Testicular cancer

 

Introduction

Testicular cancer accounts for approximately 0.7% of all cancers. It's the most common cancer in men between the age of 20 and 35. Approximately 1,960 men are diagnosed with the condition each year in the UK. Around 70 people die every year from testicular cancer.

The testicles are part of the male reproductive system. They produce sperm and the male hormone testosterone. The testicles hang down behind the penis, and are located within the scrotum (a loose bag of skin).

The body is made up of millions of different types of cells. Sometimes these cells can become abnormal and start to multiply. When this happens it causes a growth, known as a tumour, to form. Tumours can be benign (not cancerous) or malignant (cancerous). They can occur in any part of the body where the cells multiply abnormally.

Testicular cancer is different from many other types of cancer. Most cancers tend to affect older people. Testicular cancer, however, is more common in young and middle-aged men. Approximately 50% of all cases of testicular cancer affect men who are under 35 years of age, and 90% of cases affect those who are under the age of 55.

Cancer of the testicles is also one of the most treatable forms of cancer. Over 95% of men make a full recovery from testicular cancer.

Types of testicular cancer

There are two main types of testicular cancer:

  • seminoma, and
  • non-seminoma

The terms seminoma and non-seminoma refer to the type of cell that makes up the cancerous tumour. Seminoma testicular cancers only contain seminoma cells. Non-seminomas may contain a variety of different cancer cells. However, both types of testicular cancer are treated in a similar way.

Testicular cancer is also a type of germ cell cancer. A germ cell cancer is one that starts in the cells that are used to make sperm or eggs (ovarian cancer is another type of germ cell cancer).

Symptoms

The most common symptom of testicular cancer is a lump, or swelling, in one of your testicles. Testicular lumps are most commonly found on either the front, or the side, of the testicle. They often feel like a hard, pea-sized swelling.

See your GP or urologist if you have a lump or swelling in your testicle

Most testicular lumps are not a sign of cancer. Research has shown that less than 4% of testicular lumps are cancerous.

However, this does not mean that you should ignore a lump, or swelling, in your testicle. It is very important that you see your GP, who will be able to examine your testicles to help determine whether the lump is cancerous.

 

Testicular cancer can also cause other symptoms, including:

  • a dull ache, or sharp pain, in your testicles, or scrotum, which may come and go,
  • a feeling of heaviness in your scrotum,
  • a dull ache in your lower abdomen,
  • a sudden collection of fluid in your scrotum (hydrocele),
  • fatigue, and
  • generally feeling unwell.

Rarer symptoms

In rare cases of testicular cancer, the tissue in your breast area may be enlarged, or tender. Your nipples may also feel sore and tender as a result of the hormonal changes going on in your body.

If your testicular cancer has spread to other parts of your body, you may also experience a variety of other symptoms. Although testicular cancer can spread to your lymph nodes (part of your immune system) and lungs, it rarely travels to other organs.

This means that if your cancer does spread, you are most likely to experience symptoms such as:

  • coughing,
  • difficulty breathing,
  • difficulty swallowing, and
  • a swelling in your chest.

     

Causes

The causes of testicular cancer are not yet fully understood. However, research has identified a number of factors which may increase your chances of developing the condition. Some of these risk factors are outlined below.

Undescended testicles

The medical name for undescended testicles is cryptorchidism. When male babies grow in the womb, their testicles develop inside their abdomen. The testicles then normally move down into the scrotum when the baby is born, or during their first year of life.

However, for some children, the testicles fail to descend into the scrotum. Surgery is normally required to move the testicles down. If your testicles require surgery because they do not descend, it may increase the risk of you developing testicular cancer.

One study found that if surgery is performed before the child is 13 years of age, their risk of testicular cancer is approximately double than that of the rest of the population. However, if the operation is carried out after the boy is 13 years of age, or older, the risk of developing testicular cancer is five times greater than that of the rest of the population.

Age and race

Unlike most other cancers, testicular cancer is more common in young and middle-aged men, than in older, or elderly, men. It most commonly affects men who are between 20-44 years of age, with 90% of testicular cancer cases affecting men who are under the age of age 55.

Testicular cancer is also more common in white men, compared with other racial groups. It is also more common in northern and western Europe than in any other part of the world.

Close family member

If a close family member has had testicular cancer, such as your father, or brother, it may increase your risk of developing the condition. It is thought that approximately 1 in 5 cases of testicular cancer are the result of an inherited faulty gene.

