Testicular Cancer

Testicular cancer forms when malignant (cancerous) cells develop in one or both of your testicles. Your testicles are two walnut-shaped sex glands that make sperm and testosterone. They sit inside your scrotum, a sac of skin that lies below your penis.

This condition is rare overall, but it’s still the most common cancer in males aged 15 to 44 years old. Usually, the first sign is a lump or hard mass in one testicle. 

Like any cancer, it’s a serious condition that requires immediate treatment. Most people need surgery to remove the affected testicle. Depending on your case, you may also need treatments like chemotherapy and radiation therapy. Fortunately, testicular cancer is often curable with treatment.

Types of testicular cancer

Nearly all testicular cancers (95%) are germ cell tumors. Germ cells are sex cells that eventually become sperm. But with cancer, they turn cancerous before this happens. The main types are:

• Seminomas: This slow-growing type primarily affects males in their 40s and 50s.
• Nonseminomas: This type grows more rapidly than seminomas. It mainly affects males in their late teens, 20s and early 30s. There are four subtypes of nonseminoma tumors: embryonal carcinoma, yolk sac carcinoma, choriocarcinoma and teratoma.

The tumor type can affect your treatment and your prognosis (outlook).

Symptoms of testicular cancer

The most common sign of testicular cancer is a painless lump in your testicle. It may feel like a hard mass. You may notice any of the following changes in your testicle:

• Heaviness or pressure
• Swelling
• Dull ache
• A sharp, stabbing pain (rare)

Disease that’s spread beyond your testicle can cause:

• Back pain
• Flank pain
• Belly pain
• Chest pain
• Cough or shortness of breath
• Unexplained weight loss

Testicular cancer causes

Testicular cancer forms when cells multiply faster than usual, eventually becoming a lump or tumor. Researchers aren’t sure what causes the change. But they’ve found several factors that increase the risk of this disease, like:

• Being white and of European descent (but the incidence in Hispanic males in particular is on the rise)
• Having a father, brother or son who’s had testicular cancer
• Having a prior history of testicular cancer
• Having conditions like undescended testicles or Klinefelter syndrome
• Having low fertility or infertility

How doctors diagnose this condition

Your healthcare provider will check for lumps or swelling in your testicle. They may check to see if the lymph nodes in your groin are swollen.

Tests needed to diagnose testicular cancer include an:

• Ultrasound: An ultrasound of your scrotum can show if there’s a tumor inside your testicles. Often, providers can tell if it’s cancer or not based on the ultrasound.
• Inguinal orchiectomy and biopsy: If the ultrasound reveals a tumor, your provider will remove the affected testicle through an incision (cut) in your groin. A specialist will test the tissue for cancer cells. Removing the testicle is also the main treatment.

You’ll need tests to see how advanced the condition is or if it’s spread. You’ll need:

• A tumor marker test: This blood test checks for biomarkers, or substances in your blood linked to testicular cancer. Biomarkers include elevated levels of a-fetoprotein (AFP), b-hCG and lactate dehydrogenase (LDH). 
• CT scans and MRIs: These imaging tests can show if cancer has spread to places outside your testicle, like your lymph nodes.

Testicular cancer stages

Diagnosis also involves cancer staging. Staging lets providers know how advanced the cancer is. This helps them choose treatments. The stages of testicular cancer are:

• Stage I: The tumor is only in your testicle. Most diagnoses happen at this stage.
• Stage II: Cancer cells have spread to the lymph nodes in the back of your abdomen (belly). These are called your retroperitoneal lymph nodes.
• Stage III: The disease has spread to lymph nodes beyond your abdomen or to an organ. It most often spreads to your lungs and liver.

What are the treatments for testicular cancer?

Treatment depends on several factors, including your health, cancer stage and tumor type. Doctors who treat testicular cancer include urologists, oncologists and radiologists.

Surgery

Surgery to remove the affected testicle is the most common treatment. Before surgery, your healthcare provider will likely discuss sperm banking options with you. You can still conceive a child with one testicle. But it may be more challenging depending on the type of surgery. Your provider will advise you based on your situation. 

Procedures include:

• Radical inguinal orchiectomy: Your healthcare provider likely removed your testicle so they could biopsy it during your diagnosis. This is also the main treatment. They’ll close off blood vessels and lymph tissue from the tumor site to prevent cancer from spreading.
• Retroperitoneal lymph node dissection (RPLND): This surgery removes these lymph nodes. It’s more common with nonseminoma testicular cancers. 

You’ll have the option of getting a prosthesis to replace the removed testicle. This helps some people feel more comfortable with the changes in their body after surgery.

Radiation therapy

Radiation therapy uses a machine that delivers high-dose X-rays to kill cancer cells. You may need it after surgery to prevent the tumor from returning. Usually, radiation is limited to the treatment of seminomas. It’s less effective with nonseminomas.

Chemotherapy

Chemotherapy uses drugs that travel in your bloodstream to kill cancer cells throughout your body. You may need it after surgery to reduce the risk of cancer returning. Providers also use chemotherapy to treat cancer that’s spread or come back after remission. Remission means there are no signs or symptoms of cancer.

When should I see my healthcare provider?

You’ll visit your provider regularly so they can see how treatment is working. You may need imaging scans or blood tests to check your tumor markers. Both can show how chemotherapy is working. They can also show signs that the cancer has come back. If it does, you can get treatment right away.

Most testicular cancers don’t return. But those that do usually come back within the first two or three years after treatment. This is likely when you’ll see your provider most often.

What is the prognosis (chance of recovery) for people with testicular cancer?

The outlook for testicular cancer is excellent. It’s usually curable. The five-year survival rate is 95%. This means that nearly everyone treated for testicular cancer is alive five years later. The rates are high, regardless of stage:

• Stage I: 99%
• Stage II: 92%
• Stage III: 85%

Testicular cancer can be fatal, but this is rare. Still, early detection makes a big difference in your prognosis. The earlier you see a provider and receive a diagnosis, the greater your chances of being cancer-free.

What is the life expectancy for someone with testicular cancer?

Most people are cured and go on to live for several decades. One study that tracked survival among males diagnosed with testicular cancer at 30 showed that with treatment, they lived about 1.3 years fewer than those without testicular cancer. 

In other words, most testicular cancer survivors have a life expectancy that’s close to what’s typical.

How can I prevent testicular cancer?

Testicular cancer isn’t preventable, but you can perform a monthly testicular self-exam (TSE) to help identify changes in your testicles. Tell your healthcare provider about lumps, hardness or a testicle that’s become bigger. These changes don’t always mean cancer. But if they do, the sooner you’re treated, the sooner you can get on with your life.