Testicular cancer is a relatively rare cancer with one important feature: it is the most common solid malignant tumour in men aged between 15 and 40. That is why its first sign, a painless, firm lump in one testicle, is often ignored for weeks.
At the same time, it is one of the most treatable cancers – when it is found early, the chances of a complete cure are very good, provided the change in the testicle is examined by a urologist without delay.
What is testicular cancer?
In the vast majority of cases the tumour arises from the cells that develop into sperm – these are germ cell tumours. They are divided into seminomas, which grow more slowly and are more common after the age of 30, and non-seminomas, which are typical of younger men and grow faster.
Symptoms
Most often the man himself feels the change. Pay attention to:
- a firm, painless lump or hard area in a testicle;
- enlargement of one testicle or a change in how firm it feels;
- a feeling of heaviness or dragging in the scrotum;
- a dull ache in the lower abdomen or groin.
Back pain or a cough can be signs of advanced disease. Not every lump is a tumour – cysts, hydrocele and inflammation are far more common causes of swelling or a lump in the testicle, but the difference can only be told with an examination and an ultrasound.
When it is urgent. Sudden severe pain in a testicle may be testicular torsion – twisting that cuts off the blood supply. Do not wait for an appointment with a urologist: go straight to an emergency department or call 112 (the European emergency number). A painful, red swelling with a fever also needs to be seen the same day.
Causes and risk factors
The exact cause is unknown, but the likelihood is higher with:
- an undescended testicle (cryptorchidism) in childhood, even after it has been brought down surgically – more in the article on undescended testicle;
- a family history – testicular cancer in a father or brother;
- a previous tumour in the other testicle;
- reduced fertility and poor semen analysis results.
Diagnosis
The consultation with Dr Penev includes a conversation about your symptoms and an examination of both testicles, the epididymides and the lymph nodes, followed by a scrotal ultrasound – a painless test that is usually done during the consultation itself and distinguishes a solid tumour from a cyst, fluid or inflammation with very high accuracy.
If a tumour is suspected, tumour markers are measured in the blood – alpha-fetoprotein (AFP), human chorionic gonadotropin (β-hCG) and lactate dehydrogenase (LDH) – and the stage is determined with a CT scan. A biopsy through the skin of the scrotum is not done because of the risk of spreading tumour cells – the final diagnosis comes from histological examination of the removed testicle.
Treatment
The first step is surgical removal of the affected testicle together with the spermatic cord through a small incision in the groin – a radical inguinal orchidectomy. It gives the exact diagnosis and, at an early stage, is often the only treatment needed; if you wish, a testicular prosthesis (implant) can be inserted. The operations are performed at the Department of Urology at Kaspela University Hospital (UMBAL Kaspela) in Plovdiv, where Dr Penev works – more about uro-oncological surgery.
The further plan depends on the type of tumour, the stage and the markers after surgery, and is decided by a team made up of a urologist, a medical oncologist and a radiation oncologist: active surveillance with scheduled check-ups and tests in early-stage disease; chemotherapy, to which these tumours are highly sensitive, for disease that has spread or to reduce the risk of recurrence; and, less often, radiotherapy for seminoma.
One healthy testicle is usually enough for normal testosterone, erections and fathering children, and before treatment Dr Penev discusses freezing sperm. Afterwards come years of regular follow-up.
When to see a urologist
Book an examination within the next few days if you feel a new lump or hard spot in a testicle, even if it does not hurt; if one testicle has become larger, heavier or changed shape; if you have a persistent dull ache in the scrotum or groin; or if you have risk factors and notice any change at all. If the finding is harmless, you will have peace of mind; if it is not, you will have gained the most valuable thing of all – time.
Prevention and self-examination
Testicular cancer cannot be prevented, but it can be found early – and here the main role is yours. Examine yourself once a month after a warm shower, when the scrotum is relaxed:
- Look at the scrotum for swelling or asymmetry – a small difference in size between the two testicles is normal.
- Roll each testicle between your thumb and fingers – the surface should be smooth and the firmness even.
- Feel the epididymis – the soft, elongated structure at the back; it is a normal structure, not a tumour.
If you have felt something that worries you, do not put it off – a short examination with ultrasound gives a clear answer. Book an appointment with Dr Penev in Plovdiv or Karlovo.
Frequently asked questions
Does testicular cancer hurt?
Typically not. The most common sign is a firm lump or hard area that does not hurt, sometimes with a feeling of heaviness. The lack of pain is also why many men put off seeing a doctor – yet it is precisely a painless lump that needs attention most urgently.
Can a blow to the testicle cause cancer?
No. An injury does not cause a tumour, but it is often what prompts a man to feel his testicles and discover a hard area that was already there. If the swelling or lump has not gone one to two weeks after a blow, an examination with ultrasound is needed.
Will I be able to have children after one testicle is removed?
In most cases, yes – one healthy testicle produces enough sperm and testosterone. Because chemotherapy can temporarily or permanently reduce sperm quality, freezing sperm is discussed before treatment starts.
How often should I examine myself?
Once a month is enough – checking more often brings no benefit, only anxiety. If you feel something new, do not wait for the next check; book an examination within the next few days.
What do tumour markers show?
These are substances in the blood that some testicular tumours release. Raised levels support the diagnosis and suggest the type of tumour, and a fall after surgery shows that treatment is working. Normal markers, however, do not rule out a tumour.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.