About the Condition
Cancer of the testicles, also known as testicular cancer, is one of the less common cancers. It usually affects younger men between the ages of 15 and 49*. Testicular cancer is relatively uncommon, accounting for just 1% of all cancers that occur in men. Each year in the UK around 2,300 men are diagnosed with testicular cancer. Testicular cancer occurs when the genetic material of cells in the testicles become damaged or changed, producing mutations that affect normal cell growth and division. The abnormal cells then replicate, causing cancer. If undetected, the cancer can spread beyond the testicles and move to other parts of the body.
Rates of testicular cancer are five times higher in white men than in black men. The reasons for this are unclear. The number of cases of testicular cancer that are diagnosed each year in the UK has roughly doubled since the mid-1970s. Again, the reasons for this are unclear.
The causes of testicular cancer are not fully understood, but a variety of risk factors are apparent. These include:
- Undescended testicles – when male babies grow in the womb, their testicles develop inside their abdomen. The testicles then normally move down into the scrotum when the baby is born or during their first year of life. However, for some children, the testicles fail to descend. Surgery is usually required to move the testicles down, and following this surgery the patient may have an increased risk of developing testicular cancer
- Previous testicular cancer – Men who have previously been diagnosed with testicular cancer are 12 times more likely to develop testicular cancer in the other testicle*.
- Age – Unlike most other types of cancer, testicular cancer is more common in young and middle-aged men with an average of 85% of cases diagnosed in men aged 15-49. Men aged 30-34 are most likely to be diagnosed with testicular cancer*.
- Race – testicular cancer is more common in white men than other ethnic groups. It is also more common in Northern and Western Europe compared with other parts of the world.
- Family history – Having a close relative with a history of testicular cancer increases your risk of developing it. The son of a testicular cancer patient is four-to-six times more likely to develop the condition, while the brother of a testicular cancer patient is eight-to-ten times more likely. Having an identical twin with testicular cancer elevates the risk 75 times*.
- Exposure to certain chemicals which include:
- some types of pesticide
- polychlorinated biphenyls (PCBs), chemical compounds used as a coolant
- dibutyl phthalate, a chemical used to manufacture cosmetics, such as nail polish
In most countries including the UK, many of these chemicals have been withdrawn as a result of their link to health problems.
- Infertility – Men who are infertile are three times more likely to develop testicular cancer than fertile men*.
- Smoking – Research has found that long-term smokers (people who have been smoking a pack of 20 cigarettes a day for 12 years or 10 cigarettes a day for 24 years) are twice as likely to develop testicular cancer than non-smokers*.
- HIV and AIDS – Studies show that men with HIV or AIDS have an increased risk of testicular cancer.
- Height – A study that was carried out in 2008 found that a man’s height affects his chances of developing testicular cancer. Men who are 190-194cm (6.1-6.3ft) tall are twice as likely to develop testicular cancer than men of average height. Very tall men, who are 195cm (6.4 ft) or above, are three times more likely to develop testicular cancer than men of average height. Being shorter, less than 170cm (5.6ft) tall, decreases your risk of getting testicular cancer by around 20%*.
The most common symptom of testicular cancer is a lump or swelling in one of the testicles. The lump or swelling can be about the size of a pea, but may be larger. Most testicular lumps or swellings are not a sign of cancer, but they should never be ignored.
Testicular cancer can also cause other symptoms, including:
- a dull ache or sharp pain in the testicles or scrotum, which may come and go
- a feeling of heaviness in the scrotum
- a sudden collection of fluid in the scrotum (hydrocele)
- a general feeling of being unwell
If testicular cancer has spread to other parts of your body, you may also experience other symptoms. Cancer that has spread to other parts of the body is known as metastatic cancer.
Around 5% of people with testicular cancer will experience symptoms of metastatic cancer*.
The most common place for testicular cancer to spread is to nearby lymph nodes in your abdomen or lungs. Lymph nodes are glands that make up your immune system. Less commonly, the cancer can spread to your liver, brain or bones.
