Testicular Cancer

• Read Ryan's story: 'Have the balls to ask for help.'

What is it?

A relatively rare cancer that usually affects one testicle.

What are the main symptoms?

The key symptoms to look out for are:

• a lump in either testicle
• any enlargement of the testicle
• a feeling of heaviness in the scrotum
• a dull ache in the abdomen or groin
• a sudden collection of fluid in the scrotum
• enlargement or tenderness of the breasts

It's important to remember that testicular cancer may not cause any discomfort or pain, especially in the early stages. The most common symptom is a small painless lump.

Any of these symptoms can also have benign (i.e. non-cancerous) causes, but they should always be checked by a doctor.

As some of these symptoms aren't always obvious, it's important to check your testicles. 

How do I check my testicles?

It's pretty easy. It's best to examine your testicles after a warm bath or shower.

• Support your balls in the palm of one hand. Note the size and weight of your testicles. This will help you to detect any changes in the future.  
• Find the epididymis, the tube that carries sperm to the penis. This can be felt at the top and back of each testicle. This is one lump that is supposed to be there.
• Now examine each testicle in more detail by rolling it between your fingers and thumb. Press firmly but gently to feel for any lumps, swellings or changes in firmness.

Examine yourself every couple of months or when you feel like it. Testicular cancer is very uncommon so don't get obsessed with it. But if you do find anything unusual, don't wait for it to disappear or start throbbing - see your doctor.

What's the risk?

Testicular cancer is the most common cancer affecting men aged 20—35 but the lifetime risk of developing the disease is still only 1 in 400. That compares with 1 in 12 for lung cancer and for prostate cancer. However, the incidence of testicular cancer is increasing — in fact, it's doubled in the past 20 years.

The risks are greater (1 in 44) for men who were born with undescended testicles. Men with a brother or father who had a testicular tumour have a 6—10 times higher risk of developing this cancer. 

What causes it?

The causes aren't yet fully understood. However, the fact that men who develop testicular cancer are more likely to have had undescended testicles, and to be affected by fertility problems, suggests some sort of common cause.

One plausible theory, not yet fully proven, is that testicular tissues are damaged while male foetuses are still developing, possibly as a result of their mothers' exposure to environmental pollutants which are chemically similar to the female hormone oestrogen. It may be that male foetuses are being over-exposed to oestrogen and that, as a result, some develop a range of problems with their reproductive systems.

Some studies have also linked testicular cancer to a sedentary lifestyle in boys, although further research is needed to confirm this. 

How can I prevent it?

You can't.

Should I see a doctor?

If you have any of the symptoms listed above you should see your doctor as soon as possible.

Your doctor will examine your testicles and, if he or she suspects a problem, you'll probably be referred to a specialist doctor (normally a urologist). Your testicles will be examined again and you may be asked to have an ultrasound (a painless procedure) and a blood test. 

What are the main treatments?

• If cancer is suspected the testicle will almost always have to be surgically removed for a detailed biopsy (diagnostic test). Unfortunately it isn't possible to do a biopsy on a testicular tumour without removing the testicle. However, it is sometimes possible to perform a biopsy during the operation, and before the testicle has been removed. The testicle is opened up and a small piece of tissue is sent away immediately to be looked at by a pathologist. If cancer is found then the testicle is removed as planned. The difficulty is that sometimes the tumour may not be found on the sample removed, although it is present in the testicle. Normally it will be reasonably certain before surgery that the testicle contains a tumour, and most surgeons will therefore remove the testicle without taking a further biopsy during the operation.
• If your cancer has been caught early, and hasn't spread to other parts of the body, removal may be the only treatment required. The type of testicle cancer known as a seminoma may sometimes also be treated by a short course of radiotherapy, to which this tumour is particularly sensitive. Other treatment centres prefer a policy of surveillance (keeping a close eye on things) only.
• If the cancer has spread, however, further treatment will usually be required. The usual first site of spread for these tumours is to the lymphatic glands (lymph nodes) in the back of the abdomen. If follow-up X-rays suggest that the disease may have spread to involve these lymph glands then surgery to remove them may be necessary to get a better picture of the stage the disease has reached. Further treatment with a course of chemotherapy or radiotherapy may also be necessary.
• Because the treatment can sometimes affect fertility, you may be offered the opportunity to store a supply of sperm first.
• If you have a testicle removed you may be given the option of having an artificial replacement fitted, to make your scrotum look normal. However, many men don't bother with this. The artificial testicle has no function and there have been concerns with some of the artificial testicles made of silicone (because the silicone may leak from the testicle into the rest of the body).

How can I help myself?

• Inform yourself about your condition and its treatment. Talk to your doctor; contact cancer organisations; read material on the Internet (although with care — not all of it is accurate).
• Accept that it's inevitable that you'll feel anxious and scared. However, it's also important to remember that testicular cancer is one of the easiest cancers to treat successfully.
• Consider ways in which you can reduce your stress, such as counselling, meditation, yoga and relaxation exercises.
• If it feels right, join a cancer support group. Your hospital or a cancer organisation can give you details of groups that might be suitable for you. 

What's the outlook?

Generally very good indeed. If diagnosed early, 96% of patients can be cured completely. Even when the cancer has spread, up to 80% of men can still be cured. 

• Read Ryan's story: 'Have the balls to ask for help.'