Mumps orchitis

Mumps orchitis is a rare complication of mumps (a viral infection of your salivary glands). In men, mumps orchitis can cause either one, or both, of the testicles to become inflamed. This can be very painful, and it can also increase your risk of developing testicular cancer later in life.

Fertility problems

Some research has suggested that men with fertility problems, such as a low sperm count, or low sperm mobility (when the sperm do not move around as well as they should), may be at an increased risk of testicular cancer. However, this risk is relatively small. For example, one study found that out of 32,000 men who had fertility problems, only 89 went on to develop testicular cancer.

No link to vasectomies

Past research had suggested that there may be a link between vasectomies and testicular cancer. However, more recent studies have shown that this is not the case. You are not at any increased risk of developing testicular cancer if you undergo vasectomy surgery.

Injuries, or strains, to the groin will also not increase your risk of developing testicular cancer.

Diagnosis

Visiting your GP

If you notice a lump, or abnormality, in your testicles, you should first see your GP. Although most testicular lumps are not cancerous, it is essential for you to have the abnormality checked. This because the treatment for testicular cancer is much more effective the earlier the condition is diagnosed.

Physical examination

As well as asking you about your symptoms, and consulting your medical history, your GP will normally need to carry out a physical examination of your testicles.

Your GP may hold a small light, or torch, against the lump in your testicle, to see whether light passes through it. Cancerous lumps tend to be solid, and light cannot normally pass through them.

If your GP suspects that the lump in your testicle may be cancerous, you will be referred for further testing at a hospital. Some of the tests that you may have are outlined below.

Scrotal ultrasound

A scrotal ultrasound scan is a painless procedure which uses high frequency sound waves to produce an image of the inside of your testicles. This is one of the main ways in which your specialist will be able to determine whether or not your lump is cancerous.

During a scrotal ultrasound, your specialist will be able to determine the position and size of the abnormality in your testicle.

It will also give them a good indication of whether the lump is solid, or whether it is filled with fluid. A lump filled with fluid is known as a cyst, and is usually harmless. However, a more solid lump may be a sign that the swelling is cancerous.

Blood tests

To help confirm your diagnosis, you may require a series of blood tests. These tests will be used to detect certain hormones in your blood, which are known as 'markers'. Testicular cancer often produces these markers, so having them in your blood may be a strong indication that you have the condition.

The markers in your blood that will be tested for include:

  • AFP (alpha feta protein),
  • HCG (human chorionic gonadotrophin), and
  • LDH (lactate dehydrogenate).

It is important to remember that not all forms of testicular cancer produce these markers. There may still be a chance that you have testicular cancer, even if your blood test results come back normal.

Biopsy

The only way to definitively confirm a case of testicular cancer is to have a biopsy of the tumour taken. The cells from the tumour can then be examined in a laboratory to determine whether it is cancerous (malignant), or non-cancerous (benign).

Usually, a biopsy involves taking a small sample of cells from the tumour. Unfortunately, for most cases of testicular cancer, the only way to safely take a biopsy is to remove the affected testicle completely. This is because specialists often think that the risk of the cancer spreading is too high for a conventional biopsy to be taken.

Your specialist will only remove your testicle if they are relatively certain that your lump is cancerous. Losing a testicle will not affect your ability to have children, or your sex life. The main form of treatment for testicular cancer is to have the testicle removed, so it is likely that you will need to undergo this procedure at some point anyway.

The removal of a testicle is known as an orchidectomy. See the 'treatment' section for more information about the procedure.

Other tests

If your specialist feels it is necessary, you may require further tests to check whether your testicular cancer has spread to any other parts of your body. When cancer of the testicle spreads, it most commonly affects the lungs. This means that you may require a chest X-ray to check for any signs of a tumour.

You may also require a scan of your body, such as a magnetic resonance imaging (MRI) scan, or a computerised tomography (CT) scan to check for signs of the cancer spreading.

Treatment

Testicular cancer is one of the most treatable cancers, with approximately 95% of men making a full recovery. As with most cancers, the earlier the condition is detected and diagnosed, the better your chance of recovery.

The three main forms of treatment for testicular cancer are:

  • surgery,
  • chemotherapy, and
  • radiotherapy.

Surgery is the most common and effective form of treatment for testicular cancer. It is normally the first line of treatment for all stages and types of testicular cancer. Surgery and other treatments for testicular cancer are outlined below.

Orchidectomy

An orchidectomy is the medical name for the surgical removal of a testicle. If you have testicular cancer, it is necessary to remove the whole testicle because only removing the tumour may lead to the cancer spreading. Therefore, by removing the entire testicle your chances of making a full recovery are greatly improved.

