Testicular cancer - symptoms, causes, treatment and testicle examination

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Testicular cancer
Published by Bupa's health information team, December 2007.

This factsheet is for men who have testicular cancer, or anyone who would like information about it.

According to Cancer Research UK, each year about 1,800 men are diagnosed with testicular cancer in the UK. It accounts for one to two percent of all cancers in men. Most men with testicular cancer can be cured. It's most likely to occur in young and middle-aged men.

About testicular cancer
The testicles are located inside the scrotum, the loose bag of skin that hangs below the penis. From the start of puberty, each testicle produces sperm. The testicles also produce the hormone testosterone.

A testicular tumour is a lump created by the abnormal and uncontrolled growth of cells. Testicular tumours can grow and sometimes spread to other parts of your body (through the bloodstream or the lymph system). Testicular cancer can also spread to the lymph nodes (part of the lymph system) or form tumours in the lungs or other organs. The spread of cancer is called metastasis.

Types of testicular cancer
There are two main types of testicular cancer: seminoma and non-seminoma. Seminomas are made up of a single kind of testicular cell, while non-seminomas (eg teratomas) are made up of more than one type of cell.

Very rarely, another type of cancer, called a lymphoma, can occur in the testicles. This is cancer of the lymphatic tissue (tissue that forms part of the immune system). Lymphoma is the most common type of testicular cancer in men over 50.

Symptoms
The main symptom of testicular cancer is a lump, irregularity or swelling in one testicle. Other symptoms that may be present include:

• a pulling sensation or feeling of unusual heaviness in the scrotum
• a dull ache in the groin or lower abdomen
• pain or discomfort (which may come and go) in the testicle or scrotum
• tenderness or enlargement of tissue in the breast area
• a sudden collection of fluid in the scrotum (called a hydrocele)

These symptoms don't always mean you have testicular cancer. But you should see your doctor if you are concerned about your symptoms.

A few men with testicular cancer may experience lower back pain, stomach pain or a cough as their first symptoms.

Causes
The causes of testicular cancer are unknown, but the number of men who develop testicular cancer is increasing and research is being carried out to find out why.

Men born with an undescended testicle (one that remains in the abdominal cavity rather than descending into the scrotum) may be at greater risk of developing testicular cancer.

Other factors that are thought to make testicular cancer more likely include:

• having a brother or father who had testicular cancer
• fertility problems
• being from a wealthy social group
• being white rather than of African or Asian descent
• having a rare complication of mumps called orchitis (painful swelling of the testicles)

Having a vasectomy or injury to the testicles does not cause testicular cancer.

Diagnosis
Most lumps in the scrotum are not testicular cancer. However, if you notice one or more of the symptoms above, you should see your GP or a local sexual health clinic for advice. They will carry out a physical examination to rule out any other conditions or infections that can cause similar symptoms. Your GP may then refer you to a urologist - doctor specialising in the urinary organs - at a local hospital. You may also need to have an ultrasound scan so your doctor can examine your testicles.

If the ultrasound scan suggests cancer, a surgical procedure called a biopsy will be carried out to confirm this, and to see what type of cancer it is. This involves removing a small amount of the tumour and examining it under a microscope. If the biopsy confirms that there is cancer, the doctor will remove the affected part of your testicle.

Other tests may be carried out to see whether the cancer has spread. These may include:

• CT scans
• a chest X-ray
• blood tests to assess levels of tumour marker proteins in the blood

Assessing how far the cancer has spread is called staging. The stages are:

• stage 1 - cancer is only in the testicle
• stage 2 - cancer has spread to the lymph nodes in the abdomen
• stage 3 - there are cancer cells in the lymph nodes in the chest or above the collarbone
• stage 4 - cancer has spread to other organs, often the lungs

Treatment
The type of treatment used depends on the type of cancer and how far it has spread. Chemotherapy and radiotherapy can temporarily lower your fertility. As a precaution, many men store (cryopreserve) their sperm in a sperm bank before treatment.

Surgery
Surgical removal of the affected testicle (orchidectomy) is the standard initial treatment for testicular cancer. If the cancer has spread further, you may need to have chemotherapy first, so the removal of your testicle will be delayed. You may wish to have an artificial testicle (an implant or prosthesis) inserted into your scrotum - you can discuss this with your doctor before the surgery. The removal of one testicle will not affect your ability to have erections or father children.

After surgery, you will be referred to a team of specialists and seen by an oncologist - a doctor specialising in cancer - to decide on the best course of further treatment.

Seminoma treatment
Early stage seminomas are treated with radiotherapy, or sometimes chemotherapy (see Related topics). More advanced stages are treated with radiotherapy, if the cancer is confined to a small area, or chemotherapy if it's more spread out.

Non-seminoma treatment
If you have an early stage non-seminoma, you probably won't need treatment, but you will be monitored for any signs of the cancer coming back (relapsing). This is because if testicular cancer does come back, there is a good chance that it can be cured with chemotherapy. Chemotherapy can leave the remains of tumours behind, and these may need to be surgically removed to make sure the cancer doesn't come back.

After your treatment you will need to have follow-up appointments so your doctors can see whether the cancer has come back. Depending on the nature of your testicular cancer, your surgeon or oncologist will arrange follow-up care.

Further information
Cancerbackup
0808 800 1234
Cancerbackup online: cancer information, support & resources : Cancerbackup
CancerHelp UK
0800 226 237
Homepage: Cancer Research UK: CancerHelp UK

Sources
Cancer Trends Table 21.1. Testicular cancer: key statistics
Home: UK National Statistics Publication Hub
accessed 18 November 2007
Testicular Cancer. CancerBackup.
Cancerbackup online: cancer information, support & resources : Cancerbackup
accessed 18 November 2007
Guidelines on Testicular Cancer. European Association of Urology, 2006.
UroToday
accessed 18 November 2007
UK Testicular Cancer incidence statistics. Cancer Research UK.
Cancer Research UK : News & Resources
accessed 18 November 2007
Management of Adult Testicular Germ Cell Tumours. Scottish Intercollegiate Guidelines Network, 1998 (reviewed 2005), publication no 28.
Scottish Intercollegiate Guidelines Network (SIGN)
accessed 18 November 2007

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: December 2007.