Testicular cancer is a disease caused by the uncontrolled growth of abnormal cells in the testes, or testicles.

The testicles (testes) are located inside the scrotum, a loose bag of skin underneath the penis. They produce male sex hormones and sperm cells for reproduction.

When diagnosed early, testicular cancer is highly treatable. Regular testicular self-examinations can help identify dangerous growths early, when the chance for successful treatment is highest.

Signs and symptoms

Testicular cancer can result in a number of signs and symptoms. These may include:

• A lump or enlargement in either testicle

• A feeling of heaviness in the scrotum

• A dull ache in the abdomen or groin

• A sudden collection of fluid in the scrotum

• Pain or discomfort in a testicle or the scrotum

• Enlargement or tenderness of the breasts

• Unexplained fatigue or a general feeling of not being well

Cancer usually affects only one testicle.

Risk factors

Researchers don't know what causes testicular cancer. Risk factors may include:

• An undescended testicle. Usually the testes form in the abdominal area during fetal development and later descend into the scrotum. Men who have a testicle that never descended are at greater risk of testicular cancer than other men are. The risk remains even if the testicle has been surgically relocated to the scrotum. Still, the majority of men who develop testicular cancer don't have a history of undescended testicles.

• Age. Testicular cancer affects younger men, particularly those between ages 15 and 40. This form of cancer is uncommon in children and in men over age 40.

• Race. Testicular cancer is more common in white men than in black men.

• HIV infection. Some research has shown that men infected with the human immunodeficiency virus (HIV), especially those with AIDS, are at increased risk of developing testicular cancer.

• fatigue

• HIV/AIDS

When to seek medical advice

See your doctor if you detect any pain, swelling or lumps in your testicles or groin area, especially if these symptoms last longer than 2 weeks. Make an appointment with your doctor even if a lump in your testicle is not painful. Only a small percentage of testicular cancers are painful from the outset.

Other diseases and conditions can produce testicular lumps. These may include:

• Scrotal masses. These masses — made up of fluid or solid material in, on or around the testicles — may be caused by cysts, inflammations, physical injury or hernia.

• Epididymitis. This inflammation affects the tubes that transport sperm.

• Hydrocele. This soft and usually painless swelling in the scrotum is due to a collection of watery fluid.

• Spermatocele. This type of cyst is formed by blockage in the tubes that transport sperm.

• Varicocele. This swelling in the scrotum is caused by enlarged veins.

• Orchitis. This inflammation of the testicle is often due to bacterial infection or the mumps virus.

Some of these conditions are harmless. However, see your doctor any time that you have a lump or other symptoms of testicular cancer.

Screening and diagnosis

Most men discover testicular cancer themselves, either unintentionally or while doing a testicular self-examination to check for lumps.

If you bring signs and symptoms of testicular cancer to your doctor's attention, or your doctor discovers a lump during a routine office visit, your doctor will likely do a physical exam and order lab tests to see if they're due to infection or another cause. You may also undergo an ultrasound examination. This painless test passes sound waves through your scrotum to make an image of your testicles.

The testicles contain several types of cells, and each may develop into several types of cancer. Each type grows and spreads differently. Treatment and prognosis also vary according to type.

Doctors classify testicular cancer as one of two types:

• Seminoma. This is the most common type of testicular cancer, representing about 60 percent of all cases. If it's discovered and treated early, nearly all men recover from this type of cancer.

• Nonseminoma. This group of cancers includes choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumors. These types of cancer tend to develop earlier in life than seminomas, usually occurring in men between their late teens and early 40s.

Sometimes the diagnosis is unclear. If so, a pathologist can check tissue taken from the affected testicle. This is done to see if cancer cells are present. If the lump is noncancerous, there's usually no need to remove the testicle. If the lump is a malignant tumor, the pathologist will also determine what types of cancer cells are present.

After the type of cancer has been established, you may need blood tests, X-rays, computerized tomography (CT) or magnetic resonance imaging (MRI) scans, and other tests to determine if the cancer has spread to other parts of your body.

With these test results, your doctor classifies the cancer according to its stage. These include:

• Stage I. Testicular cancer is confined to the testicle.

• Stage II. Testicular cancer has spread to the lymph nodes in the abdomen.

• Stage III. Testicular cancer has spread beyond the lymph nodes to other regions of your body, such as your lungs and liver.

If cancer is confirmed, your surgeon may remove the affected testicle through a surgical incision in your groin. Your surgeon doesn't remove just a part of the testicle for examination. Doing so might allow cancer cells to spread elsewhere; therefore, the entire testicle is removed.

Complications

Losing a testicle won't make you sterile or interfere with your ability to have sexual intercourse. The remaining healthy testicle can maintain your normal sexual and hormonal functions.

Removal of both testicles results in infertility. But you can take male hormones to keep your sexual function essentially normal. The three ways to replace testosterone are:

• Intramuscular injection, which is usually given every two weeks

• Patches, which are applied to your skin daily

• Testosterone gel, which you rub into your skin daily

If you're concerned about your ability to have children now or in the future, talk with your doctor about preserving some of your sperm before the removal of one or both testicles. Sperm can be frozen and stored (cryopreserved) before treatment for later use.

• Infertility, female
• Infertility, male

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