that support the growth of germ cells. Like Leydig cells, they are typically benign but have limited effective treatment options if they do spread beyond the testis.
Treatment options and prevention for testicular cancer
Treatment options include a few different procedures, as well as surveillance, chemotherapy and radiation therapy. Sperm banking is a precautionary measure if you wish to have children in the future and are unsure of your fertility down the road.
Self-screening for testicular cancer
There is little you can do to prevent testicular cancer. Physicians have had disagreements about whether testicular self-exams are useful in preventing poor outcomes from testicular cancer. Current research suggests self-exams have minimal benefits. Your physician can discuss with you the pros and cons of screening, and if you choose to self-screen, self-examination may be done according to this routine.
Surgical removal of affected tissue is both diagnostic since tissue examination guides further therapy, and therapeutic, as removal of pathologic tissue protects against the further spread of disease.
- Removal of the testicle (radical inguinal orchiectomy): The primary treatment for a confirmed malignant tumor is the removal of the testis, along with the spermatic cord and internal inguinal ring. Testicular prostheses are routinely offered to replace the removed testicle. Testis sparing surgery may be an option for some small tumors.
- Removal of lymph nodes in the back (retroperitoneal lymph node dissection): This may be recommended in cases of advanced testicular cancer.
In many cases, orchiectomy alone is adequate treatment, sparing exposure to the negative side effects of chemotherapy and radiation. However, close follow-up for at least five years — often with blood tests, CT scans, and ultrasounds to evaluate any changes — is critical to catch any recurrence of disease.
Chemotherapy and radiation therapy
People with tumors that have spread beyond the testis or have factors associated with high rates of recurrence may be recommended to have adjuvant therapy, either with chemotherapy or radiation. Both are highly effective for most testicular cancers, but side effects can vary depending on the type of treatment used.
Some treatments for testicular cancer, although potentially life-saving, can cause infertility. If you may wish to have children, sperm banking prior to treatment can protect opportunities for fatherhood in the future.
Generally, the prognosis for testicular cancer is good. The five-year survival rate is >95 percent for people with a germ cell tumor localized to the testis. The prognosis of testicular cancer depends on the following:
- Stage of cancer: This is whether it is confined to the testicle or has spread elsewhere in the body.
- The type of cancer: This is whether it is a seminoma, nonseminoma, or stromal tumor.
- Size of the tumor
- Levels of tumor markers: This includes alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (B-hCG), and lactate dehydrogenase (LDH) levels.
However, even people with advanced disease at presentation can be cured.
Among testicular cancer survivors, 48 to 92 percent successfully have children following treatment, often utilizing assisted reproductive techniques. Ask your physician about sperm banking early in your course of treatment.
When to seek further consultation for testicular cancer
If you notice a lump in your testicle, your scrotum becomes swollen, or you develop pain in your scrotum
If you notice any changes in your testicles or scrotum, especially if these changes persist for more than two weeks, report these concerns to your physician as soon as possible. These may be signs of testicular cancer or another condition, and the prognosis is best if these symptoms are evaluated and treated early.
Questions your doctor may ask to determine testicular cancer
- Do you feel pain when you ejaculate?
- Do you feel pain when you urinate?
- How long has your testicle/scrotum pain been going on?
- How severe is your testicle/scrotum pain?
- Do you notice anything going on with your testicles or scrotum?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Becker is a psychiatry resident at the Mount Sinai Hospital. He received his undergraduate degree in Urban & Regional Studies from Cornell University (2012) and completed his medical degree at the Perelman School of Medicine at the University of Pennsylvania (2018). Prior to medical school, he worked as a pre-medical teaching assistant at Weill Cornell Medicine-Qatar, where he received an Excellence in Teaching Award. His research has focused on global health (including explanatory models of mental illness in Botswana, epidemiology of head trauma, and psychosocial aspects of HIV), adolescent and young adult mental health, and quality improvement. He enjoys communicating health-related science through writing and teaching and joined Buoy Health as a writer in 2018. In his free time he enjoys running, hiking, and exploring new places.
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