The Facts About Testicular Cancer

While testicular cancer rates have been rising for years in the United States, it's still a relatively uncommon disease.

The American Cancer Society (ACS) estimates that fewer than 9,200 new cases of testicular cancer will be diagnosed in 2023 in the U.S. About 470 people will die from the disease this year.

Receiving any cancer diagnosis can be scary, especially when it's for a rare cancer. Fortunately, testicular cancer can usually be treated successfully. A man's lifetime risk of dying from this disease is about 1 in 5,000, according to the ACS. The five-year relative survival rate for the disease is 95 percent overall. That jumps to 99 percent when it is detected in the localized stage.

Testicular cancer is a disease that tends to affect young and middle-aged men. The average age at diagnosis is about 33 years old. For several decades, the rates of testicular cancer in the U.S. and around the world have increased for unknown reasons, but statistics show the increase has recently slowed.

Early diagnosis and treatment are important, so understanding the disease and the signs and symptoms that accompany it are crucial.

The testicles, also referred to as testes or male gonads, are the part of the male anatomy responsible for producing sperm and sex hormones, such as testosterone. In adult men, the testes are typically slightly smaller than a golf ball.

These two organs are housed in the scrotum, a sac of skin that hangs just beneath the base of the penis.

Sperm are made in the testicles through a process called spermatogenesis. This process occurs in the seminiferous tubules, which are the several hundred tubes located within each of the testicles.

It takes about 74 days for the sperm cells to reach maturation. When they do, the sperm cells are pushed to the epididymis, which is a tube located along the back side of each testicle, toward the top. The epididymis is connected to the vas deferens, which is the tube through which sperm is transported to the urethra and out of the body during ejaculation.

The sex hormones made by the testicles are responsible for the development of the male reproductive organs, as well as the development of a deeper voice, body hair and stronger muscles.

Testicular cancer is a disease that occurs when cells within the testicles begin to grow out of control. More than 90 percent of testicular cancers begin in germ cells, the cells that make sperm, according to the ACS.

The two main types of germ cell tumors are seminomas and nonseminomas. Statistics show that seminomas and nonseminomas occur at equal rates, with many testicular cancers containing both types of cells in what are known as mixed germ cell tumors.

Seminomas typically grow and spread more slowly than nonseminomas. These tumors are split into two main types:

• Classical seminoma. These typically occur in men ages 25 to 45 and account for more than 95 percent of seminomas.
• Spermatocytic seminoma. The rarer type of seminomas, this tumor usually appears in older men at an average age of 65. These tumors are slower to grow and less likely to spread to other areas of the body than classical seminomas.

Nonseminomas, on the other hand, are germ cell tumors that manifest mostly in men in their late teens to early 30s.

The four main types of nonseminoma tumors include:

• Yolk sac carcinoma. A type of tumor commonly found in boys.
• Embryonal carcinoma. A tumor that grows rapidly and spreads to other areas of the body.
• Choriocarcinoma. A tumor that is highly aggressive and spreads rapidly but is the rarest of all testicular cancers.
• Teratoma. A tumor made of several kinds of tissue, including bone, teeth, hair and muscle.

Other forms of testicular cancer can begin as carcinoma in situ of the testicle, stromal tumors, or cancer that starts elsewhere in the body and spreads to the testicles.

It is not yet known what causes testicular cancer. What is known is that testicular cancer begins when, for some reason, the DNA of the testicle cells begins to change. This leads to rapid growth and the multiplication of cancer cells.

Eventually, cancer cells can outnumber healthy cells, continue to grow and form a tumor. Tumors sometimes grow beyond the testicle in which they originate, and some cancer cells can spread to other parts of the body.

When testicular cancer grows beyond the testes, it is referred to as metastatic testicular cancer, which most often spreads to the lymph nodes, liver and lungs.

Early diagnosis and treatment are important when addressing any type of cancer, so recognizing the signs of the disease can be a lifesaver. If you experience symptoms in only one testicle, that's normal, because testicular cancer typically affects just one testis.

Some common symptoms of testicular cancer include:

• Presence of a lump or swelling in a testicle
• Swelling of the scrotum that comes on suddenly
• A feeling of heaviness in the scrotum
• Discomfort or pain in your testicle or scrotum generally
• Aching in the lower belly or groin area
• Back pain
• Swelling and tenderness of the breasts

If you experience any signs or symptoms of testicular cancer that last more than two weeks, contact your doctor. Early detection and treatment of testicular cancer is important to prevent the spread of the disease and to avoid further complications.

