Testicles (testis) , scrotum and surrounding area.
What is testicular cancer?
Testicular
cancer forms when malignant (cancer) cells develop in the tissues of
one or (less commonly) both testicles. Your testicles are two
walnut-shaped sex glands that produce sperm and the hormone testosterone. They sit inside a sac of skin that lies below your penis called the scrotum.
Like any cancer, testicle cancer is a serious condition. Fortunately, testicular cancer is highly treatable and curable.
What are the types of testicular cancer?
About
90% of all testicular cancer arises from germ cells in your testicles
that clump together to form a mass or tumor. Germ cells eventually
develop into sperm. Two types of testicular cancer arise from germ
cells.
Seminoma: Slow-growing cancer that primarily affects people in their 40s or 50s.
Non-seminoma:
Cancer that grows more rapidly than seminomas. It mainly affects people
in their late teens, 20s and early 30s. There are four types of
non-seminoma tumors. Each is named after the type of germ cell that
makes up the tumor. Non-seminoma tumors include embryonal carcinoma,
yolk sac carcinoma, choriocarcinoma and teratoma.
Some testicular cancer tumors consist of both seminoma and non-seminoma cells.
How common is testicular cancer?
Testicular
cancer is rare, affecting only about 1 in 250 people with testicles in
their lifetimes. Still, it’s the most common cancer among people
assigned male at birth aged 15 to 35.
Symptoms and Causes
What are the signs and symptoms of testicular cancer?
The most common sign of testicular cancer is a painless lump in your testicle. Other symptoms include:
Swelling or sudden fluid build-up in your scrotum.
A lump or swelling in either testicle.
A feeling of heaviness in your scrotum.
Dull ache in your groin or lower abdomen.
Pain or discomfort in your scrotum or a testicle.
A shrinking testicle (testicular atrophy).
These
symptoms can occur with other conditions, too, so don’t panic if you
notice them. Still, schedule a visit with your provider to be sure.
Delays in diagnosis allow cancer cells time to spread, making the
disease harder to treat.
What causes testicular cancer?
Testicular
cancer develops when cells multiply faster than usual, eventually
forming a lump or tumor. Researchers aren’t sure what causes cells to
behave this way. They do know that the cells that become testicular
cancer are usually germ cells.
What are the risk factors for developing testicular cancer?
Several
factors may increase your testicular cancer risk. Risk factors don’t
cause testicular cancer, but they may increase its likelihood of
developing.
Risk factors for testicular cancer include:
Age: Testicular cancer most commonly affects people between ages 15 and 35.
Undescended testicles:
Testicles form in the abdomen of a fetus during pregnancy and usually
drop into the scrotum before birth. Testicles that don’t drop are called
undescended testicles and may require surgery. Being born with this condition may increase your testicular cancer risk even if you have surgery.
Race and ethnicity: Testicular cancer is more common among non-Hispanic whites in the United States and Europe.
Personal or family history: You
may be more likely to develop testicular cancer if a biological parent
or sibling had it. Certain inherited genetic conditions, like Klinefelter Syndrome,
may also increase your risk. Having testicular cancer in one testicle
increases your likelihood of developing a second cancer in the other
testicle.
Infertility: Some
of the same factors that cause infertility may also be related to the
development of testicular cancer. More research is needed to understand
the connection.
Diagnosis and Tests
How is testicular cancer diagnosed?
Your
provider may diagnose testicular cancer after investigating a lump or
other change in your testicle you found during a self-exam. Sometimes
testicular cancer gets diagnosed during a routine physical exam.
Common procedures and tests to help diagnose testicular cancer include:
A physical exam and history:
Your provider will ask about your symptoms and examine you closely to
check for signs of testicular cancer. They may feel your testicles for
lumps and inspect your lymph nodes for signs of cancer spread.
Ultrasound: If your provider notices an abnormality during the exam, they’ll likely order an ultrasound. An ultrasound is a painless medical procedure that uses high-energy sound waves to create pictures of tissue inside your body.
Inguinal orchiectomy and biopsy: If
the ultrasound shows evidence of cancer, your provider will remove the
affected testicle through an incision (cut) in your groin. A specialist
will examine tissue from your testicle using a microscope to check for
cancer cells.
Other tests may include:
A serum tumor marker test:
This procedure examines a blood sample to measure the amounts of
certain substances linked to specific types of cancers. These substances
are called tumor markers. The tumor markers that are often elevated in
testicular cancer are alpha-fetoprotein (AFP), human chorionic
gonadotropin (HCG or beta-HCG) and lactate dehydrogenase (LDH).
Different types of tumors elevate different markers. For example,
seminomas sometimes raise HCG but not AFP. Non-seminomas may raise AFP
but not HCG. Elevated LDH levels may indicate cancer spread.
CT scans, X-rays and MRIs: A CT scan
(or CAT scan) uses X-rays to form pictures of the inside of your body.
Your provider may perform a CT scan of your abdomen and pelvis to see if
your cancer’s spread to your abdominal organs. They may order a CT scan
or standard X-ray
to see if cancer’s spread to your lungs. If your provider suspects
cancer has spread to your central nervous system (brain and spinal
cord), you may get an MRI. An MRI uses magnets and radio waves to form pictures of the inside of your body.
What are the stages of testicular cancer?
Diagnosis also involves cancer staging.
Staging provides important information that will guide treatment
decisions, such as tumor size and whether the cancer’s spread.
