Everything you need to know about testicular cancer

Since the early 1990’s the number of men diagnosed with testicular cancer has increased by more than a quarter, today over 2,000 men are diagnosed with testicular cancer each year in the UK and the majority of these men are under the age of 45.

Men are encouraged to check their testicles regularly, at least once a month, and have any changes checked by their GP or a healthcare professional without delay. This is because finding cancer at an early stage can make it easier to treat and more likely to be cured - but do you know how to check your testicles and are you checking them often enough?

We spoke to Mr Aziz Gulamhusein, Consultant Urological and Robotic Surgeon, from The Wilmslow Hospital and The Christie Private Care, both part of HCA Healthcare UK, to get his expert insight and answers to some of the most common questions about testicular cancer, including how to check your testicles.

What is testicular cancer?

The testicles, also known as testes, are made up of different types of cells. Testicular cancer develops when normal healthy cells in the testes begin to reproduce uncontrollably. The type of cancer you have depends on what kind of cell it develops in but the majority of testicular cancers, more than 90%, develop from the germ cells – these are the cells which are responsible for producing sperm. The two main types of germ cell testicular cancers are seminomas and non-seminomas.

Statistically, each year in the UK there are around 2,300 men diagnosed with testicular cancer, most often affecting younger men aged 30 to 34, and unfortunately instances are on the rise. Whilst this is concerning, early diagnosis and treatment usually leads to a positive outcome for the majority of men.

What are the risk factors for testicular cancer?

Unfortunately, there is no hard evidence as to why certain men develop testicular cancer, or why the incidence is increasing. We still don’t know what causes the cells in the testes to mutate and cause cancerous cells to develop, however we do know that there are certain risk factors that will make some men more susceptible to testicular cancer than others. These risk factors include: 

• An undescended testicle.This means that one or both testicles fail to move from the abdomen into the scrotum before birth. Men who were born with this condition are more likely to develop testicular cancer than those whose testicles descended normally.
• Family history. Having a close family member who has been diagnosed with testicular cancer such as a father or a brother, can increase your risk.
• HIV infection. There is some evidence to suggest that men who are HIV positive or have AIDS are at an increased risk of testicular cancer.
• A previous diagnosis of testicular cancer. If you have been diagnosed with testicular cancer you are at an increased risk of developing cancer in your other testicle.
• Age. Testicular cancer is most common in men between the ages of 20 and 34, around half of all cases are diagnosed in this age group. However younger and older men can be diagnosed with testicular cancer, so it is important not to ignore any changes to your testicles and have these checked by your GP or a healthcare professional - no matter your age.
• Race/Ethnicity. The risk of testicular cancer among white men is about 4 to 5 times higher than in Black or Asian men.

What are the symptoms of testicular cancer?

Testicular cancer can cause a number of different symptoms and warning signs, which include: 

• A painless swelling or lump in one of the testicles - the swelling or lump is commonly about the size of a pea, but in some instances, they can grow bigger than this.
• A change in the shape and/or texture of the testicles.
• A dull ache or sharp pain in the testicles or scrotum which may come and go, or a feeling of heaviness in the scrotum.
• A sudden build-up of fluid in the scrotum.

How, and how often, should you check your testicles?

It’s important that all men regularly check their testicles for signs of testicular cancer, this should be done at least once a month as part of a regular routine, for example when showering or bathing.

There are three basic steps for self-examination:

1. Hold one testicle between the thumbs and fingers of both hands and roll it gently between your fingers
2. Look and feel for any hard lumps, or smooth rounded bumps, along with any changes to the shape, size or consistency of the testicles
3. Repeat the process for the other testicle

It’s worth noting that “normal” testicles have blood vessels, supporting tissues and tubes carrying sperm, these can be confused with abnormal lumps. If you have any concerns, or you’re not sure you should see your doctor.

How is testicular cancer diagnosed?

Your doctor will ask you about your symptoms and examine your testicles. After this physical examination they may refer you to a specialist for some tests. These tests usually include blood tests and a scan such as a CT, MRI or ultrasound.

How is testicular cancer treated?

If you have been diagnosed with testicular cancer, your treatment will depend on your individual diagnosis and the stage and type of testicular cancer you have been diagnosed with.

Treatment in the majority of patients will begin with surgery to remove the affected testicle in a procedure called an orchidectomy. Once the affected testicle or testicles have been removed you may require additional treatment with radiotherapy or chemotherapy depending on the stage of the cancer and if it has spread beyond the affected testicle or testicles.

Will treatment affect fertility?

Most men are still fertile after having one testicle removed, however some treatments for testicular cancer can cause infertility. Your consultant will talk through your treatment options with you and discuss your individual options for fertility preservation. You will be offered the opportunity to bank your sperm prior to beginning treatment – this is the collection and storage of semen for potential later use.

If you have noticed any changes to your testicles do not delay in getting these checked by your GP or a healthcare professional.

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