Testicular cancer happens when cells in one of the testicles (the organs in the scrotum that make sperm and hormones) grow in an uncontrolled way. It is uncommon compared with other cancers, but it is the most common cancer in young men ages 15-45. The good news is that most cases are highly curable, even when the cancer has spread.
Who is most at risk?
Several things can raise a man’s chance of getting testicular cancer:
- Undescended testicle (cryptorchidism) — the testicle did not move down into the scrotum before birth.
- Previous or family history of testicular cancer.
- Abnormal testicle development or certain genetic conditions, such as Klinefelter syndrome.
- Being white — the disease is about four times more common in white men than in Black or Asian men.
Studies show that testicular cancer is highly heritable, meaning that genetic factors explain 37% to 50% of the risk. However, no single “cancer gene” has been found.
Why is early detection important?
There is no standard screening test for testicular cancer because it is rare and usually curable. Large programs like those used for breast or colon cancer are not recommended. Instead, doctors encourage men to be aware of what is normal for their own testicles so they can spot changes early. Finding a tumor early often means simpler treatment and a better chance of cure.
How to check yourself
Doctors often suggest that men, especially those with risk factors, do a self-exam once a month. The American Cancer Society says this is especially useful after puberty. Here’s how:
- After a warm bath or shower, stand in front of a mirror and look for any swelling or changes.
- Check one testicle at a time. Gently roll it between your thumb and fingers. It should feel smooth and firm, with a soft tube at the back. Lumps or hard areas should be checked by a doctor.
If you notice any lump, change in size, or heaviness that does not go away, see a health care provider. Doctors can also detect problems during routine physical exams.
What happens if a lump is found?
- A scrotal ultrasound is usually the first test. It uses sound waves to see whether the lump is solid or filled with fluid.
- Blood tests measure tumor markers like AFP, hCG and LDH. These help doctors understand the type of tumor.
- If cancer is likely, surgeons remove the testicle through a small incision in the groin (called radical inguinal orchiectomy). Doctors do not do needle biopsies because they might spread cancer cells.
Signs and symptoms to watch for
Most men with testicular cancer notice a painless lump or swelling in one testicle. Other possible signs include:
- A feeling of heaviness in the scrotum.
- Dull ache in the lower abdomen or groin.
- Sudden collection of fluid in the scrotum.
- Pain or discomfort in a testicle or scrotum.
- Breast tenderness or growth, caused by hormone changes.
- Back pain if the cancer has spread.
Most lumps are not cancer. Conditions like hydroceles (fluid around the testicle) or varicoceles (enlarged veins) are common and treatable, but only a doctor can tell.
Does it affect fertility?
Losing one testicle usually does not prevent a man from having children because the other testicle can still produce sperm and testosterone. However, treatments can cause temporary or permanent fertility problems:
- Chemotherapy can lower sperm counts for months or even longer. Doctors often suggest waiting 6 to 24 months after treatment before trying for a baby.
- Radiotherapy can damage the remaining testicle, even with shielding.
- Surgery to remove lymph nodes may cause “dry” or backward ejaculation (retrograde ejaculation).
Men who want children in the future are usually offered sperm banking before treatment starts.
New tests and research
Scientists are developing new ways to detect and monitor testicular cancer. One promising test measures a small molecule called microRNA 371a-3p in the blood. In early studies, this test has about 90% accuracy and can show whether cancer cells are still present after treatment. Researchers are also looking at other microRNAs that may help distinguish between types of testicular cancer.
What about genetic testing?
Large studies have found more than 70 genetic regions linked to a higher risk of testicular cancer. Men in the top 5% of a polygenic risk score (a score based on many small genetic changes) have about a 6.8 times higher risk than men with average scores. These risk scores might one day help doctors decide who needs closer monitoring.
However, because testicular cancer is still rare and often curable, routine genetic testing is not recommended. Scientists note that although these scores can separate higher-risk men from lower-risk men, the overall benefit is small because the disease is uncommon.
Key takeaways
- Testicular cancer is rare but common in young men and highly curable.
- No routine screening programs exist; instead, know your own body and check for lumps regularly.
- See a doctor for any lump, swelling or persistent change.
- Treatments can affect fertility; discuss sperm banking with your care team.
- New blood tests and genetic studies show promise but are not yet standard care.
With prompt treatment, most men with testicular cancer go on to live healthy lives.
LEARN MORE ABOUT TESTICULAR CANCER CARE AT NORTHSIDE.
