Testicular cancer is the commonest cancer affecting young men. It usually develops between the ages of 15 and 49, but it can also affect young children and older people.
Around 2,300 cases of testicular cancer are diagnosed in the UK per year. Testicular Cancer Awareness Month is marked annually in May and aims to raise awareness of the condition, as well as how to check for it.
Mr Jas Kalsi, Consultant Urological Surgeon and Male Fertility Expert at Cromwell Hospital, is an expert in the treatment of testicular cancer and explains more about the condition.
What is testicular cancer?
Testicular cancer is a type of cancer that begins in the testicles. It occurs when tissue within the testicles becomes malignant (cancerous).
There are different types of testicular cancer, which are named after the cells they start in. The most common type is called germ cell tumours.
Germ cell tumours
Germ cell tumours develop from abnormal cells in the testicles, which are known as germ cell neoplasia in situ (GCNIS). GCNIS are found only in the small tubes inside the testicle (the seminiferous tubules).
GCNIS is not cancer, but around 50% of people with GCNIS will develop cancer within five years. Germ cell tumours develop when the abnormal cells grow beyond the tubules into other parts of the testicle.
Germ cell tumours can be categorised into two groups: tumours that develop from GCNIS, and tumours that don’t.
Germ cell tumours that develop from GCNIS
There are two types of germ cell tumours that develop from GCNIS, which are called seminomas and non-seminomas. These types of tumours only develop after puberty has occurred.
- Seminomas – These are the more common type, occurring in up to 60% of cases. They usually affect people between the ages of 15 and 55.
- Non-seminomas – There are many different types of non-seminoma tumours, including teratoma (post-pubertal type), embryonal carcinoma, choriocarcinoma, and yolk sac tumours (post-pubertal type). They usually affect younger people between the ages of 15 and 35.
- Mixed germ cell tumours – These contain a mixture of seminoma and non-seminoma cells.
Germ cell tumours that don't develop from GCNIS
Germ cell tumours that aren’t caused by GCNIS tend to occur in either young children or older people. These types of tumours are usually less aggressive and do not tend to spread beyond the testicles.
Young children are more likely to develop teratomas or yolk sac tumours (pre-pubertal type), while older people are more likely to develop spermatocytic tumours.
A lump or swelling in the testicle
The most common symptom of testicular cancer is a lump or swelling in the testicle. Most testicular lumps aren’t cancer, but you should always visit a doctor to get confirmation.
Your GP may perform a test called transillumination, where a strong light is shone through the testicle. A solid lump, where light cannot pass through, is more likely to be cancer.
Symptoms of metastatic cancer
Metastatic cancer is cancer that has spread to other parts of the body. Occasionally testicular cancer can spread to the lymph nodes.
If the cancer spreads to the retroperitoneal lymph nodes (located in the back of the abdomen), it may cause backache or a dull ache in the stomach.
If the cancer spreads to the lymph nodes in your mediastinum (between the lungs), it may cause a cough, difficulty breathing or swallowing, or swelling of the chest.
Depending on the location of the affected lymph nodes, you may develop a lump in the area.
Undescended testicles (cryptorchidism) occur when the testicles fail to move down into the scrotum from the abdomen. This usually happens either in-utero or within the first year of life.
If the testicles move down after this time, or require surgery to move them, they are referred to as undescended testicles.
People who have or have had undescended testicles are at least three times more likely to develop testicular cancer in their lifetime.
Abnormal cells in the testicles
Having abnormal cells in the testicles is called germ cell neoplasia in situ (GCNIS). GCNIS isn’t cancer, but it develops into cancer in around 50% of cases.
Most testicular cancers that occur after puberty develop from GCNIS. To prevent GCNIS from developing into cancer, it may be recommended that you have radiotherapy or surgery.
How to check your testicles for testicular cancer
Once you hit puberty, it’s important to check your testicles regularly – ideally, every month. This will help you get an idea of their usual look and feel so if there are any changes, you’ll notice them.
The best time to do it is while you’re in the shower or bath, or just afterwards. The warmth will relax your scrotum and make it easier to feel anything unusual.
- Stand in front of a mirror and check if you can see anything unusual like any swelling on the skin.
- Feel the size and weight of each testicle. You may notice that one testicle is larger or hangs lower than the other. This is completely normal.
- Get to know the feel of your testicles by rolling each one between your fingers and thumb. They should feel smooth, without any lumps or swellings.
- Compare your testicles with each other – get to know any differences between them.
Towards the top, at the back of each testicle, you’ll feel a soft, tender tube. This is called the epididymis, and stores sperm, so it’s good to remember where it is so you don’t mistake it for a lump. Cancerous lumps don’t usually develop here but on the sides or in front of your testicle.
If you’re concerned about any lump, contact your GP for advice.
Can testicular cancer kill you?
Testicular cancer is highly treatable and has one of the best outlooks for cancer.
In the UK, 99% of people will survive for a year or more after being diagnosed, with 98% surviving five years or more. Even if the cancer has spread to the lymph nodes, there is still a 96% of survival for five or more years following diagnosis.
Germ cell tumours can usually entirely curable, with low instances of the cancer reoccurring.
How long can you have testicular cancer without knowing?
Some people with testicular cancer experience little to no symptoms. It is important that you are aware of your body and what is normal for you, so that you can spot any abnormalities (such as lumps or swelling) if they occur.
Germ cell neoplasia in situ (GCNIS), which are abnormal cells in the testicles, may cause infertility but do not cause any other symptoms. They are occasionally detected when undergoing an investigation for another problem, and can be formally diagnosed using a biopsy.
Why choose Cromwell Hospital for testicular cancer care?
Cromwell Hospital is a world leader in cancer care, delivered exclusively under one roof at the Integrated Cancer Campus.
Our Integrated Cancer Campus is an internationally recognised centre of excellence that provides state-of-the-art diagnostics, cutting-edge treatments and surgery, and the expertise of our world-class consultants.
Should you require radiotherapy, we are home to Europe’s most advanced radiotherapy facility in partnership with GenesisCare. We also provide a range of other treatments, including surgery and chemotherapy.
About the consultant
Mr Jas Kalsi is a Consultant Urological Surgeon and Male Fertility Expert at Cromwell Hospital. He is an expert in the investigation and treatment of male health problems such as lumps in scrotum, infertility, Peyronie’s disease, erectile dysfunction and lower urinary tract symptoms. He provides a range of minimally invasive procedures including injection therapy for Peyronie’s, sound wave treatment for ED and Rezum and Urolift for urinary symptoms.