Testicular cancer often begins in the germ cells, i.e. cells that make sperm. While it can happen at any age, it’s diagnosed mostly in young men around the ages of 15 to 45. We rarely see it in children, younger teens, and older men. 

Testicular cancer is not common with about 1 of every 250 men developing testicular cancer. As per the 2023 American Cancer Society’s estimates, they’ve been about:

• 9,190 new cases of testicular cancer diagnosed
• 470 deaths from testicular cancer

However, testicular cancer has been increasing in America and across the world. Let’s learn more about this cancer.

What is testicular cancer?

Cancer that begins in the testicles is called testicular cancer. 

Testicles are part of the male reproductive system. These two walnut-shaped sex glands are slightly smaller than a golf ball. They’re located inside a sac of skin called the scrotum that hangs under the base of the penis. The functions of testicles are to make:

• Androgens or male hormones such as testosterone
• Sperm or the male cells needed to fertilize a female egg cell for pregnancy

Testicular cancer refers to the growth of abnormal cells that start in the testicles. Usually, it develops in one testicle, and less commonly in both the testicles.

Testicular cancer occurs when the cells multiply rapidly, forming a lump or tumor. Scientists are still not sure what causes the cells to behave this way or what causes testicular cancer. 

The tumor can grow beyond the testicle, before breaking away and spreading to other parts of the body, such as the lymph nodes, lungs, and liver. When testicular cancer spreads to other parts of the body, it is called metastatic testicular cancer.

There are factors that might increase the risk of testicular cancer, such as

• Being overweight and obese 
• Cryptorchidism (having an undescended testicle) 
• Carcinoma in situ of the testicle
• Family history of testicular cancer 
• Being a young male 
• Being white 
• Previous incidence of testicular cancer

Types of testicular cancer

We classify testicular cancer by the type of cells where the cancer begins.

The most common type of testicular cancer is germ cell testicular cancer, accounting for over 90% of the cases. The body uses germ cells to create sperm.

In germ-cell testicular cancer, the germ cells clump together to form a mass or tumor.  There are two subtypes of germ cell testicular cancer:

• Seminomas: These are the most common type accounting for 40%-45% of testicular cancers. It’s a slow-growing cancer that mostly affects men in their 40s-50s. There’s been an increase in the incidence of seminomas in the last two decades.  
• Non-seminomas: It grows more rapidly than seminomas, affecting younger males in their late teens, 20s, and early 30s. There are four types of non-seminoma tumors -embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and teratoma. 

Both types of germ-cell testicular cancer usually respond well to chemotherapy. Some testicular cancer tumors comprise both seminoma and non-seminoma cells. Less common testicular cancers of testicular cancer include:

• Leydig cell tumors account for around 1%-3% of cases
• Sertoli cell tumors account for less than 1% of cases

What are the first signs and symptoms of testicular cancer? 

Detecting the early signs of testicular cancer can help find better treatment options and timely recovery. 

Here are some first signs of testicular cancer: 

• A persistent bump, lump, or swelling on a testicle is usually the first sign of testicular cancer. It may be painful or painless.
• Heaviness or pain in the lower stomach and scrotum
• Sudden swelling or fluid buildup in the scrotum
• Breast growth and enlargement or loss of sexual desire 
• Soreness or tenderness of the breast 
• Back pain
• Testicular atrophy (shrinking testicle)
• Early puberty in boys 

Some of the first symptoms of advanced testicular cancer are: 

• Low back pain
• Shortness of breath
• Chest pain
• Cough, even coughing up blood
• Stomach pain
• Headaches or confusion

If you experience any of the above signs, consult your doctor right away. While some of these signs may be common to other conditions, and not testicular cancer, like testicle injury or inflammation, it’s better to be certain. 

It’s also smart to consult your best physician for men in Saratoga as sometimes, men with testicular cancer may not show any symptoms, even when it spreads to the other parts of the body. Medical tests taken during the doctor’s visit can help diagnose testicular cancer. 

When to See A Doctor

If you notice any symptoms that last longer than two weeks, it’s time to see your doctor. These symptoms can include any changes in your testicles or groin area in terms of texture and shape, such as a lump or swelling, a feeling of heaviness, and pain. 

The diagnostic tests for testicular cancer include

• Physical exam
• Chest X-Ray
• CT scan
• MRI
• PET scan
• Bone scan
• Scrotal ultrasound
• Blood tests 
• Histology 

Keep in mind that while these symptoms may not necessarily indicate testicular cancer, it’s always better to err on the side of caution and get checked out. 

