Testicular Cancer

Different types of testicular cancer are classified by the type of cells where the cancer begins.

The most common type is known as germ cell testicular cancer, which accounts for around 95% of all cases. Germ cells are a type of cell within the testicles that helps to create sperm.

There are two main subtypes of germ cell testicular cancer. They are:

• seminoma tumour, which account for around 40-45% of all germ cell testicular cancers
• non-seminoma tumour, which account for around 40-45% of all germ cell testicular cancers.

Seminomas and non-seminomas often respond well to chemotherapy, a drug treatment that is used to kill cancer cells.

Some rarer types of testicular cancer include leydig cell tumours (around 1-3% of cases), sertoli cell tumours (around 1% of cases) and lymphoma (around 4% of cases).

The causes of testicular cancer aren’t known, but there a number of factors can increase the risk, and these include:

• if you have a family history of testicular cancer
• if you are between 15 to 49 years of age – 85% of cases fall within this age range, and men aged 30-34 are most likely to be diagnosed
• if you’re born with undescended testicles (cryptorchidism) – about 3-5% of boys are born with their testicles inside their abdomen, which usually descend into the scrotum during the first four months of life
• if you smoke – research shows long-term smokers are twice as likely to develop testicular cancer compared to non-smokers.⁶

⁶ NHS Choices, Causes of testicular cancerhttp://www.nhs.uk/Conditions/Cancer-of-the-testicle/Pages/Causes.aspx

The most common symptom of testicular cancer is a lump felt in a testicle, but there are other symptoms of testicular cancer, which include:

• swelling in a testicle, usually painless – though sometimes the swelling may suddenly increase in size and become painful
• a dull ache or pain, or heaviness in the scrotum.

If testicular cancer is advanced and has spread to the lymph nodes or other parts of the body, some of the following symptoms may be felt:

• pain in the back, groin, or lower abdomen, possibly caused by the spread of the cancer to lymph nodes in the abdomen
• a cough, breathlessness or difficulty swallowing if lymph nodes in the chest area or the lungs are affected
• nipple tenderness or swelling (gynaecomastia) – not a common symptom, but this can be caused by hormones produced by the cancer.⁷

Testicular self-examination
Testicular cancer can be easier to treat if it’s found early. Which is why it’s important for men to check their testicles at least once a month for anything unusual like a lump or swelling.

By checking your testicles regularly, you get to know what feels normal for you. The best time to check is during or after a warm bath or shower, when the scrotum is soft and relaxed. Cup your scrotum gently in the palm of your hand, and carefully use your fingers and thumb to feel each testicle for lumps, anything unusual, or differences between your testicles.

A normal testicle should feel smooth and firm, but not hard. Remember that it’s normal for the testicles to be slightly different in size and for one testicle to hang lower than the other.

If you feel any unusual, it’s important that you get it checked out by your doctor as soon as possible.

Diagnosing testicular cancer
It’s important to know that most testicular lumps are not cancerous, but you must have the lump checked – this is because any treatment for testicular cancer is much more effective when it’s started earlier.

Physical examination
As well as asking about your symptoms, your GP will carry out a physical examination of your testicles. If your GP suspects the lump in your testicle may be cancerous, you will be referred for one or some of the following tests:

Scrotal ultrasound
A scrotal ultrasound scan is a painless procedure that uses high-frequency sound waves to see inside your testicle, and is one of the main ways your health professional call tell whether the lump is cancerous (malignant) or non-cancerous (benign).

Blood tests
To confirm any diagnosis, you might need a series of blood tests to detect certain hormones in your blood, known as 'markers'. Testicular cancer often produces these markers, so having them in your blood may be an indication you have the disease.

Biopsy
To confirm a case of testicular cancer you’re likely to require a biopsy of the tumour, so that cells can be examined in a laboratory to determine whether the tumour is cancerous.

For most cases the only way to safely take a biopsy is to remove the affected testicle completely, because specialists consider the risk of the cancer spreading to be too high for a conventional biopsy.

Other tests
If your specialist feels it necessary, you might need more tests to see if testicular cancer has spread. If cancer of the testicle spreads, it commonly affects the lymph nodes and lungs, so you may require a chest X-ray to check for signs of a tumour.

Stages of testicular cancer
After your tests, your doctor or consultant will tell you what stage your testicular cancer is at. This describes the size of your tumour and how far it’s spread, and will influence the type of testicular cancer treatment you’re offered.

There are four stages of testicular cancer:

• 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.⁸

⁷ Macmillan Cancer Support, Symptoms of testicular cancer and 
how to check http://www.macmillan.org.uk/Cancerinformation/
Cancertypes/Testes/Symptomsdiagnosis/Symptoms.aspx
8 NHS Choices, Diagnosing testicular cancer http://www.nhs.uk/Conditions/Cancer-of-the-testicle/
Pages/Diagnosis.aspx 

If you are diagnosed with testicular cancer, the treatment plan you are recommended will depend on two factors:

• whether you have a seminoma or a non-seminoma
• the stage of your cancer.

Regardless of the stage, for all cases of testicular cancer, the first treatment is usually to surgically remove the affected testicle (this is called an orchidectomy). An artificial testicle (called a prosthesis) can be inserted at the time of orchidectomy – your specialist will discuss this with you.

In stage one non-seminomas, close follow-up (called surveillance) is recommended, or a short course of chemotherapy, depending on the risk of recurrence.

In stage one seminomas, after the testicle has been removed, a single dose of chemotherapy is usually given to help prevent the cancer returning, and sometimes a short course of radiotherapy is recommended. Increasingly stage one seminomas are also being managed with surveillance.

In stage two and three cancers, three to four cycles of chemotherapy may be needed, also further surgery to remove any affected lymph nodes.

To treat stage four cancer, additional surgery may also be required after chemotherapy to remove tumours from other parts of the body, depending how far the tumour has spread.

Even if testicular cancer recurs it can often be very successfully treated.

Paying for your treatment 
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself. Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy. If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.

Ask the hospital for a quote beforehand, and ensure that this includes all the consultants’ fees and hospital charges for your diagnostics and procedure.


Want to know more?
If you’d like to read more about testicular cancer, treatment or living with testicular cancer, please visit cancerresearchuk.org.uk.