Testis Cancer

Testicular cancer is a growth of cells that develops in the testicles, most commonly affecting men between the ages of 15 and 45. While it’s not a common type of cancer, it’s highly treatable with cure rates exceeding 90%, making it one of the most curable cancers when diagnosed and treated promptly.

Table of contents

• What is testicular cancer?
• Associated anatomy
• Types of testicular cancer
• How common is testicular cancer?
• Signs and symptoms
• Causes and risk factors
• Diagnosis and testing
• Treatment
• Outlook and prognosis
• Living with testicular cancer

What is testicular cancer?

Testicular cancer is a disease in which malignant (cancer) cells form in the tissues of one or both testicles^[1]. The testicles are two walnut-shaped or egg-shaped sex glands that produce sperm and the male hormone testosterone^[2]. These glands sit inside a sac of loose skin called the scrotum, which lies directly below the penis^[4].

While testicular cancer is a serious condition, it is highly treatable and curable, especially when identified promptly^[2]. The cancer cells can grow quickly and may spread outside the testicle to other parts of the body, but treatments remain effective even when the disease has spread^[1].

Associated anatomy

• Testicles (testes)
• Scrotum
• Spermatic cord
• Epididymis
• Vas deferens

Types of testicular cancer

Almost all testicular cancers start in the germ cells, which are cells within the testicles that produce immature sperm^[4]. About 90% of all testicular cancer arises when these germ cells clump together to form a mass or tumor^[2].

The two main types of testicular germ cell tumors are seminomas and nonseminomas. These two types grow and spread differently and are treated differently^[4]:

Seminoma: This is a slow-growing cancer that primarily affects people in their 40s or 50s. Seminomas are more sensitive to radiation therapy^[2][4].

Non-seminoma: This type of cancer grows more rapidly than seminomas and mainly affects people in their late teens, 20s, and early 30s^[2]. There are four types of non-seminoma tumors, each named after the type of germ cell that makes up the tumor. These include embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and teratoma^[2].

Some testicular cancer tumors consist of both seminoma and non-seminoma cells. A testicular tumor that contains both types is treated as a nonseminoma^[4].

How common is testicular cancer?

Testicular cancer is relatively rare, affecting only about 1 in 250 people with testicles^[2]. It represents 1% of male tumors and 5% of urological cancers^[3]. Still, it’s the most common cancer among males aged 15 to 35^[2][4].

The incidence of testicular cancer has been increasing over recent years. In fact, it has doubled over the past 40 years^[3]. The incidence is highest in white men and lowest in African-American men^[5].

Signs and symptoms

The most common sign of testicular cancer is a painless lump in your testicle^[2]. The first sign is often a bump or lump on a testicle^[1].

Other symptoms of testicular cancer include^[1][2]:

• Swelling or sudden fluid build-up in the scrotum
• A feeling of heaviness in the scrotum
• A dull ache in the lower belly or groin
• Pain or discomfort in a testicle or the scrotum
• A change in how the testicle feels
• Enlargement or tenderness of the breast tissue
• Back pain
• A shrinking testicle (testicular atrophy)

These symptoms can occur with other conditions too, so you shouldn’t panic if you notice them. However, it’s important to schedule a visit with your healthcare provider to be sure^[2]. Delays in diagnosis allow cancer cells time to spread, making the disease harder to treat^[2].

Causes and risk factors

Testicular cancer develops when cells multiply faster than usual, eventually forming a lump or tumor. Researchers aren’t sure what causes cells to behave this way, but they do know that the cells that become testicular cancer are usually germ cells^[2]. Both genetic and environmental factors have been studied in the development of testicular cancers^[3].

Several factors may increase your testicular cancer risk. Having a risk factor doesn’t mean that you will develop cancer, and not having risk factors doesn’t mean that you won’t^[4]. Risk factors include^[2][3][4]:

Undescended testicles (cryptorchidism): Testicles form in the abdomen during pregnancy and usually drop into the scrotum before birth. Testicles that don’t drop are called undescended testicles and may require surgery. Being born with this condition may increase your testicular cancer risk by 2 to 4 times, even if you have surgery^[2][3].

