Testicular cancer: diagnosis and treatment

Testicular cancer occurs when the cells in your testicles grow abnormally. Your testicles sit inside your scrotum (the sack of skin under your penis) and are part of the male reproductive system. 

Testicular cancer is rare and accounts for 1% of all cancers in men. It usually affects males aged 15 to 44 and is one of the most treatable cancers in men.

What are the risk factors for testicular cancer?

The exact cause of testicular cancer is unknown but a number of risk factors have been identified.

Undescended testicles

This is the most common risk factor for testicular cancer. Testicles usually descend from the abdomen before birth. However, 3-5% of baby boys are born with their testicles still inside their abdomen — the testicles usually descend during the first year of their life. Having undescended testicles can increase the chances of developing testicular cancer by three times.

Family history

If you have a close family member who has had testicular cancer, then your risk of developing it is higher — up to four times higher if your father has had it and up to eight times higher if your brother has had it.

Other risk factors

• A history of testicular cancer — if you have previously been diagnosed with testicular cancer, the chances of developing it in your other testicle is 12-18 times higher than someone who has never had it
• HIV/AIDS
• Infertility with an abnormal sperm count
• Klinefelter’s syndrome — a genetic condition where a man has an extra X chromosome

Symptoms of testicular cancer

The most common symptom of testicular cancer is painless swelling of the testicle or a lump that is the size of a pea or larger.

Other symptoms may include: 

• A feeling of heaviness in your scrotum
• Aching or sharp pain in your testicle/scrotum
• Change in the appearance of one testicle
• Change in the shape or texture of the testicle/scrotum
• Increased firmness of a testicle

See your GP if you notice any of these symptoms. It’s important to have any changes checked out in case you have testicular cancer as early detection increases your chances of making a full recovery following treatment.

How is testicular cancer diagnosed?

During your examination, your doctor may shine a light through your scrotum to check for lumps. Cancerous lumps are usually solid and won’t allow any light to pass through, while lumps containing fluid will allow light to pass through. If your doctor is concerned that you may have testicular cancer, they will refer you for further tests.

These tests may include:

Blood tests

Blood tests can detect the levels of certain proteins in your blood that may be signs of testicular cancer. These proteins include alpha-fetoprotein (AFP) and human chorionic gonadotrophin (HCG). 

Blood tests can also help determine how active a cancer is by measuring levels of an enzyme called lactate dehydrogenase (LDH).

Scrotal ultrasound scan

A scrotal ultrasound scan is a painless procedure where high-frequency sound waves are used to produce images of the inside of your testicle. The images can be used to determine whether or not a lump is full of fluid (non-cancerous) or a solid mass (cancerous). An ultrasound scan can also determine the size and position of the lump.

Histology

If blood tests and ultrasound scans haven’t produced a clear answer on whether or not you have testicular cancer but your doctor thinks you are at a high risk of having testicular cancer, they may recommend removal of your testicle. Once removed, it can be examined under a microscope to confirm the diagnosis — this is called histology.

If you are diagnosed with testicular cancer, you may then have other tests to check whether the cancer has spread. These tests may include a chest X-ray, MRI scan and/or a full-body CT scan.

Types of testicular cancer

There are two main types of testicular cancer, seminomas and non-seminomas. Both generally respond well to treatment.

• Seminomas testicular cancer — this has become more common in the past 20 years and accounts for 40-45% of all testicular cancers; it affects males of all age groups
• Non-seminomas — these account for the majority of testicular cancer cases and tends to develop in younger males; it includes several different tumour types, including choriocarcinomas, embryonal carcinomas, teratomas and yolk sac tumours

Other rare types of testicular cancer include:

• Leydig cell tumours — 1-3% of all testicular cancers
• Sertoli cell tumours — less than 1% of all testicular cancers

Treatment options

There are three main treatment options for testicular cancer; chemotherapy, radiotherapy and surgery. Your recommended treatment plan will depend on what type of testicular cancer you have, what stage the cancer is at, your general health and your personal preferences. 

Surgery

The first treatment option for all types of testicular cancer, regardless of what type you have, is surgery to remove the testicle and its attached blood vessels and tubes (orchiectomy). This is carried out under general anaesthetic and involves making a cut in your groin. If you wish, an artificial testicle can be inserted in its place for cosmetic reasons.

Radiotherapy

Radiotherapy uses high-powered beams of energy to destroy cancer cells. It’s sometimes needed after surgery for seminoma testicular cancers to reduce the chances of the cancer returning. It is also recommended if you are unable to tolerate chemotherapy and have stage 2 or stage 3 testicular cancer. 

If your testicular cancer has spread to your lymph nodes, you may need radiotherapy after having chemotherapy. 

Side effects of radiotherapy may include:

• Abdominal and groin irritation 
• Diarrhoea
• Fatigue
• Nausea
• Redness of the skin

Radiotherapy can affect your sperm count, so if you want children in the future you should speak to your doctor about freezing your sperm. Sperm banks allow you to freeze some of your sperm for later use in artificial insemination or in vitro fertilisation (IVF) to impregnate your partner or a surrogate.

Chemotherapy

Chemotherapy uses powerful drugs to kill cancer cells. It can be used to treat both seminoma and non-seminoma testicular cancer, particularly in advanced stages. Chemotherapy drugs can travel throughout your body and therefore are often used if your cancer has spread.

Chemotherapy is usually recommended following surgery to remove your testicle and other nearby tissues. It can reduce your chances of the cancer returning.

Chemotherapy drugs are injected into a vein (intravenously) usually via a central line. A central line is a catheter (thin tube) passed into a large vein, which remains there throughout the length of your treatment. This means you do not need to have a new needle inserted every time you have a round of chemotherapy or have blood taken for testing. 

The side effects of chemotherapy vary depending on the specific drugs used for your treatment. However, the most common side effects are:

• Breathlessness and fatigue 
• Gastrointestinal problems such as a sore mouth, mouth ulcers, loss of appetite, nausea and/or vomiting
• Hair loss
• Infertility 
• Skin that bruises or bleeds easily and an increased risk of infection
• Unusual sensations — tingling or numbness in your hands or feet

You should avoid fathering children for one year after completing your treatment. This is because the drugs used to treat your cancer can have an adverse effect on your sperm, which increases the risk of birth defects in any children you father. 

Although most of the side effects of chemotherapy are temporary and ease or completely disappear over time, there can be some side effects that have serious long-term effects on your health. Your doctor will discuss these with you before you begin treatment.