If your testicular cancer is caught in the early stages, an orchidectomy may be the only treatment that you require.

The operation is performed under general anaesthetic. A small cut is made in your groin and the whole testicle is removed through this incision. If you want to, you can have an artificial (prosthetic) testicle inserted into your scrotum, so that the appearance of your testicles is not greatly affected. This artificial testicle is normally made from silicone.

How will an orchidectomy affect me?

An orchidectomy will usually be performed as a day stay in hospital. If you only have one testicle removed, there should not be any lasting side effects. Your sex life, and your ability to father children, should not be affected.

If you have both testicles removed, you will be infertile. However, it is very rare for both testicles to be affected by cancer and, therefore the removal of both is uncommon. You may be able to bank your sperm before your operation, which should allow you to father children if you decide that you want to.

Testosterone replacement therapy

Having both testicles removed will also stop you from producing testosterone. This means that you will require testosterone replacement therapy.

Testosterone tends to be given either in injections or skin patches. If you have injections, you will normally need to have them every 2-3 weeks. If you have testosterone replacement therapy, you will be able to maintain an erection and your sex drive.

Lymph node surgery

If your testicular cancer is more advanced, it can sometimes spread to your lymph nodes. Your lymph nodes help form part of your body's immune system, which protects the body against illness and infection.

Lymph node surgery is carried out under general anaesthetic. The lymph nodes in your chest and abdomen are the most likely nodes which need to be removed.

In some cases, the removal of your lymph nodes may leave you infertile. As with an orchidectomy, you may wish to bank your sperm before your operation, in case you become infertile.

Nerve sparing lymph node dissection

There is a type of operation, known as a 'nerve sparing' lymph node dissection, which can greatly reduce your risk of becoming infertile.

However, as this operation is a fairly new procedure, and can only be performed by specialised surgeons, it may not be available at all hospitals or treatment centres. This type of operation can also increase the risk of your cancer returning because not all of the lymph node is removed.

Radiotherapy

Radiotherapy is a form of cancer therapy which uses high energy beams of radiation to help destroy cancer cells. Most seminoma types of testicular cancer will require radiotherapy as well as surgery. This is to help prevent the cancer from returning.

If your testicular cancer has spread to your lymph nodes, you may also require radiotherapy.

Side effects of this type of treatment can include:

  • fatigue,
  • skin rashes,
  • stiff joints and muscles,
  • loss of appetite, and
  • nausea.

These side effects are usually only temporary, and you should find that they improve once you have completed your treatment.

Chemotherapy

Chemotherapy is a type of cancer treatment that uses anti-cancer medicines to either kill the malignant (cancerous) cells in your body, or stop them multiplying.

If your testicular cancer is advanced, or has spread to other places in your body, you may require chemotherapy. It is also used to help prevent the cancer from returning. Chemotherapy is most commonly used to treat non-seminoma tumours.

Chemotherapy medicines can either be injected or given to you orally (by mouth).
Chemotherapy can also attack the normal, healthy cells in your body, which is why this form of treatment can potentially have many side effects. The most common side effects include:

  • vomiting,
  • hair loss,
  • nausea,
  • mouth sores, and
  • fatigue.

These side effects are usually only temporary and you should find that they improve once you have completed your treatment.

Prevention

Although testicular cancer can rarely be prevented, it is important for you to check your testicles on a regular basis. Cancer is easier to treat when it is diagnosed early on. If you regularly examine your testicles, you will soon notice if any swelling or abnormality develops.

When to check your testicles

The best time to check them is after you have had a warm shower or bath as this is when your scrotal skin will be most relaxed.

Feel the size and weight of your testicles

Hold your scrotum in the palms of your hands, and use your fingers and thumbs to examine your testicles. You should first feel the size and weight of your testicles. A lot of men have one testicle which is larger than the other. You may also have a testicle which hangs slightly lower than the other.

However, if you notice any significant increase in the size or weight of your testicles, it could be a sign that something is wrong, so make sure that you visit your GP for advice.

Feel each testicle individually

As well as feeling the size and weight of your testicles, you should also gently feel each testicle individually.

When you examine your testicles, they should feel smooth, with no lumps or swellings. You should be able to feel a soft, tube-like section at the top and back of each testicle. This is your epididymis which is used to store sperm. It may feel slightly tender, but this is perfectly normal.

It is very rare to get cancer in both testicles, so if you are unsure about what your testicle should feel like, try comparing it to your other one.

If you do find a lump, or swelling, make sure that you see your GP as soon as possible.

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