What are the testicles?
The testicles (also called the testes or gonads) are the male sex glands. They are located behind the penis in a pouch of skin called the scrotum. The testicles produce and store sperm, and they also serve as the body's main source of male hormones.
These hormones control the development of the reproductive organs and other male characteristics, such as body and facial hair, low voice, wide shoulders and libido.
What is cancer?
Cancer is a group comprising more than 100 diseases. Although each kind differs from the others in many ways, every type of cancer is a disease of some of the body's cells. (In 'testicular cancer' there are as many as 14 different types of cancer that can start in the testicle.)
Healthy cells that make up the body's tissues grow, divide and replace themselves in an orderly way. This process keeps the body in good repair. Sometimes, however, some cells lose the ability to limit and direct their growth. They grow too rapidly and without any order. Too many cells are produced, and tumours are formed.
Tumours can be either benign or malignant
Benign tumours are not cancer. They do not spread to other parts of the body and are seldom a threat to life. Benign tumours can often be removed by surgery, and they are not likely to return. Some tumours of the testicle are benign, but most are not.
Malignant tumours are cancer. They can invade and destroy nearby healthy tissues and organs. Cancerous cells can also spread (metastasise) to other parts of the body and form new tumours. Cancer that develops in a testicle is called testicular cancer.
When testicular cancer spreads, the cancer cells are carried by blood or by lymph, an almost colourless fluid produced by tissues all over the body. The fluid passes through lymph nodes, which filter out bacteria and other abnormal substances such as cancer cells.
Doctors use CT scans of the abdomen and chest in an attempt to determine if the cancer has spread to the lymph nodes or lungs.
Some facts on testicular cancer:
- Testicular cancer is the most common cancer in men between the ages of 15 and 35 years - but it can strike any male at any time.
- Testicular cancer is almost always curable if it is found early.
- Most testicular cancers are found by men themselves, either as a painless lump, a hardening or change in size of the testicle, or pain in the testicle.
- Children born with an undescended testicle have an increased risk of getting testicular cancer regardless of whether surgery is done to correct the problem. However, the surgery for an undescended testicle should still be done to preserve fertility.
- Testicular cancer can be treated with surgery, radiation therapy, chemotherapy, surveillance, or a combination of these treatments.
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What is testicular cancer?
Testicular cancer is one of the most common cancers in men between the ages of 15 and 35, but the disease also occurs in other age groups, so all men should be aware of its symptoms.
While testicular cancer is common among young men, young men typically do not get a lot of cancer, so overall testicular cancer is a relatively rare disease.
Most testicular cancers are found by men themselves, by accident or when doing a testicular self-examination. The testicles are smooth, oval-shaped and rather firm. Men who examine themselves regularly (once a month) become familiar with the way their testicles normally feel. Any changes in the way they feel from month-to-month should be checked by a doctor, preferably a urologist.
Germ cell tumours (seminomas and nonseminomas)
In men under 60 years, 95% of testicular tumours originate in the germ cells, the special sperm-forming cells within the testicles.
These germ cell tumours fall into one of two types, seminomas or nonseminomas (in some countries nonseminomas are called teratoma instead).
Other forms of cancer can arise in the testicle but these types are rarer and are much harder to treat. Men over the age of 60 can still get a germ cell tumour, but overall they are more likely to get leukaemia, lymphoma, or a benign tumour called spermatocytic seminoma. Unless otherwise noted, all the information on this topic concerns testicular germ cell tumours.
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There are three stages of testicular cancer:
- Stage I - the cancer is confined to the testicle.
- Stage II - the cancer has spread to the retroperitoneal lymph nodes, located in the rear of the body below the diaphragm and between the kidneys.
- Stage III - the cancer has spread beyond the lymph nodes to remote sites in the body, including the lungs, brain, liver and bones.
- Stage IV - there is no Stage IV for testicular cancer.
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Pure seminomas account for about 40% of all testicular cancers and are made up of immature germ cells. Usually, seminomas are slow growing and tend to stay localised in the testicle for long periods.
Nonseminomas are a group of cancers that often occur in combination with one another, including choriocarcinoma, embryonal carcinoma, immature teratoma and yolk sac tumours. Nonseminomas arise from more mature, specialised germ cells and tend to be more aggressive than seminomas.