Stage 0: Abnormal
cells have developed but are still inside the testicles where sperm
cells start to develop. Stage 0 is also called germ cell neoplasia in
situ (GCNIS).
Stage I: Cancer is confined to the testicle, which may include nearby blood or lymph vessels. Tumor markers may or may not be elevated.
Stage II:
Cancer has spread to the lymph nodes in the back of your abdomen (also
called the retroperitoneum) but not anywhere else. If you have cancer in
your lymph nodes along with moderately or highly elevated tumor
markers, then you’re in stage III rather than stage II.
Stage III: Cancer has spread to lymph nodes beyond your abdomen or to an organ.
Management and Treatment
What are the treatments for testicular cancer?
Treatment
depends on several factors, including your health, treatment
preferences, cancer stage, and tumor type. Seminomas tend to grow more
slowly and respond better to radiation therapy than non-seminomas. Both
kinds of testicular cancer tumors respond well to chemotherapy
treatments.
If testicular cancer involves both seminoma and non-seminoma tumors, your provider will treat it as a non-seminoma.
Surgery
Surgery
to remove the cancerous testicle is the most common treatment for
testicular cancer, regardless of cancer stage or tumor type. In some
cases, your provider may also remove your lymph nodes.
Radical inguinal orchiectomy: Your provider may perform orchiectomy
(removing the testicle) to treat both seminoma and non-seminoma
testicular cancers. During the procedure, your provider will make an
incision into your groin to remove the testicle with the tumor. They’ll
also close off blood vessels and lymphatic tissue to prevent the spread
of cancer from the tumor site to the rest of your body.
Retroperitoneal lymph node dissection (RPLND): Your provider may perform retroperitoneal lymph node dissection depending
on your cancer’s stage and the tumor type. RPLND is more common with
non-seminoma testicular cancers. During the procedure, your provider
makes an incision into your abdomen and removes the lymph nodes behind
your abdominal organs. RPLND may be used to treat cancer and may also be
used for cancer staging.
Your provider may also perform surgery to remove tumors that have spread to your lungs or liver.
Radiation therapy
Radiation therapy uses
high-dose X-rays to kill cancer cells. Radiation might be used after
surgery to prevent the tumor from returning. Usually, radiation is
limited to the treatment of seminomas.
Chemotherapy
Chemotherapy uses
drugs such as cisplatin, bleomycin, and etoposide to kill cancer cells.
Chemotherapy has improved the survival rate for people with both
seminomas and non-seminomas. Depending on your cancer, you may receive
chemotherapy instead of surgery. It may be used before an RPLND
procedure or after a radical inguinal orchiectomy. Chemotherapy may also
be used to treat cancer that’s returned (recurred) following remission.
Prevention
How can I prevent testicular cancer?
Testicular
cancer isn’t preventable, but you can perform testicular self-exams
(TSE) to identify changes in your testicles that you should bring to
your provider’s attention. Your provider should know about lumps,
nodules, hardness or a testicle that’s become bigger or smaller.
Many providers recommend performing a testicular self-exam monthly.
How do I perform a testicular self-exam to protect myself from testicular cancer?
You can complete a TSE in as little as two minutes. Many providers recommend performing a testicular self-exam monthly.
To do a self-exam, follow these steps.
Do the exam after a warm shower or bath. The warmth relaxes the skin of your scrotum, making it easier to feel anything unusual.
Use both hands to examine each testicle.
Place your index and middle fingers underneath the testicle with your
thumbs on top. Roll each testicle between your thumbs and fingers.
Familiarize yourself with what’s normal.
As you feel each testicle, you might notice a cord-like structure on
top and in the back. This structure is called the epididymis. It stores
and transports sperm. Don’t confuse it with a lump. It’s also normal for
testicles to be slightly different sizes. Although the left and right
testicles are often different sizes, each testicle should remain
generally the same size.
Feel for any lumps. Lumps can be pea-size or larger and are often painless. If you notice a lump, contact your healthcare provider.
If you notice a change in the size of your testicles or feel a lump, contact your healthcare provider.
What is the prognosis (chance of recovery) for people with testicular cancer?
The
prognosis for testicular cancer is excellent. This form of cancer is
treated successfully in more than 95% of cases. Even people with
unfavorable risk factors have, on average, a 50% chance of being cured.
Can testicular cancer be cured?
Testicular
cancer is curable. While a cancer diagnosis is always serious, the good
news about testicular cancer is that it is treated successfully in 95%
of cases. If treated early, the cure rate rises to 98%.
Is testicular cancer fatal?
Testicular
cancer can be fatal, but this is rare. Still, early detection makes a
big difference in your prognosis. The earlier you see your provider and
receive a diagnosis, the greater your chances of being cancer-free.
Living With
How do I take care of myself?
Many
people wonder how having a testicle removed will impact their sex drive
and fertility. One testicle is usually all you need to make enough
testosterone to keep your hormone levels healthy and maintain your sex
drive. You should still be able to get an erection and ejaculate.
In some instances, people with lymph nodes removed can get an erection but may have difficulty ejaculating.
Talk to your provider about any risks related to treatment. If you’re concerned about your fertility, sperm banking, or freezing your sperm for later, use may be an option.
A note from Cleveland Clinic
Don’t
delay scheduling a provider visit if you notice a change in one or both
testicles. Most people would rather avoid or postpone exams that
involve close inspection of their genitals. When it comes to cancer,
though, timing is essential. Depending on your cancer type, early
treatment can cure testicular cancer.