Testicular Cancer: First Signs of Testicular Cancer & Typical Prognosis with Treatment

What is testicular cancer?

The testicles, or the male sex glands, are two egg-shaped glands located in a sac of skin (scrotum) beneath the penis. Most testicular cancers originate in the germ cells of the testicles, which produce immature sperm that then matures in order to fertilize a female egg and start a pregnancy.

Signs and symptoms of testicular cancer include a lump in the testicle, a change in how the testicle feels, aching in the lower abdomen of the groin, swelling of the scrotum, and pain in the scrotum.

Treatment for testicular cancer typically includes surgical removal of the affected testicle (orchiectomy). It may also include radiation or chemotherapy. Since treatment for testicular cancer can lead to infertility, sperm banking early in treatment is important to preserving fertility options for the future.

You should visit your primary care physician who will coordinate care with a cancer surgery specialist (surgical oncologist). Testicular cancer responds well to surgical treatment.

Symptoms of testicular cancer

Testicular cancer is the most common solid cancer in men aged 15 to 35 but is often curable.

The first sign of testicular cancer may be any of the following changes:

• A lump in either testicle
• Enlargement of the testicle
• Heaviness in the scrotum
• An aching feeling in the lower abdomen or groin
• Swelling of the scrotum
• Pain or discomfort of the testicle or scrotum
• Back pain

Causes of testicular cancer

The testicles are primarily responsible for producing male hormones, such as testosterone, as well as sperm. The exact cause of testicular cancer is unknown. However, several risk factors have been identified that increase chances of developing the condition. These include:

• An undescended testicle (cryptorchidism): This increases risk three- to six-fold. The risk is highest if surgical correction (orchiopexy) is delayed until after puberty.
• Abnormal testicles: This includes small testicles that do not fully function.
• Whites, Hispanics, and American Indian/Alaska Natives: These groups have an elevated risk when compared to other ethnic groups.
• A family history of testicular cancer: In the immediate family the risk is raised 3.8- to 9.6-fold.
• Klinefelter syndrome: This is a genetic condition in males associated with having more than one X chromosome, learning difficulties, a lack of body hair, and small testicles.

Germ cell tumors

These tumors originate from the cells that produce sperm (>90 percent of all testicular cancer).

• Seminomas: These grow more slowly than non-seminomas. They can increase the level of a protein in the blood called HCG.
• Nonseminomas: Although there are four main types, most tumors are a mix of several different types. One type is an embryonal carcinoma, which under a microscope may look like the tissue of early embryos. They tend to grow rapidly and spread outside the testicle. They can also increase levels of AFP (another protein) and HCG in the blood. Another type is yolk sac carcinoma, which is the most common form of testicular cancer in children but is rare in adults. They also increase AFP in the blood. Choriocarcinoma is a rare type but grows very rapidly in adults. It is likely to spread elsewhere in the body, such as the lungs, bones, and brain, and increases HCG in the blood. Another type, teratomas, contain multiple layers of a developing embryo when examined under a microscope.

Non-germ cell tumors

Also known as stromal tumors, these originate from other cells in the testicles (<10 percent of all testicular cancers).

• Leydig cell tumors: These originate from cells that make male hormones, such as testosterone. Most Leydig tumors are benign, but if they spread outside the testicle, treatment options are limited.
• Sertoli cell tumors: These form in cells that support the growth of germ cells. Like Leydig cells, they are typically benign but have limited effective treatment options if they do spread beyond the testis.

Treatment options and prevention for testicular cancer

Treatment options include a few different procedures, as well as surveillance, chemotherapy and radiation therapy. Sperm banking is a precautionary measure if you wish to have children in the future and are unsure of your fertility down the road.

Self-screening for testicular cancer

There is little you can do to prevent testicular cancer. Physicians have had disagreements about whether testicular self-exams are useful in preventing poor outcomes from testicular cancer. Current research suggests self-exams have minimal benefits. Your physician can discuss with you the pros and cons of screening, and if you choose to self-screen, self-examination may be done according to this routine.

Surgery

Surgical removal of affected tissue is both diagnostic since tissue examination guides further therapy, and therapeutic, as removal of pathologic tissue protects against the further spread of disease.

• Removal of the testicle (radical inguinal orchiectomy): The primary treatment for a confirmed malignant tumor is the removal of the testis, along with the spermatic cord and internal inguinal ring. Testicular prostheses are routinely offered to replace the removed testicle. Testis sparing surgery may be an option for some small tumors.
• Removal of lymph nodes in the back (retroperitoneal lymph node dissection): This may be recommended in cases of advanced testicular cancer.

Surveillance

In many cases, orchiectomy alone is adequate treatment, sparing exposure to the negative side effects of chemotherapy and radiation. However, close follow-up for at least five years — often with blood tests, CT scans, and ultrasounds to evaluate any changes — is critical to catch any recurrence of disease.

When to seek further consultation for testicular cancer

If you notice a lump in your testicle, your scrotum becomes swollen, or you develop pain in your scrotum

If you notice any changes in your testicles or scrotum, especially if these changes persist for more than two weeks, report these concerns to your physician as soon as possible. These may be signs of testicular cancer or another condition, and the prognosis is best if these symptoms are evaluated and treated early.