Some people may receive a testicular cancer diagnosis in a proactive way. They consult their doctor about symptoms they are experiencing or lumps and swelling they found during an at-home testicular self-exam. Recommendations vary, but many organizations encourage men to conduct a self-exam regularly.

In other cases, signs such as lumps or swelling may be discovered during a routine physical exam administered by your doctor.

After symptoms are discovered, your doctor may use one or more of the following tests to reach a diagnosis:

• Ultrasound
• Blood tests
• Surgery to remove and biopsy a testicle with a lump that is suspected to be cancerous

Once a testicular cancer diagnosis is given, further testing is done to determine the type and stage of testicular cancer.

Fortunately, testicular cancer is highly treatable even when it has spread to other parts of the body. Treatment most commonly involves a combination of surgery and chemotherapy. Options can vary based on the type of testicular cancer, its stage and the patient's preferences.

Surgery typically involves the removal of the affected testicle. In cases where there's concern that cancer may have spread, surgery may be required to remove affected lymph nodes.

Other potential treatment options include radiation therapy and immunotherapy.

Finding out you have testicular cancer can have a significant emotional impact. Leaning on your support system during this time is more important than ever, as is seeking professional support if you find yourself struggling.

One obvious concern for many men with testicular cancer is how it will affect their sex life in the long term. Some men may experience decreased sex drive after recovering from testicular cancer. This decline can be the result of anxiety and embarrassment surrounding losing a testicle or lowered testosterone production (low-T).

Counseling and open and honest communication with your partner can help address emotional issues regarding intimacy. As for your hormone levels, have them checked regularly. If you find that you have low-T, your doctor may recommend hormone replacement therapy (HRT).

Men whose treatment involved only the removal of the cancerous testicle are unlikely to face infertility. However, radiation and chemotherapy may cause long-term fertility issues. Talk to your doctor about banking sperm beforehand if you want to have children in the future.

Since the exact causes of testicular cancer remain unknown, there is no surefire way to prevent or avoid the disease. Still, a number of factors make an individual more at risk for developing testicular cancer.

These factors include:

• Having an undescended testicle
• A family history of testicular cancer
• Being a young adult
• Being a biological male of white/European descent

Talk to your doctor about your risk level and check yourself regularly for any abnormal symptoms. If you notice anything out of the ordinary, consult your doctor right away, as early detection and treatment are important for positive treatment outcomes.

Your care does not stop after your initial treatment for testicular cancer. In fact, it's vital to continue seeing your doctor for follow-up appointments. These appointments may consist of regular lab tests and other screening measures. Your doctor can continue to monitor you for any signs of a recurrence.

Follow-up care also allows you the opportunity to talk to your doctor about any side effects you may be experiencing from treatment. Issues such as low testosterone can be monitored and treated, which can have a positive impact on physical health, mood and sex drive.

The field of research into the treatment and prevention of diseases such as testicular cancer is active. Clinical trials are an important part of furthering that research.

If you're interested in participating in a clinical trial, it's important to do your research, talk to your doctor and take time to think about what is right for you. A list of active private and public clinical trials can be found at clinicaltrials.gov.

No testicular cancer patient has to suffer alone or without a wealth of available knowledge. A few handy resources include:

• The American Cancer Society
• Online communities
• Mayo Clinic
• Testicular Cancer Society (a good resource for caregivers)
• National Cancer Institute
• Testicular Cancer Foundation
• Testicular Cancer Awareness Foundation

• Is testicular cancer usually fatal?

  The American Cancer Society reports that a man's lifetime risk of dying from testicular cancer is very low, about 1 in 5,000. As is the case with any cancer, early detection and treatment are key to increasing your likelihood of achieving favorable treatment outcomes.

  Is testicular cancer very treatable?

  The good news is that testicular cancer is highly treatable, even in cases in which it has spread to other parts of the body. Treatment most commonly involves a combination of surgery and chemotherapy. Options vary based on the type of testicular cancer, its stage and the patient's preferences.

  What is the main cause of testicular cancer?

  The exact cause of testicular cancer remains unknown. However, experts do know that testicular cancer begins when the DNA of the cells in the testicle begins to change, leading to the rapid growth and multiplication of cancer cells. These can eventually outnumber healthy cells, grow and form a tumor. In some cases, the cancer can metastasize (spread) beyond the testicle to other parts of the body.