Cancer Care
Testicular Cancer
Self-examination plays an important part in the early detection of testicular cancer. It is treated successfully in the majority of cases.
Testicular cancer develops in the testicles (testes), the male reproductive glands, and typically affects males between the ages of 15-35. The testicles are located in the scrotum and are suspended from the body by the spermatic cord. They produce sperm (male reproductive cells) and testosterone. Testicular cancer has a very high rate of cure when caught early. Even in more advanced stages, there is typically a high rate of cure, however multiple types of treatment may be necessary. The exact cause of testicular cancer is not known at this time, but ongoing research is examining links between known risk factors and possible causes.
In order to provide high quality care and excellent patient outcomes, Urology of Indiana’s team of urologic surgeons and advanced practice providers reference national guidelines to inform current and best practices in the diagnosis and treatment of testicular cancer.
Risk Factors
Testicular cancer risk factors include:
- Undescended testicles
- More common among white males
- Family history of testicular cancer
- Infertility
Symptoms
The most common symptom of testicular cancer is a firm lump. Other symptoms can include:
- Irregularity or swelling in one testicle
- A pulling sensation or feeling of unusual heaviness in the scrotum
- A dull ache in the groin or lower abdomen
- Pain or discomfort (which may come and go) in the testicle or scrotum
- Tenderness or enlargement of tissue in the breast area
- Sudden collection of fluid in the scrotum (called a hydrocele)
Most lumps in the scrotum are NOT testicular cancer; however, anyone who notices one or more of the symptoms above should see their doctor for advice. Patients with a history of undescended testicle are at higher risk for cancer.
Testicular self-examination is an important part of early detection. To help detect cancer in its early stages, you should be aware of how your testicles feel normally, so that you are able to notice any new irregularities, enlargements or areas of firmness.
A good time to feel the testicles is in the shower or bath, when the scrotal skin is relaxed. Feel each testicle by rolling it between thumb and forefinger. You may notice that one testicle is slightly larger than the other, which is normal. It is normal to feel the epididymis – a small, firm, tube-like structure at the back of the testicle. This stores and transports the sperm.
Cysts and fluid collections around the testicle are non-cancerous. In addition, dilation of some of the veins in the scrotum or cord leading to the testicle can seem like a mass. If there are any abnormalities that you can feel, a physician visit is required so that they can examine you. In most cases, the physician can tell from the exam and/or an ultrasound whether a lump is due to cancer or to other causes.
Other tests may be carried out to see if the cancer has spread, and if so, how far. These may include:
- Additional scans such as ultrasound or CT scans
- Chest X-ray
- Blood tests
Staging
Assessing how far the cancer has spread is called “staging”.
- Stage I: cancer in the testicle only
- Stage II: cancer has spread to the lymph nodes nearby
- Stage III: cancer cells in the abdomen or above the collarbone
- Stage IV: cancer has spread to other parts of the body, often the lung
Surgical Treatment
Surgical removal of the affected testis (orchiectomy) is the normal treatment for testicular cancer. If it has spread to the lymph nodes in the abdomen (also known as lymph glands), these may be removed as well. The removal of one testicle does not affect a man’s sex life, his ability to have erections or father children. An artificial testicle (called an implant or prosthesis) can be inserted into the scrotum to give a normal appearance if desired.
The earlier the stage at which your cancer is diagnosed, the better your chances for recovery. Stage I and II testicular cancer have a high cure rate.
Non-Surgical Treatment
Several other types of treatments are commonly used for testicular cancer depending on the stage of the cancer and specific cell type. Treatments in addition to orchiectomy are known as adjuvant treatments.
Chemotherapy
Drugs are often given together with surgery, particularly if the cancer has spread beyond the testicles. Chemotherapy drugs may be taken by mouth or injection.
Radiotherapy
This may also be used, but unlike chemotherapy, radiation is focused to treat just the area of the cancer. Radiotherapy is a particularly effective treatment for a specific type of testicular cancer called seminomas.
Chemotherapy and Radiotherapy may cause some short-term side effects such as nausea, vomiting and temporary hair loss, but these will get better after treatment has finished. Chemotherapy and radiotherapy can temporarily interfere with sperm production and, therefore, fertility. As a precaution, many men store their sperm in a sperm bank before treatment.