Testicular cancer: Risks, signs, symptoms and treatment

Testicular cancer is the most common type of cancer in young adult men – yet it’s also one of the most curable. While new cases of testicular cancer have doubled in the past 40 years, deaths from the disease have decreased as treatments have improved.

As with other forms of cancer, an earlier diagnosis can improve the likelihood of surviving testicular cancer. Knowing the signs and symptoms and understanding whether you’re at increased risk can help you spot testicular cancer sooner. Here, we take a look at some of the key facts you should know.

What is testicular cancer?

Nearly all testicular cancers begin in the germ cells – the cells in the testicles responsible for producing sperm. The two main types of testicular germ cell tumors are seminomas and nonseminomas. These forms of the disease grow and spread differently and are treated in different ways.

Seminomas tend to develop and spread slowly and are typically found in men in their 40s and 50s. Seminomas can spread to the lymph nodes, where they are usually treated with radiotherapy or chemotherapy.

Nonseminomas tend to grow and spread more quickly than seminomas nd are most commonly found in men aged 15 to 35. They are often made up of more than one type of cell.

Some testicular tumors contain both seminoma and nonseminoma cells. Doctors usually treat these tumors in the same way as nonseminomas.

How common is testicular cancer?

Testicular cancer is relatively rare, affecting approximately 5–6 in every 100,000 men each year in North America and Europe as a whole (Table 1). However, despite being among the least common forms of cancer overall, it is the most frequently diagnosed cancer in men aged between 20 and 34, with over 50% of new cases occurring in this age group. In the US, for example, the average age for a diagnosis of testicular cancer is 33.

The good news is testicular cancer can usually be cured, even in late stages of the disease. In developed countries, more than 95% of those diagnosed with testicular cancer will survive at least a further five years (Table 2).

Table 1: Testicular cancer: Incidence rate by country

Source: World Health Organization GLOBOCAN 2020.

Table 2: Testicular cancer: 5-year survival rates by country

Sources: Canadian Cancer Society; Zentrum Für Krebsregisterdatum; Associazione Italiana Registri Tumori; Chirlaque et al., 2010; Jung et al., 2019; Cancer Research UK; SEER.

Check yourself: Signs and symptoms of testicular cancer

Currently, there are no standard screening tests for the early detection of testicular cancer. In most cases, testicular cancer is found by men themselves, either by chance or during self-examination, or by a doctor during a routine physical examination.

When it comes to spotting testicular cancer, it’s good to be aware of what’s normal for your body. It can be helpful to regularly check the size and weight of your testicles, and check for any lumps or swellings.

Spotting testicular cancer earlier may make it easier to treat. Arrange an appointment with your doctor if you notice any of the following signs and symptoms.

• A painless lump or swelling in your testicle
• A change in how your testicle feels
• A dull ache in your lower abdomen or groin
• A sudden build-up of fluid in your scrotum
• Pain or discomfort in your scrotum

Risk factors

Some men are at greater risk of developing testicular cancer than others. Having a risk factor does not necessarily mean you will get cancer but you should be particularly vigilant. Speak with your doctor if you think you may be at greater risk.

Risk factors for testicular cancer include:

• Cryptorchidism (an undescended testicle): Testicles that have not descended may indicate the presence of an underlying abnormality that could increase your risk of cancer. Men with undescended testicles are approximately 3 times more likely to develop testicular cancer than those whose testicles developed at or shortly after birth.
• A testicle that has not developed normally: Other unusual signs, such as a testicle that is significantly smaller or does not function properly, may indicate an underlying abnormality associated with an increased cancer risk.
• Testicular carcinoma in situ (abnormal cells that remain where they first formed): These cells can potentially become cancerous and spread.
• Race: White men are four times as likely to get testicular cancer than Black men.
• A personal or family history of testicular cancer: Having had cancer in one testicle puts you at greater risk of developing cancer in the other. Some inherited mutations also increase your chances of developing testicular cancer.
• Klinefelter syndrome: This genetic disorder, resulting from having one or more additional X chromosomes, causes men to produce lower levels of male hormones and higher levels of female hormones and increases the risk of developing germ cell tumors.

Diagnosing and treating testicular cancer

If your doctor suspects you have testicular cancer, they will first examine your testicles, take scans and perform blood tests. If these initial tests show that it is likely that you have testicular cancer, an operation to remove a testicle (known as an orchiectomy) will be necessary to confirm the diagnosis and understand the type of cancer you have. In this procedure, a surgeon will make an incision in your groin to cut the spermatic cord and remove the testicle. Complete removal of the testicle is essential, as extraction of a tissue sample for analysis may disturb the tumor and cause it to spread. Surgery also removes the tumor, and is one of the main treatments for testicular cancer.

Having cancer in both testicles is uncommon. The removal of one testicle will not normally affect your ability to have children.

After testicular cancer has been diagnosed and your doctor has determined how far it has advanced, your doctor will plan treatment. Standard approaches to treating and managing testicular cancer are:

• Surgery to remove one or both testicles and lymph nodes.
• Radiation therapy, involving high-energy X-rays or other types of radiation to kill the cancer cells or prevent their growth.
• Chemotherapy medication to kill or slow the growth of cancer cells.
• High-dose chemotherapy with stem cell transplant, where high doses of chemotherapy are given to kill cancer cells. As healthy cells are also destroyed by the chemotherapy, stem cells from the blood or bone marrow of the patient or a donor are given back to the patient through an infusion.
• Surveillance of the patient’s condition without treatment, to closely monitor for changes indicating the cancer has come back.

Clinical trials: Shaping future treatments and diagnostic tests

While outcomes for testicular cancer have improved significantly over the last few decades, there is still room for improvement. Scientists are continually working to find new ways to treat the disease, improve on existing approaches, and establish more accurate and convenient detection techniques.

Clinical trials play an essential role in this process, helping scientists assess the effectiveness of new tests and treatments, and better understand how testicular cancer develops. Joining a clinical trial could mean that you receive close monitoring of your cancer or investigational treatments not otherwise available. Indeed, for some men with testicular cancer, participating in a clinical trial may be the best option if standard treatment pathways have been tried.

If you’re interested in participating in a clinical trial, ask your doctor about ongoing trials that are available to you.

Testicular cancer is one of the most curable types of cancer, especially if found early. So be aware of what’s ‘normal’ for your testicles, and look out for potential signs and symptoms of cancer, particularly if you’re at greater risk.