What are the causes of testicular cancer?
To date, no one really knows the cause. Researchers study patterns of cancer in the population to discover whether some people are more likely than others to develop certain cancers. If they can learn what causes the disease, they may be able to suggest ways to prevent it.
At this time, there is no way to prevent testicular cancer, apart from the obvious one...
Testicular cancer is not contagious: no one can 'catch' it from another person. Exactly what causes this disease is unknown and seldom can it be explained why one person gets it while another doesn't.
Research does show that some men are more likely than others to develop testicular cancer. For example, the risk is higher than average for boys born with their testicles in the lower abdomen rather than in the scrotum (called undescended testicles or cryptorchidism).
The cancer risk for boys with this condition is increased regardless of whether the condition is corrected, and in fact, the risk exists even in the normal testicle. The theory is that the increased risk of testicular cancer is due to whatever caused the undescended testicle, not just by the fact that the testicle was undescended.
Research has also shown that testicular cancer is sometimes linked to certain other rare conditions in which the testicles do not develop normally. There is even some line of thought that pollutants may be contributing to this problem, evidenced by the considerable increase in occurrences over the last few decades and paralleled with industrial growth and waste.
Some men whose mothers took a hormone called DES (diethylstilbestrol) during pregnancy to prevent miscarriage have testicular abnormalities. But scientists have never proven that prenatal exposure to DES (or any other female hormone) increases the risk of testicular cancer. To date, this link has never been verified.
Some patients with testicular cancer have a history of injury to the scrotum. But again, no one knows whether such an injury can actually cause cancer. Many doctors think such an injury simply calls attention to a tumour that was already growing.
What are the symptoms of testicular cancer?
Testicular cancer can cause a number of symptoms. Listed below are warning signs that men should watch for:
These symptoms are not sure signs of cancer; they can also be caused by other conditions.
There are numerous other causes of swelling of the testicle that are harmless, including hydrocoele, a collection of fluid in the scrotum; epididymitis, a swelling of the epididymis (the structure behind the testicle where sperm mature) which may also cause fever and discharge from the penis; and varicocele, varicose veins in the scrotum which is described as feeling like 'a bag of worms'.
Inflammation of the testicles can also be related to bacterial infections.
Torsion of the testicle occurs when a testicle rotates and the spermatic cord becomes obstructed and the blood supply is cut off. This most commonly occurs around puberty and causes excruciating pain and swelling of the testis. (If this happens, it is a surgical emergency and the patient should be rushed to a hospital emergency department.)
However, it is important to see a doctor, preferably a urologist, if any of these symptoms occur - any illness should be diagnosed and treated as soon as possible. Early diagnosis of testicular cancer is especially important because the sooner cancer is found and treated, the better a man's chance for complete recovery and the easier the treatment protocol.
It may be difficult to discuss this or let yourself be examined, but it is very important. Cancer is not going to go away on its own, and neither will your concern. If you are suspicious that something is going on down there, get it checked out. You will feel better that you did, even if it turns out to be nothing serious!
What's the prognosis? Can testicular cancer be cured?
Don't ever say that there has not been progress in the war against cancer. In 1970, 90% of testicular cancer patients with metastatic disease (disease that has spread) died of their cancer. By 1990, with the introduction of chemotherapy drugs such as cisplatin, these numbers had basically flipped. Now almost 90% of men with metastatic disease are cured of their cancer.
Specifically, the survival rate for men diagnosed with Stage I seminoma is about 99%. The survival rate for men with Stage I nonseminoma is about 98%. Cure rates for Stage II tumours range above 90%, while cure rates for Stage III tumours vary between 50% and 80%.
Related topics
For more information about cancer, see What is cancer? What causes cancer?
How do you examine the testicles? See Testicular self-examination
How is testicular cancer diagnosed? How is it treated? See Testicular cancer - diagnosis and treatment
What does that term mean? See Cancer glossary
Testicular Cancer Resource Center
This is a US support organisation with a good amount of quality information on its website: www.acor.org/TCRC/
Original material provided by the Testicular Cancer Resource Center. Reproduced with permission, and kindly reviewed by New Zealand urologist Dr Peter Gilling. Edited by everybody, February 2005.
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