Men's Health

Testicular Cancer

Testicular cancer is one of the most common cancers in young men, and represents 30% of all cancers in 25-39 year olds. It starts as an abnormal growth or tumour that develops in one or both testicles. It is a highly treatable type of cancer with a very good cure rate (over 95%) if found and treated early.
  • Testicular cancer is one of the least common forms of cancer with an estimated incidence of approximately 7.2 in every 100,000 men
  • The incidence of testicular cancer varies across the globe from as low as 1 man in 100,000 in many African nations to a high as 20 men in 100,000 in parts of Europe
  • African and Asian men appear to have a much lower incidence of testicular cancer
  • An average of 175 cases of testicular cancer were diagnosed per year in Ireland between 2008-2010
  • 92.4% of men diagnosed with testicular cancer are under the age of 50
  • There is an average of 5 deaths from the disease in Ireland per year
  • The lifetime risk of an Irish man being diagnosed with testicular cancer by the age of 74 is 0.5%
  • Instances of testicular cancer are increasing in Ireland. Similar trends have been reported internationally, where worldwide incidence rates have more than doubled in the past 40 years
  • Relative survival rates for testicular cancer have also increased, with the five-year relative survival rate being 97.6% for men with testicular cancer in Ireland, which may reflect the fact that the majority of patients are now diagnosed at an early stage (stage I)
  • Less than 10 men a year are diagnosed over the age of 50
  • Testicular cancer in young men would rank as 1st. Testicular cancer is actually the most common cancer diagnosed in young men in Ireland (aged between 15 and 39)


What is testicular cancer?
Cancer begins when cells in a part of the body begin to grow abnormally. As these cancer cells grow and divide, they invade normal tissue and form a tumour. As the tumour grows, it is possible that some cells will get into the bloodstream or lymph vessels, travel to other parts of the body and begin to grow and form new tumours in a process called metastasis.
Cancer that develops in one or both testicles is called testicular cancer. The testicles are part of the male reproductive system and are responsible for the production of male hormones (mostly testosterone) and sperm. 
Testicular cancer commonly presents as a small hard lump, with swelling or a change in the consistency of the testicle. Some men also experience a dull ache in the testicle or lower abdomen. In the majority of cases, only one testicle is affected. 
Men, regardless of age, who find such an abnormality should go to the doctor immediately.

Are there different types of testicular cancer?
Cancers of the testicle are named after the type of cell in which they develop. Testicular cancer can be grouped into three types of tumours:
1.    Germ cell tumours
2.    Stromal tumours
3.    Secondary testicular tumours

More than 90% of testicular cancers develop in germ cells, which are responsible for the production of sperm. There are two main types of germ cell tumours; seminomas and non-seminomas. Testicular cancer can include a mix of seminoma and non-seminoma cells or a combination of the different types of non-seminoma including;

  • Classical seminoma (85%)
  • Anaplastic seminoma (10%)
  • Spermatocytic seminoma (5%)
  • Choriocarcinoma
  • Embryonal Carcinoma
  • Teratoma
  • Yolk Sac Tumour
A small number of testicular cancers start in cells that make up the supportive (structural) and hormone producing tissue of the testicles. These are call stromal tumours and have two main types:
  • Leydig cell tumours
  • Sertoli cell tumours
Secondary testicular tumours are caused by cancerous cells that have spread to the testicles from other parts of the body. These cancers are much rarer than the previous forms of testicular cancer.

What are the risk factors?
Young men between the age of 25 and 39 years are at the highest risk of developing testicular cancer. The causes of testicular cancer are unknown, however possible factors that may increase a man’s risk include:
  • Undescended testes at birth
  • Family history (father or brother with testicular cancer)
  • Previous incident of testicular cancer (Around one in 25 men who have had cancer in one testicle are likely to develop cancer in the other testicle at some stage)
  • Down syndrome may also increases a man’s risk
There is no known link between testicular cancer and injury to the testicles, sporting strains, hot baths or wearing tight clothes.

What are the symptoms?
Men may experience few or no symptoms of testicular cancer. Important symptoms to watch for include:
  • Swelling or a lump in either testicle (usually painless)
  • A feeling of heaviness in the scrotum
  • Change in the size and shape of the testicles
  • Aches or pain in the lower abdomen or groin
  • A sudden build-up of fluid in the scrotum
  • Pain or discomfort in a testicle or in the scrotum
  • Enlargement or tenderness of the breast tissue
What is testicular self-examination (TSE)?
Regular self-examination of the testicles is important for young men, particularly those at risk of testicular cancer. Being familiar with the size, shape and usual level of lumpiness can help you determine if something is not quite right. 
A testicular self-examination can help a man find any changes in the testes early, so that if treatment is needed it can start as early as possible.
A step-by-step guide for conducting a testicular self-examination can be found here.

Testicular cancer is a highly treatable cancer, and can be effectively treated, and potentially cured, if diagnosed and treated early. Advanced testicular cancer can also be cured with treatment.
If diagnosed with testicular cancer, the most important step is to talk at length with your doctor about your treatment choices. In choosing a treatment plan, factors such as your overall health and the type and stage of the cancer should be considered. You may consider getting a second or third doctor’s opinion.
In most men with testicular cancer, treatment involves the surgical removal of the affected testicle. This may be followed with surveillance, chemotherapy or radiotherapy.
An orchiectomy (surgical removal of the affected testis) is done under general anaesthetic. The removed testis is then sent to a pathology laboratory to confirm the stage and type of cancer. 
Chemotherapy or radiotherapy is often prescribed after surgery to treat any remaining cancer cells that may have spread to other parts of the body, such as lymph nodes. The level or amount of chemotherapy and radiotherapy will be different for each man and will depend on the stage and type of cancer. 
Testicular cancer and the removal of one testicle should not alter sexual function or fertility. The effect on fertility following removal of one of the testicles is minimal as a single testicle produces such large numbers of sperm.
For more detailed information of treatment options visit the Irish Cancer Society’s website.

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