Testicular Cancer Symptoms, Diagnosis and Treatment

Testicular cancer is a health concern that primarily affects young men, affecting most between the ages of 15 and 35. It’s estimated that about one of every 250 males will develop testicular cancer at some point during their lifetime (American Cancer Society).

Testicular cancer occurs when abnormal cells in the testicles grow uncontrollably. The testicles, or testes, are part of the male reproductive system and are located in the scrotum. They are responsible for producing sperm and testosterone. Most testicular cancers begin in the germ cells, which are the cells that produce sperm.

There are two main kinds of testicular cancer — seminoma (a slow-growing cancer) and nonseminoma (which tends to grow and spread more quickly).

Symptoms of Testicular Cancer

Recognizing the symptoms of testicular cancer early can lead to prompt diagnosis and treatment. Here are five common signs to watch for:

1. Lump or swelling in the testicle: The most common symptom is a lump or swelling in one of the testicles. It may feel like a pea-sized lump or larger.
2. Pain or discomfort: Some men experience pain or discomfort in the testicle or scrotum.
3. Heavy feeling in the scrotum: A sensation of heaviness in the scrotum can be a warning sign.
4. Dull ache in the lower abdomen or groin: Persistent pain in these areas may indicate testicular cancer.
5. Sudden fluid accumulation in the scrotum: An unexpected buildup of fluid can be a symptom.

It's important to note that these symptoms can also be caused by conditions other than cancer, such as infections or injuries. However, any persistent changes should be evaluated by a health care professional.

Causes and Risk Factors

The exact cause of testicular cancer is not known, but several risk factors have been identified:

• Undescended testicles (cryptorchidism): Men with a history of undescended testicles are at a higher risk.
• Family history: Having a family member with testicular cancer increases the risk.

How Testicular Cancer is Diagnosed

Early detection of testicular cancer significantly improves treatment outcomes. Here are the steps involved in diagnosing testicular cancer:

Self-Examination

Regular self-examinations can help detect changes early. Men should perform a self-exam monthly, ideally after a warm shower when the scrotal skin is relaxed. Gently roll each testicle between the fingers and thumbs, feeling for lumps or changes in size or consistency.

Medical Evaluation

If a lump or other symptoms are detected, a health care provider will conduct a thorough examination, which may include:

• Ultrasound: This imaging test uses sound waves to create a picture of the testicles and can help distinguish between solid masses and fluid-filled cysts.
• Blood tests: Certain blood tests can detect tumor markers, such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG), lactate dehydrogenase (LDH) which may indicate cancer.
• Biopsy: In some cases, a biopsy may be performed to confirm the diagnosis.

Staging Testicular Cancer

Once diagnosed, testicular cancer is staged to determine the extent of the disease. Staging helps guide treatment decisions and predict outcomes. The stages are:

• Stage 1: Cancer is confined to the testicle.
• Stage 2: Cancer has spread to the lymph nodes in the abdomen. 
• Stage 3: Cancer has spread (metastasized) to other parts of the body, such as the lungs or liver.

Prognosis and Survival Rates

The prognosis for testicular cancer is generally excellent, with high cure rates. The five-year survival rate for men with testicular cancer is over 95%, and even higher for those diagnosed at an early stage. Regular follow-up care is essential to monitor for recurrence and manage any long-term side effects of treatment.

Treatment Options for Testicular Cancer

Testicular cancer is highly treatable, especially when detected early. Treatment options vary based on the stage and type of cancer. Even after the cancer has spread beyond the testicles, men who receive the right treatment from urologic cancer specialists who have expertise in treating the disease have a good chance of long-term survival.

Surgery

• Orchiectomy: The primary treatment for testicular cancer is the surgical removal of the affected testicle. This procedure is called an orchiectomy and is often curative for early-stage cancer.
• Retroperitoneal lymph node dissection (RPLND): In some cases, surgery to remove lymph nodes in the abdomen may be necessary.

Radiation Therapy

Radiation therapy uses high-energy X-rays to kill cancer cells. It is often used for seminoma, a type of testicular cancer that is sensitive to radiation.

Chemotherapy

Chemotherapy involves using drugs to kill cancer cells. It is typically used for advanced testicular cancer or when cancer has spread beyond the testicle.

Clinical Trials

Participation in clinical trials may provide access to new treatments and therapies. Patients should discuss this option with their health care provider.

Fertility and Survivorship

Treatment for testicular cancer can affect fertility, a concern since most testicular cancer patients are younger. Men who are undergoing treatment should discuss sperm banking with their doctor before starting treatment. Sperm banking involves collecting and freezing sperm for future use.

Testosterone levels can be negatively affected by treatment and should be routinely monitored as part of surveillance. Our Cancer Sexual Health Program offers treatment before, during and after cancer treatment for low sex drive, erectile dysfunction, and more.