Testicular cancer is one of the least common cancers in males, but unlike others it is more prevalent among young men. Pain in the testicles is not always present, so it's vital to check them regularly, and be aware of the other symptoms that raise a red flag.
To put your mind at ease, we look at the causes, treatment and symptoms of testicular cancer:
What is testicular cancer?
Testicular cancer is cancer that develops in the testicles, which are part of a man's reproductive system. Testicular cancer represents only one per cent of all cancers in men. Unlike most cancers which are more common in older people, testicular cancer usually occurs in younger men, typically between the ages of 15 and 60 (with a peak around the early 30s).
Unfortunately, the number of UK cases has nearly trebled in the past 35 years and is still rising. Thanks to improvements in treatments in recent years, survival rates are now very high and more than 97 per cent of men will still be alive 5 years after the diagnosis.
What are the symptoms of testicular cancer?
It's important to examine your testicles regularly. If there's anything unusual about them, consult your GP. Signs of testicular cancer to watch out for include:
✔️ A lump in one testicle
✔️ Pain and tenderness in either testicle
✔️ Discharge or pus from the penis
✔️ Blood in the sperm at ejaculation
✔️ A build-up of fluid inside the scrotum
✔️ A heavy or dragging feeling in the groin or scrotum
✔️ An increase in size of a testicle (one testicle is normally larger than the other but the size and shape should remain more or less the same)
✔️An enlargement of the breasts with or without tenderness
What causes testicular cancer?
The causes of testicular cancer and reasons for the recent increase in frequency in some countries are unknown. As testicular cancer is uncommon before puberty it's likely that hormones influence growth of the tumour even if they aren't the initial cause.
Exposure to female hormones in the environment, in water (possibly from the oral contraceptive pill in water supplies) has been suggested as a cause for increases in the cancer in recent years.
Undescended testicles (in which one or both testicles stay inside the body after birth and never sit in the scrotum) are a major risk factor. If a man has one or both testicles undescended, their risk of cancer is increased up to five-fold.
Your risk increases up to 4 times if your father suffered from testicular cancer, and up to 9 times if your brother did, indicating an inherited or genetic influence. There is no link between injury to the testicles, or groin strains, and testicular cancer.
Outlook for testicular cancer
Testicular cancer can be cured in more than 96 per cent of cases if caught at an early stage. Late diagnosis increases the risk of a poorer response to treatment. More than 97 per cent of men with testicular cancer now survive more than 5 years and more than 96 per cent will survive at least 10 years (which effectively means they area cured).
If the cancer has spread, the prognosis depends on which type of tumour it is and how far it has spread but results are still generally quite good.
Five-year survival for a man with a seminoma that has spread to the lymph nodes or lungs is 86 per cent for example, while it is still as high as 72 per cent if spread includes the brain or liver. Similarly, a non-seminoma which has spread only locally has a 92 per cent five-year survival.
Testicular cancer treatment
Treatments include surgery, chemotherapy and radiotherapy which may be given alone or in combination, depending on the situation. In most cases the man has initial surgery to remove the affected testicle (an operation known as orchidectomy) in order to make the diagnosis.
Although the affected testicle is removed, an artificial testicle (prosthesis) can be inserted to disguise the fact almost completely. Chemotherapy (anticancer drugs) may be given to reduce the chance of an early stage cancer returning.
If the seminoma has spread further, then either radiotherapy or radiotherapy chemotherapy (anticancer drugs) is used. With teratomas, provided there is no evidence of spread on examination and scans, and blood tests show none of the protein markers produced by the cancer cells, then a closely observed 'wait and see' policy (also known as surveillance) can be taken following tumour removal.
If there is any sign of recurrence of a testicular cancer then chemotherapy may be started. The treatment of germ cell tumours has been one of the great successes of modern chemotherapy. Usually three or four courses are given, at three-weekly intervals, of bleomycin, etoposide and cisplatin (BEP).
Where there are remaining tumours following chemotherapy (for example within the lymph nodes – the commonest site for the tumour to spread first) these are removed surgically.
Based on a text by Dr Ian Banks, GP and men's health expert