Testicular Cancer

This article provides an overview of cancer of the testicle and its impact on men’s health.  Fortunately, testicular cancer is relatively rare and affects about 1 in 20,000 mean each year.  The disease is a bit more common in Caucasian men and occurs most commonly between the ages of 15-35 years.  Overall, cancer of the testicle is about 1% of cancer in men.

The testicle performs several key functions to help maintain a normal man’s health.  A healthy testicle produces sperm and also produces male hormones in the androgen family the most common one being testosterone.  During development as a fetus, both male and females have common organs that under the influence of key chemical messengers direct the formation of the testicles.  The health and function of the testicle is closely regulated by the body.  The most immediately noticed form of regulation is temperature control.  The muscles in the spermatic cord, the cremasteric muscles, will contract and relax to move the testicles close to the body with cold and farther from the body with warmth.  This temperature control mechanism is thought to help regulate the proper environment for the growth and development of sperm.  The testicle actually forms in an area in the abdomen and descend through a pathway that connects to the scrotum.  This pathway is also known as the inguinal canal.  Abnormal descent of the testicle might occur during development.  A testicle that does not descend properly in the scrotum, or descends partially / half-way, is known as cryptochordism.

There are several known risk factors for testicular cancer.  Unfortunately, almost all of them are non-modifiable.  Established risk factors for testicular cancer include:

  • Undescended testicle: This applies if you had an undescended testicle (i.e. cryptochordism) at birth and it is now fully descended, it is partially descended or never descended properly.
  • Family members with testicular cancer: This is a risk factor, particularly if it is a “first-degree” relative such as father, son or brother.
  • Infertility: Any history of difficulty conceiving is a known risk factor for testicular cancer.
  • Cigarette smoking: As should be no surprise, tobacco use of any form carries with it multiple significant health risks that impacts every part of the body.
  • Caucasian ancestry: Hereditary factors are an example of a non-modifiable risk factor.

There are several different kinds of testicular cancer.  The most common type is Non-seminoma (of which there are several types) germ cell tumors.  This type is about 60% of all testicular germ cell tumors.  Seminoma-type germ cell testicular tumor is about 40%.

The most common symptom is a lump noticed in the testicle or some type of asymmetry of the testicles.  Fortunately, there are many lumps and asymmetries of the testicles that are not cancer.  Non-cancer causes of lumps and asymmetry of the testicles includes:

  • Size difference: Slight asymmetry in size is normal and is analogous to common differences in female breasts.
  • Ptosis: The testicles commonly “hang” at different lengths with the right being more dependent than the left.  This is also very common in female breasts.
  • Spermatocele / Hydrocele / Varicocele: These are all examples of swelling or lumps of the testicle and scrotum that are not cancer.  Many of these can be determined by an experienced physician often with the assistance of an ultrasound examination.

Pain of the testicle is very common and is almost always NOT a sign of testicular cancer.  This is analogous to pain in the female breast which is almost NEVER a sign of breast cancer.  Pain in the testicle can occur from a number of reasons including:

  • Testicular Torsion: The testicle is normally fixed in place and receives blood and nerve supply via the spermatic cord.  When the fixation is abnormal or the cord twists on itself it can kink off the blood supply and thus the testicle has the effect of a tourniquet around its base.  This will cause severe sudden pain.  Emergency surgery is often needed to salvage the testicle.
  • Trauma: Any type of injury to the testicle can cause significant pain.
  • Hematoma: Injury or a direct blow to the testicle can cause bleeding in or around the testicle causing painful pressure in the scrotum.
  • Orchitis: Many types of infections can occur in the testicle causing pain, many of these are viruses.
  • Epididymitis: Infection of the support structures in the scrotum can also be felt in the testicle.

The key signs of disease of the testicle include lump, asymmetry, swollen lymph nodes in the groin, pain or swelling of the scrotum.  As described above, many of these are not cancer but they usually represent a disorder that should be treated.  If any of these key symptoms occur the best course of action is to discuss them with your doctor as soon as possible.

An evaluation of a lump in the testicle will include a complete examination, detailed history of you and your family, and an ultrasound of the scrotum.  Based upon these findings further testing to confirm cancer of the testicle might include blood work for tumor markers (such as Beta-HCG, AFP and LDH), and a CAT scan of the chest, abdomen and pelvis.  The purpose of these additional x-rays is to help determine if a cancer has spread to other areas of the body because this changes the treatment strategy.  In general, biopsy or needle sampling is not done of testicular tumors.  The “sample” and diagnosis is obtained at the same time by removing the testicle permanently via surgery.

REFERENCES:

  1. Townsend Jr, CM; Beauchamp RD; Evers BM; Mattox KL. (2008) Townsend: Sabiston Textbook of Surgery, 18thed.  Chapter 77.  New York, NY: Saunders.
  2. www.cancer.gov/cancertopics/types/testicular
  3. seer.cancer.gov/statfacts/html/testis.html
  4. Wein, AJ: (2007) Wein: Campbell-Walsh Urology, 9th ed.  Chapter 31. Philadelphia, PA: Saunders Elsevier
  5. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.