Age: Testicular cancer most commonly affects people between ages 15 and 35, though it can happen at any age^[1][2].

Personal or family history: You may be more likely to develop testicular cancer if a biological parent or sibling had it. The relative risk is increased 6 to 10 times in brothers or sons of an affected man^[3]. Having testicular cancer in one testicle increases your likelihood of developing a second cancer in the other testicle^[2].

Race and ethnicity: Testicular cancer is more common among non-Hispanic whites in the United States and Europe^[2]. It is more common in white men and less common in African-American men^[5].

Abnormal testicle development: Having abnormal development of the testicles may increase risk^[4].

Infertility: Some of the same factors that cause male infertility may also be related to testicular cancer^[2].

Other risk factors that have been studied include infections (such as Human papillomavirus, Epstein-Barr virus, Cytomegalovirus, Parvovirus B-19, and HIV), testicular trauma, and high maternal estrogen levels^[3].

Diagnosis and testing

Tests that examine the testicles and blood are used to diagnose testicular cancer^[4]. If you have symptoms, your healthcare provider will use several methods to determine if you have testicular cancer:

Physical exam and health history: An exam of the body checks general signs of health, including checking for lumps or anything else that seems unusual. The testicles will be examined to check for lumps, swelling, or pain^[4]. A history of your health habits and past illnesses and treatments will also be taken^[4].

Ultrasound exam: A testicular ultrasound uses high-energy sound waves (ultrasound) that are bounced off internal tissues or organs to make pictures called a sonogram^[1][4]. During an ultrasound you lie on your back with your legs spread. A healthcare provider puts a clear gel on the scrotum and moves a hand-held probe over the scrotum to make the pictures^[1]. This test helps your provider see whether lumps look like something that isn’t cancer or if they look like cancer. It shows whether the lumps are inside or outside the testicle. Lumps inside the testicle are more likely to be testicular cancer^[1].

Blood tests (serum tumor marker test): A blood sample is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers^[4]. The following tumor markers are used to detect testicular cancer: alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (beta-hCG), and lactate dehydrogenase^[1][4]. Having these substances in your blood doesn’t mean you have cancer, but having levels higher than is typical is a clue your healthcare team uses to understand what’s going on in your body^[4].

Surgery to remove a testicle (inguinal orchiectomy): If your healthcare provider thinks a lump on your testicle may be cancerous, you might have surgery to remove the testicle^[1]. The testicle is sent to a lab for testing. The tests can show whether it’s cancerous^[1]. This procedure is performed through a small incision in the groin and is done for both diagnosis and treatment^[5].

Treatment

Testicular cancer can usually be cured. The vast majority of testicular cancers are cured, with more than 95% of patients surviving and living a normal life^[18]. Treatment options depend on the type of testicular cancer and how far it has spread^[1].

Surgery (radical inguinal orchiectomy): Surgery to remove the testicle is the main treatment for testicular cancer^[13]. It may be the only treatment you need^[13]. You’ll usually be given the choice to have an artificial testicle put in^[13]. If this concerns you, a prosthetic testicle can be inserted during the procedure^[18]. Rarely, you may only need part of your testicle removed (partial orchidectomy)^[13].

You might also have surgery to remove lymph nodes (small glands that are part of the body’s immune system) in your belly if your cancer has or might have spread to them. This procedure is called retroperitoneal lymph node dissection or RPLND^[13]. If the cancer has spread to your lungs, you might have surgery on your lungs^[13].

Chemotherapy: Chemotherapy uses medicines to kill cancer cells^[13]. You may have chemotherapy after surgery to help stop the cancer coming back, or if the cancer has come back or spread to other parts of your body^[13]. Chemotherapy can cause side effects such as nerve damage to the fingers or feet, though this is often temporary^[18]. Risks such as hearing loss or sensory neuropathy may be a reasonable tradeoff for curing what would otherwise be a life-threatening disease^[18].