Symptoms of metastatic testicular cancer can include:
- a persistent cough
- coughing or spitting up blood
- shortness of breath
- swelling and enlargement of male breasts
- a lump or swelling in your neck
- lower back pain
Some men find it embarrassing to talk about these sorts of symptoms, but if any of the above apply to you, or if you have any concerns about similar symptoms, it is essential that you see your doctor at once, as your chances of recovery are much higher if your cancer is diagnosed early. Most testicular lumps are not cancerous, but it is important you have any abnormality checked as treatment for testicular cancer is much more effective when started earlier.
If you’re referred to CCL for diagnosis, your consultant or oncologist will advise you on which tests are relevant to your individual symptoms. It is important that patients receive a swift and accurate diagnosis, so that treatment can begin as soon as possible for the best chance of a full recovery. Diagnostic tests for testicular cancer include:
- A physical examination, where the doctor may hold a small light or torch against the lump in your testicle to see whether light passes through it. Cancerous lumps tend to be solid, which means light is unable to pass through.
- An Ultrasound scan, which uses high frequency sound waves to look inside the body and produce live images on a computer display.
- A blood test, to detect certain hormones that sometimes indicate testicular cancer
- A biopsy, where a cell sample is taken to be examined for signs of cancer. For most cases the only way to safely take a biopsy is to remove the affected testicle completely. This is because specialists often think the risk of the cancer spreading is too high for a conventional biopsy to be taken.
- An X-ray, which is when low level radiation is used to create an image of the body
- A Magnetic Resonance Imaging (MRI) scan, which is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body
- A Computerised Tomography (CT) scan, which shows a 3D image of the area being looked at
Stages of testicular cancer
Once these tests have been completed, it is usually possible to determine the stage of the cancer, which helps to inform the treatment plan. Testicular cancer is staged as follows:
- Stage 1 – the cancer is contained inside your testicles
- Stage 2 – the cancer has spread from the testicles into the lymph nodes in your abdomen and pelvis
- Stage 3 – the cancer has spread into the lymph nodes in your upper chest
- Stage 4 – the cancer has spread into another organ, such as your lungs
At CCL, patients with testicular cancer are treated by a team of different specialists, called a Multi-Disciplinary Team, or MDT. This team works together to create a treatment plan to suit the individual needs of the patient.
Treatment options include:
- Surgery to remove the affected testicle, which is call orchidectomy, and potentially subsequent surgery to remove any affected lymph nodes, depending on the stage of the cancer
- Radiotherapy, which is where high-energy rays are used to destroy the cancer cells.
- Chemotherapy, which involves the use of chemical agents which are toxic to cancer cells, destroying them and preventing them from spreading to different areas. This can be given by injection or in tablet form.
Even if your testicular cancer has been completely cured, there is a risk that it will return. Around 25-30% of men experience a return of testicular cancer, usually within the first two years after their treatment has finished*. Because of this risk, you will need regular tests to check if the cancer has returned. These include:
- a physical examination
- blood tests to check tumour markers
- chest X-ray
- computerised tomography (CT) scan
Follow-up and testing is usually recommended depending on the extent of the cancer and the treatment offered. This is usually more frequent in the first year or two but follow-up appointments may last for up to five years. If the cancer does return and is diagnosed at an early stage, it will usually be possible to cure it using chemotherapy and possibly also radiotherapy. Some types of recurring testicular cancer have a cure rate of over 95%*.
Cancer doesn’t just leave a physical impact on an individual, it can have a huge emotional effect as well. Cancer and its treatment can be overwhelming, causing a wide variety of emotions, and it is important to remember that there is no right or wrong response. Reactions vary hugely from person to person, and most people find that it becomes easier to cope when they’re given additional support, so that’s what we do.
At CCL we provide support that caters to both the physical and emotional needs of the patient, before, during and after treatment. We offer a wide range of services for patients, as well as their loved ones, designed to make a very difficult time as easy as possible, and to give our patients the best treatment and support possible.
Treatment for testicular cancer usually leads to the removal of one or both testicles. We understand that this can be very distressing and potentially frustrating, so at CCL we have specialist therapists on hand to help you cope with the changes you might experience after treatment.
Testicular Cancer Consultants