Testicular cancer

What is testicular cancer?

Testicular cancer affects one in 450 men before the age of 50 and is the most common cancer in men between the ages of 15 and 45. The number of cases in the UK has doubled in the past 20 years and around 2,000 new cases are diagnosed each year, but only 70 men die of it.

There are various different types of testicular cancer, 90 per cent affecting men under the age of 50. Each one attacks different types of cells that make up the testicle. The most common, teratomas, occur more often in younger men aged around 20 to 30, but other types, such as seminomas, are more often found in men in their 40s or 50s and testicular lymphoma can occur even later. So testicular lumps or other symptoms should never be ignored, whatever your age.

Testicular cancer is a highly treatable condition, affecting either one or both testicles. Men are now urged to check for the warning signs of cancer so that treatment can begin as soon as possible.

Testicular cancer symptoms

The first sign is usually a painless swelling of one of the testicles or a hard pea-size lump on the front or side. Sometimes there may also be a dull ache or a sharp pain.

Men are encouraged to check themselves regularly for these, ideally after a hot bath or shower, which relaxes the muscles. Holding your scrotum in the palms of your hands, use your fingers and thumbs to examine the shape, consistency and smoothness of the testicles.

It isn't unusual for one testicle to be slightly smaller than the other or for one to hang lower. The growing tumour may make the testicle feel heavy, produce discomfort in the groin area, or make the testicle or the scrotal sac painful. If something doesn't feel right, get it checked by the doctor - don't ignore it.

Diagnosing testicular cancer

There are a number of techniques used to confirm whether the symptoms are caused by cancer or something else.

Blood tests look for the presence of certain chemicals which aren't around at such high levels normally. Doctors can also examine lumps using ultrasound.

If a tumour is found, cancer is presumed as most tumours in the testicle are malignant. However, the only way to know for sure is to remove the testicle surgically and send samples for analysis.

Once cancer is confirmed, the doctor may use other tests, such as CT scans, to check to see whether it has spread beyond the testicle to involve other organs and parts of the body.

Testicular cancer causes

Doctors don't know precisely what causes testicular cancer, but they have spotted some clues. Men who've had undescended testicles and those with a close male relative who has had testicular cancer are more at risk. In the USA, it's five times more common in white men compared with other ethnic groups. There is no link to having had a vasectomy but there is a slightly increased risk if you have had mumps affecting your testes and a much higher risk if you have already had testicular cancer in the other testicle.

There are no guaranteed ways of preventing testicular cancer. However, if undescended testicles are corrected before a boy is 13 years old, his risk of developing testicular cancer is just twice that of the normal population. If surgery is delayed until older, the risk is five times. Regular exercise may also reduce the risk.

Testicular cancer treatments

Testicular cancer is one of the most curable cancers, with more than 95 per cent of men making a full recovery even if the cancer has spread. Treatment for testicular cancer involves removing the affected testicle, although in many cases the other one can be preserved if the doctor is confident the disease has been caught early and has not spread.

One testicle can produce enough sperm to produce children, and testicular removal does not affect the level of male sex hormones or the ability to get an erection. However, if there is a suspicion of spread, then lymph nodes in the groin area may have to be removed for analysis - this could affect the ability to ejaculate semen at orgasm. If there is any chance that fertility could be damaged, sperm can be frozen and then used in in vitro fertilisation (IVF) later in life.

If the cancer hasn't spread, further treatment may not be necessary. If it has, chemotherapy is usually given. Radiotherapy is sometimes used in the early stages. While radiotherapy does not permanently remove fertility in most cases, chemotherapy is more likely to result in a permanent reduction or removal of sperm production.