In addition to seeking medical attention promptly, it’s important to stay vigilant and discuss any concerns with your healthcare provider. While most testicular cancer can be cured even in the advanced stages, its treatment is much more effective when diagnosed and treated early.

Diagnosis helps in identifying the stage of testicular cancer. Here are the stages of testicular cancer. 

• Stage 0 or Germ Cell Neoplasia In Situ (GCNIS): Abnormal cells develop but are still inside the testicles where sperm cells begin to develop.

• Stage I: The cancer is restricted to the testicle, including nearby blood or lymph vessels. The tumor markers may or may not be elevated in this stage. 
• Stage II: Cancer spreads to the lymph nodes in the back of your abdomen or the retroperitoneum. However, if there are moderately or highly elevated tumor markers when cancer has spread to the lymph nodes, then the patient is in Stage III and not Stage II.
• Stage III: The cancer spreads to lymph nodes beyond the abdomen and to other organs.

Staging helps provide key information such as the tumor size and the spread of cancer for making treatment decisions. 

What are the treatment procedures for testicular cancer?

While testicular cancer is a serious condition, it is treatable and curable even in the advanced stages. 

The treatment for testicular cancer depends on the tumor type, cancer stage, how far it has spread, your current health status, and treatment preferences. The treatments for testicular cancer are surgery, radiation, chemotherapy, and immunotherapy 

Surgery

Surgery is the most common treatment irrespective of the tumor type and cancer stage. While it is usually done to remove the cancerous testicle, the doctor might also remove the lymph nodes or remove tumors that have spread to the lungs and liver in some cases. There are two types of surgical procedures for testicular cancer.

• Radical inguinal orchiectomy: It is used to treat both seminoma and non-seminoma testicular cancers. 
• Retroperitoneal lymph node dissection (RPLND): It is usually done for non-seminoma testicular cancers. RPLND is used to treat cancer and can also be used for cancer staging.

Radiation 

Radiation involves the administration of high-dose X-rays to kill cancer cells, usually after surgery to prevent the return of the cancerous tumors. Radiation therapy is usually limited to the treatment of seminomas as they grow more slowly and respond better to it than non-seminomas. It is also preferred in early-stage seminoma or testicular cancer that’s spread to the brain. 

Chemotherapy

Chemotherapy uses drugs to kill cancer cells and has proven to improve the survival rate for people with both seminomas and nonseminomas. The doctor might opt for chemotherapy instead of surgery depending on the cancer type and stage. They may also decide to use it before an RPLND procedure, after a radical inguinal orchiectomy, or to treat cancer that’s returned after remission. Chemotherapy is not effective for a certain germ cell tumor called teratoma which needs to be removed with surgery. 

Immunotherapy

Immunotherapy is opted for in advanced testicular cancer cases and in cases where the patient has not responded to the other treatment procedures. It uses medication that aids the body’s immune system to kill cancer cells. Since cancer cells survive by hiding from the body’s immune system, immunotherapy helps the immune system cells find and kill the cancer cells effectively. 

The doctor will know the best treatment procedure for a specific testicular cancer case. Sometimes, more than one kind of treatment procedure might be required. Usually, surgery is performed first, followed by radiation and chemotherapy. 

If testicular cancer is both a seminoma and nonseminoma tumor, then they usually consider it as a nonseminoma case and treat it accordingly. As many nonseminomas are a combination of teratomas and other kinds of germ cell tumors, the treatment procedure entails chemotherapy first, followed by surgery to remove any remaining tumor. 

Taking a proactive approach can diagnose and treat testicular cancer effectively 

Unfortunately, testicular cancer isn’t preventable. Fortunately, it is curable and treatable even in the advanced stages. 

Since there’s no research that proves self-examinations can lower the risk of testicular cancer, the American Cancer Society (ACS) does not offer any recommendations for regular self-exams for men. However, the ACS recommends that you must consult your doctor immediately if you notice a lump in your testicle, and more so if it’s been persistent for over two weeks.

By being proactive about one’s health such as taking the yearly physical exam and seeking treatment when needed, men can take steps towards preventing and detecting testicular cancer early on.

(Disclaimer: We routinely draw upon public health resources to inform our write-ups. Information in this article may be drawn up from multiple public health sources, including:

• Centers for Disease Control & Prevention
• Medline Plus
• National Institutes of Health 
• American Medical Association
• American Association of Family Physicians
• Mayo Clinic
• Family Doctor