Testicular Cancer
What is cancer?
The organs and tissues of the body are made up of tiny building blocks called cells. Cells in different parts of the body may look and work differently but most reproduce themselves in the same way. Cells are constantly becoming old and dying, and new cells are produced to replace them. Normally, the division and growth of cells is orderly and controlled but if this process gets out of control for some reason, the cells will continue to divide and develop into a lump which is called a tumour.
Testicles
The testicles are two small oval-shaped organs suspended below the penis in a pouch of skin called the scrotum. They are part of the male reproductive system. From the start of puberty the cells lining the collecting tubules of the testicles produce sperm.
Causes
It is not known exactly what causes testicular cancer. Although it is still quite rare, the number of men who develop it has been steadily increasing for the past few years. The reason for this is not known, but research is going on all the time into possible causes.
Testicular cancer is more common in men who have a testicle that has failed to descend. In the unborn child the testicles develop inside the abdomen between the kidneys and descend into the scrotum at birth or during the first year of life. If the testicles do not descend this increases the risk of testicular cancer.
Men with a brother or father who has had testicular cancer are slightly more at risk of developing it (although the risk is still small). Research has shown that a particular gene is the cause of testicular cancer in some men. It is possible that this gene is inherited and may be the reason why testicular cancer sometimes occurs in brothers or sons of men who have had the disease.
Testicular cancer is more common in white men than African or Asian men. It occurs more commonly in wealthier social groups. The reasons for this are not known.
Symptoms
The most common symptom is swelling in part of one testicle. This is usually painless, but some men may notice an ache in their lower abdomen or in the affected testicle. There may be a feeling of 'heaviness' in the scrotum. In a few men the testicle suddenly becomes swollen and very tender.
When a normal testicle is examined, it is round, soft and smooth. The epidydimis can be felt behind it as a separate structure. Cysts and benign swellings in the epidydimis are quite common and are usually harmless. Lumps in the body of the testes itself may be benign but can be a cancer. It is sensible to have any swelling examined by a doctor.
A few men may find that their first symptoms (such as backache, stomach ache, or a cough) are caused by spread of the cancer cells to other parts of the body. Rarely, tender nipples may be caused by hormonal changes within the body. If you have any of the above symptoms it is important to let your doctor know - but remember, they are more likely to be due to conditions other than cancer.
Cancers which are found early are the most easily treated. The best way to check for testicular cancer is to examine yourself once a month and the best time to do this is after a warm bath or shower, when the scrotal skin is relaxed
If you find a swelling in a testicle, it is very important that you have it checked by your doctor as soon as possible. If you feel embarrassed about seeing your GP, you can go to your local sexual health clinic.
Types of testicular cancer
There are two main types of testicular cancer - seminomas and teratomas.
They may be called germ cell tumours. Occasionally testicular tumours can be a mix of both types.
- Seminomas most commonly occur in men between 25 and 55 years of age
- Teratomas usually affect younger men - from 15 to about 35 years
How testicular cancer is diagnosed
Usually you begin by seeing your family doctor (GP), who will examine you and take your medical details. They will then refer you to a hospital specialist for further tests, expert advice and treatment.
The specialist will give you a full physical examination and take your medical history. Often, the doctor can tell by feeling the lump, whether it is likely to be a cancer.
You may have an ultrasound scan of the scrotum and the testes. This test can help to tell whether a lump is a cancer or is due to other causes. An ultrasound scan uses sound waves to build up a picture of the testes and scrotum. However, the only way to confirm that the swelling is cancer is for a surgeon to examine the testicle during an operation.
During the surgery the surgeon can sometimes see whether the lump is a cancer or not. A small piece of tissue is removed and immediately examined under a microscope by a pathologist (this procedure is known as a biopsy). If the biopsy shows that the lump is a cancer, the testicle will be removed (this operation is known as orchiectomy).
The cells are then taken to the laboratory and examined further to find out which type of testicular cancer it is.
You can usually go home the next day. If the cancer has not spread beyond the testicle, this may be the only treatment you may need, although for a few years you will have to attend the hospital regularly as an outpatient for check-ups.