Radiation therapy: Radiotherapy uses high-energy rays of radiation to kill cancer cells^[13]. You may have radiotherapy if you have a certain type of testicular cancer (seminoma) and the cancer has spread to the lymph nodes in your belly^[13]. Seminomas are more sensitive to radiation than non-seminomas^[4].

Surveillance: Surveillance might be done after surgery. It means that your provider will closely follow your condition with regular exams and tests. You won’t get any further treatment unless there are changes in your test results^[7].

High-dose chemotherapy with stem cell transplant: This treatment option may be used in certain cases^[7].

Outlook and prognosis

With effective management, the prognosis for testicular cancer is excellent, with a greater than 90% cure rate and greater than 95% five-year survival rate^[3]. Testicular cancer is highly treatable, even when it spreads to other parts of the body^[1].

Survival for testicular cancer is high and depends on many factors including the stage and type of your cancer^[8]. One important message is that the vast majority of testicular cancers are cured, and patients survive and live a normal life^[18].

After you have finished your treatment, you will need regular follow-up testing to make sure that the cancer has not come back. If you have had cancer in one testicle, you have a higher risk of getting cancer in the other testicle. So it’s important to check the other testicle regularly and let your provider know if you notice any changes or unusual symptoms^[7].

Living with testicular cancer

Getting practical and emotional support can help you cope with a diagnosis of cancer^[8]. The 5-year mark is often seen as a critical point in cancer survivorship, though reaching this milestone doesn’t mean the journey is over. Ongoing monitoring and self-care remain essential for long-term health and well-being^[23].

Fertility considerations: Some treatments for testicular cancer, such as chemotherapy, can affect your fertility. This means you might not be able to have children naturally^[13][19]. Before you start treatment, you’ll be offered the option to collect and store your sperm (called sperm banking)^[13]. In the future you can use your sperm in fertility treatment^[13]. Having a testicle removed does not usually affect your fertility^[13].

Sexual function and body image: Treatment for testicular cancer can lead to changes in your sexual function and fertility. Treatment can also change how your body looks and feels^[19]. Having one or both testicles removed affects the way you look, but it can also affect your testosterone levels and your sperm counts^[19]. It’s important to talk with your healthcare provider if you have any concerns about how cancer or its treatment can affect your sex life. There are often ways to help prepare for and cope with treatment-related changes^[19].

Options to help manage changes include prosthetic testicular implants, which look and feel like a normal testicle in the scrotum^[19]. Testosterone gel, patches, or shots can help keep your hormone levels normal even if both testicles have been removed^[19].

Emotional support: You might have a number of different feelings when you’re told you have cancer. These may include feeling shocked, upset, numb, frightened, confused, angry, guilty, or sad^[16]. You may have some or all of these feelings, or you might feel totally different. You may feel them a few at a time or altogether, leaving you feeling exhausted^[16].

Talking to your friends and relatives about your cancer can help and support you^[16]. Help your family and friends by letting them know if you would like to talk about what’s happening and how you feel^[16]. You might find it easier to talk to someone other than your own friends and family, such as a counselor^[16].

Physical effects: Testicular cancer and its treatment may cause physical changes in your body. Some changes may result from treatment such as chemotherapy, radiotherapy, and surgery^[16]. Surgery may cause scarring, and you might have pain and discomfort in the area for some weeks afterward. You have painkillers to help when you are in hospital and are given some to take home with you^[16]. You may also feel very tired and lethargic for a while after treatment^[16].

Long-term follow-up: After treatment, you have regular check-ups to look for signs of the cancer coming back^[8]. Your healthcare provider is the best person to help you know what to expect based on your treatment plan. They can also work with you to manage cancer-related changes^[19].