Testicular cancer, or cancer of the testes, occurs in the testicles (testes), inside the scrotum. The scrotum is a loose bag of skin under the penis. Male sex hormones, testosterone, and sperm for reproduction are produced in the testicles. The testicles are a pair of male sex glands, also known as gonads. Testosterone controls the development of the reproductive organs, and other male physical characteristics.
Although testicular cancer is uncommon compared to other cancers (0.7% of all cancers), it is the most common cancer in males aged between 15 and 35 in North America and Europe. Just under 2,000 men are diagnosed with this type of cancer annually in the United Kingdom. About 70 British males die each year from testicular cancer. 8,000 American males are diagnosed and 390 die each year in the USA of this disease.
Testicular cancer occurs when the cells become malignant (cancerous) in either one or both testicles. White (Caucasian) males, especially those of Scandinavian descent are more susceptible to developing the disease compared to other men.
The incidence of testicular cancer in the USA has more than doubled over the last four decades among Caucasian males, and has recently started to rise among afro-American males. Experts are not sure why people of different ancestries have varying incidence rates.
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Risk factors for testicular cancer
Although scientists are not sure what the specific causes of testicular cancer are, there are some factors which may raise a man's risk of developing the disease. These risk factors include:
1) Cryptorchidism (undescended testicle)
Testicles usually descend from the inside of the abdomen into the scrotum before a baby boy is born. If a testicle has not moved down when a male is born there is a greater risk that he will develop testicular cancer later on. The increased risk applies to both testicles, and is not lowered if surgery is performed to move it down.
2) Congenital abnormalities
Males born with abnormalities of the penis, kidneys or testicles have a higher risk.
3) Inguinal hernia
Males born with a hernia in the groin area have a higher risk than others.
4) Having had testicular cancer
If a male has had testicular cancer he is more likely to develop it in the other testicle, compared to a man who has never had testicular cancer.
5) Family history
A male who has a close relative - sibling or father - with testicular cancer is more likely to develop it himself compared to other men.
6) Abnormal testicular development
Conditions, such as Klinefelter's syndrome, where the testicles do not develop normally, may increase a person's risk of testicular cancer.
7) Mumps orchitis
This is an uncommon complication of mumps in which one or both testicles become inflamed. This painful complication can also raise a male's risk of developing testicular cancer later on.
Testicular cancer is more common among Caucasian males, compared to men of African or Asian descent. Highest rates are found in Scandinavia, Germany and New Zealand.
Having a vasectomy does not increase a man's risk of developing testicular cancer.
Symptoms of testicular cancer
A symptom is something the patient feels or reports, while a sign is something other people, including a doctor, may detect. For example, pain may be a symptom while a rash could be a sign.
In most cases the patient finds the cancer himself. Sometimes they are discovered by doctors during a routine physical exam. If you notice anything unusual about your testicles you should see your doctor, especially if you detect any of the following:
- A lump or swelling in a testicle (painless)
- Pain in a testicle or scrotum
- Discomfort in a testicle or scrotum
- A sensation of heaviness in the scrotum
- A dull ache in the lower back
- A dull ache in the groin
- A dull ache in the abdomen
- A sudden accumulation of fluid in the scrotum
- Unexplained tiredness or malaise.
These symptoms may not necessarily be caused by cancer. In fact, less than 4% of lumps in the testicles are found to be cancerous. You should not ignore a lump or swelling in the testicle, though. It is important to see your doctor, who can find out what the cause is.
In rare cases the man may notice that his breast area is enlarged and tender. His nipples may feel sore and tender as well. This is caused by hormonal changes occurring in his body.
Even though testicular cancer can spread to the lymph nodes, it hardly ever travels to other organs. If the cancer does spread, the patient may experience:
- Breathing difficulties
- Swallowing difficulties
- Swelling in the chest.
On the next page we look at how testicular cancer is diagnosed, including physical examination and testing. On the final page we look at treatments for testicular cancer and how to self-check to ensure it is caught early if you have it.