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Testicular cancer occurs when normal, healthy cells, which are carefully regulated by the body, begin to reproduce uncontrollably within the testicles.
  • 1 in 250 males will develop testicular cancer in their lifetime.
  • Over 21,000 men are diagnosed in Europe each year and around 55,000 globally.
  • It can occur at any age but most commonly affects men between the ages of 15-45.
  • It is an extremely treatable cancer, with a cure rate of over 90%, and most men will be alive 10 years after diagnosis.

Risk Factors

  • Undescended testicle (cryptorchidism). In baby boys, the testicles form in the abdomen and before birth or soon after they descend into the scrotum. In a small percentage of boys this does not happen, and surgery may be used to correct it (orchidopexy). With cryptorchidism, the risk of developing testicular cancer is very low but higher than in other males. Around 5-10% of men diagnosed with testicular cancer may have a history of cryptorchidism.
  • Family history. If your brother has had testicular cancer your risk is around 9 or 10 times greater. If your father had testicular cancer the risk is around 4 or 5 times greater.
  • Testicular cancer is slightly more common in men who have fertility problems resulting from abnormal sperm quality or poorly functioning or developed testicles.
  • A personal history of testicular cancer is associated with an increased risk (up to 3%) of developing cancer in the remaining testicle.
  • Caucasian (white) men have a higher risk of testicular cancer than men from other ethnic groups.
  • Men with HIV are more likely to develop testicular cancer.
Fig. 1: In cryptorchidism, the testicles fail to descend into the scrotum. Illustration shows the percentage of the testicle position in patients with cryptorchidism.
Fig. 1: In cryptorchidism, the testicles fail to descend into the scrotum. Illustration shows the percentage of the testicle position in patients with cryptorchidism.

Signs and Symptoms of Testicular Cancer

  • A lump within the ball of the testicle which in many cases may be painless.
  • Dragging sensation, ache, or pain, sudden enlargement of the testicle or development of a hydrocele (fluid around the testicle).
  • Male breast swelling or tenderness (called gynaecomastia). This is rare but can be caused by hormones which are produced by some types of testicular cancer. Similar symptoms can be caused simply by body changes during puberty (growing pains).
  • Back or abdominal pain caused by enlarged lymph nodes in the abdomen.

Anything that doesn’t feel normal should always be checked by a doctor as soon as possible.

Diagnosis

An ultrasound scan is the best test to check for a testicular lump. If it shows that cancer might be present the testicle will need to be removed by surgery. This operation is called an orchidectomy.

In addition to an orchidectomy other tests (below) will be performed. These may be repeated after surgery and other treatments to see how effective treatment has been.

Blood tests 

 

Some testicular cancers release chemical substances into the bloodstream called tumour markers. These can indicate how active or aggressive any cancer might be if they are abnormal. They can be measured before and after orchidectomy to see if removing the testicle has reduced cancerous activity and can also be used to assess the effect of other treatments such as chemotherapy.

Some men may have a low testosterone level before surgery and treatment may reduce it further. A blood test to check your testosterone level may be performed.

Computerised Tomography Scan (CT scan)

 

A CT scan of the chest, abdomen and pelvis is performed to see if cancer has spread to other areas of the body such as lymph nodes.

 

Sperm Storage Treatment for testicular cancer may reduce fertility (ability to father a child), and sometimes men will be advised to store sperm before surgery.

 

Can a pregnancy test identify testicular cancer?

Beta-human chorionic gonadotrophin (BHCG) is a chemical produced during pregnancy. Some testicular cancers also produce BHCG, and large amounts can be detected in urine. Therefore, a urine pregnancy test could potentially identify testicular cancer. However, many testicular cancers do not produce BHCG so a pregnancy test should never be used as a diagnostic test. Some performance enhancing drugs can also cause a positive result.

Emotional Impact

Most people feel overwhelmed when they are told they have cancer, even if the chance of cure is very high. Many different emotions arise, which can cause confusion and frequent changes of mood. You may experience fear, resentment, and anger. Reactions differ from one person to another and there is no right or wrong way to feel. These emotions are part of the process that many people go through in trying to come to terms with their illness. Partners, family members and friends often experience similar feelings and frequently need as much support and guidance in coping.

Often the information that you will get at diagnosis will be overwhelming and you may not fully appreciate the implications of what has been said. As well as having to deal with your own feelings and fears, you may also find that a cancer diagnosis and treatment impacts on your relationships in unexpected ways, adding stress when you feel least able to cope with it. Whether at the point of diagnosis or after treatment being able to explore your concerns with someone who understands how challenging a cancer diagnosis can be will allow you to discover the best way to confront what has happened to you. Many treatment centres will have a team of specialist cancer counsellors who may be able to help men talk about their fears and worries during or after treatment. It is always a good idea to ask the specialist team if counselling is available.