Testicular cancer is a relatively uncommon urological cancer which tends to affect younger men (age 15-45) more frequently, although it can occur in men of all ages.
What are the symptoms of testicular cancer?
The most common symptom of testicular cancer is a painless lump arising from the testicle, although it may occasionally be painful. Sometimes, the whole testis feels firm, enlarged or irregular. Very occasionally, testicular cancer presents after it has spread, and then more general symptoms such as malaise, weight loss and cough may occur.
What causes testicular cancer?
We do not know the exact cause of testicular cancer, but it is thought to be due to a disorder of testicular development. The main risk factors for developing testicular cancer are:
- Having a first degree relative with testicular cancer (ie father or brother)
- Having an undescended testis (which is usually detected and treated in childhood)
- Having small, poorly developed testes
What should I do if I find a testicular lump?
If you discover a scrotal lump, it is advisable to see your doctor urgently. Most of these scrotal lumps are not dangerous (see section on “scrotal lumps”), and only a minority will be related to testicular cancer.
Your doctor will examine you and will then decide if you need further tests or a referral to a Urology specialist.
What happens if testicular cancer is suspected?
If your GP cannot rule out testicular cancer after seeing you, you will be referred urgently to a Urologist, who will see you in Clinic and examine you carefully. During this initial appointment, you will be sent for some blood tests and a urine test. An urgent ultrasound scan will be arranged, which is the most accurate scan for the diagnosis of testicular cancer. If the ultrasound is suspicious of cancer, then your Urologist is most likely to recommend that you an undergo an operation to remove the testicle called an orchidectomy. During this operation, a small incision is made in the groin, and the testicle along with a length of the accompanying spermatic cord carrying the blood vessels is removed and sent to the lab for detailed analysis. You will be offered the opportunity to have a prosthetic testicular implant at the same time. Most patients undergo this surgery as a day case procedure under general or spinal anaesthesia. Once the pathology doctors have confirmed the diagnosis of testicular cancer, you will then be sent for a CT scan of the chest, abdomen and pelvis to make sure the tumour has not spread.
Will I need further treatment?
Once you have had a CT scan, you will be seen by a cancer specialist (oncologist) who can then advise you about the need for further treatment. Many patients will not require any further treatment, but need to remain under clinical surveillance for a minimum period of 5 years, having regular scans and blood tests during that time. Other patients may be offered chemotherapy to treat residual cancer or to prevent it from coming back. Your oncologist will discuss all this with you.
Will removing my testicle affect my fertility?
Although it is perfectly possible to maintain a healthy sperm count with one testicle, there is a chance that surgery and chemotherapy for testicular cancer may affect fertility. Therefore, men are given the option of storing a semen sample which can be used for in vitro fertilization (IVF) in the future if required. This sample is usually taken before the testis removed, and this will be discussed with you fully by your urologist.
Information from ORCHID (fighting male cancer): https://orchid-cancer.org.uk/Testicular-Cancer/