All about Testicular Cancer: Warning Signs, Diagnosis and Treatment

Testicular cancer cases in India have been rising steadily over the past few years, particularly among young men aged 15 to 40. The silver lining is that testicular cancer is highly treatable, with survival rates exceeding 95% when detected early. That said, many Indian men remain unaware of the warning signs or hesitate to seek medical help due to discomfort or cultural taboos around discussing testicular health.

What is Testicular Cancer?

Testicular cancer occurs when cells in one or both testicles begin to grow uncontrollably, forming a tumour. The testicles, located in the scrotum, are essential for producing sperm and testosterone, the hormone responsible for male development and reproductive health. While most lumps in the testicles are not cancerous, some can indicate malignancy. The exact cause is often unknown, but certain factors, such as undescended testicles, family history of the disease, or previous testicular cancer, can increase risk.

What are the Types of Testicular Cancer?

Testicular cancer mainly originates from germ cells, which are responsible for producing sperm. These tumours are broadly classified into two types:

1. Seminoma

Seminomas grow slowly compared to other testicular cancers and are highly sensitive to radiation therapy. They most commonly occur in men aged 25 to 45 and tend to remain confined to the testicle for a longer period before spreading to lymph nodes or other organs. Because of their slower growth, seminomas often have a favourable prognosis and respond well to both surgery and radiation.

2. Non-Seminoma

Non-seminomas grow faster and are more likely to spread early, often to the lymph nodes, lungs, or other parts of the body. This type generally affects younger men, usually between 15 and 35 years. Non-seminomas include several subtypes, such as embryonal carcinoma, yolk sac tumour, choriocarcinoma, and teratoma. Treatment typically involves surgery and chemotherapy, depending on the stage, and early detection is critical due to their aggressive nature.

Who is Most at-Risk of Developing Testicular Cancer?

Testicular cancer can affect any man, but certain factors increase the likelihood of developing the disease:

• Age: It primarily affects younger men, especially those between 15 and 40 years, which are considered the most productive years of life.
• Undescended Testicles (Cryptorchidism): Men born with one or both testicles that did not descend properly into the scrotum face a higher risk. This risk persists even if surgical correction (orchiopexy) is performed during childhood.
• Family History: A family history of testicular cancer, such as a father or brother being affected, significantly increases the chances of developing it.
• Previous Testicular Cancer: Men who have had cancer in one testicle are at a higher risk of it occurring in the other testicle.
• Genetic Conditions: Certain genetic disorders, such as Klinefelter’s syndrome, may raise the risk by affecting normal testicular development.
• Ethnicity: Men of European descent have a slightly higher likelihood of developing testicular cancer compared to men of African or Asian descent. However, it is important to note that cases occur in all ethnic groups.

What are the Warning Signs and Symptoms of Testicular Cancer?

Early detection of testicular cancer is essential, as the disease can progress quickly but often shows subtle signs initially. Men should pay attention to the following symptoms:

• Lump or Swelling in the Testicle: The most common symptom is a firm, painless lump or swelling in one testicle. Even small lumps, often about the size of a pea, should not be ignored.
• Change in Size or Shape: Any noticeable enlargement, shrinking, or irregular shape of a testicle compared to the other may indicate abnormal growth.
•   Heaviness or Dragging in the Scrotum: A persistent feeling of heaviness, tightness, or dragging in the scrotum can sometimes be an early warning sign.
• Pain or Discomfort: Some men experience a dull ache, sharp pain, or discomfort in the testicle, scrotum, lower abdomen, or groin area. Pain may come and go, making it easy to overlook.
• Fluid Accumulation (Hydrocele): Sudden or unexplained fluid buildup in the scrotum may accompany the tumour, though it is not always painful.
• Breast Changes (Gynecomastia): Hormonal changes caused by certain testicular tumours can occasionally lead to breast tenderness or enlargement.
• Back, Abdominal, or Groin Pain: If cancer spreads to lymph nodes, it can cause persistent pain in the lower back, abdomen, or groin region.
• General Symptoms: Fatigue, unexplained weight loss, or a feeling of being unwell may sometimes accompany advanced stages of the disease.

Regular self-examinations and awareness of these warning signs are key to catching the disease early.

How Can You Check Yourself for Testicular Cancer?

Testicular self-examination (TSE) is one of the simplest yet most effective tools for early detection of testicular cancer. Follow these steps once a month to familiarise yourself with your testicles and notice any changes:

• Hold the Testicle: Gently hold one testicle at a time with both hands.
• Roll and Feel: Roll the testicle between your thumbs and fingers, feeling for any lumps, hard areas, or unusual swellings.
• Check the Epididymis: Identify the soft, tube-like structure at the back of each testicle (the epididymis).
• Repeat for the Other Testicle: Perform the same steps on the other testicle
• Observe the Scrotum: Look in the mirror for any visible swelling, changes in size, or asymmetry.

How is Testicular Cancer Diagnosed?

If a lump, swelling, or other warning signs are detected during self-examination, a doctor will perform a series of tests to confirm whether it is testicular cancer. The common diagnostic methods include:

Physical Examination

The process begins with a thorough physical examination. The doctor will carefully examine both testicles, feeling for lumps, changes in size, firmness, or irregularities in texture. The scrotum, groin, abdomen and neck are also checked for enlarged lymph nodes or swelling, which could indicate that the cancer has spread. This step helps the doctor understand the location and extent of any abnormality.

Ultrasound of the Testicles

Ultrasound provides crucial information about the size, shape, and internal structure of the testicle, assisting the doctor in making a more accurate diagnosis.

Blood Tests

Certain substances, called tumor markers, can be found in the blood if testicular cancer is present. These include alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH). Measuring these markers helps identify the type of testicular cancer, gives an indication of tumour activity, and can guide decisions about the most suitable treatment plan. Tumor markers are also useful for monitoring response to treatment and detecting recurrence after therapy.

Imaging Tests

Once cancer is suspected, imaging tests such as CT scans, MRI scans, or chest X-rays may be performed. These tests reveal whether the cancer has spread to lymph nodes, lungs, or other organs. Determining the stage of cancer is critical for planning the treatment approach and estimating the prognosis.

Surgical Evaluation

In many cases, a radical inguinal orchiectomy is performed, which involves removing the affected testicle through a small incision in the groin. The removed tissue is examined under a microscope to confirm the diagnosis and identify the exact type of cancer. This procedure is often both diagnostic and therapeutic, as it removes the primary source of cancer while providing essential information for further treatment.

Additional Tests if Needed

In some cases, additional tests such as PET scans or needle biopsy of lymph nodes may be recommended to get more detailed information about the spread of cancer and to help plan chemotherapy or radiation therapy if needed.

What are the Stages of Testicular Cancer?

Doctors use staging to understand how far testicular cancer has spread and to plan the next steps. The stage is worked out using a combination of blood tests (which check for tumor markers), imaging scans such as ultrasound or CT scans (which show the tumor and any spread to organs or lymph nodes), and findings from nearby lymph nodes. These tests help show whether the cancer is limited to the testicle or has moved to other parts of the body.

Testicular cancer is generally classified into three main stages:

Stage 1
At this stage, the cancer is limited to one testicle. It has not spread to nearby lymph nodes or to other organs. Many people are diagnosed at this early stage. Treatment usually starts with surgery to remove the affected testicle. After surgery, doctors may advise regular follow-up visits or further treatment based on specific risk factors.

Stage 2
In stage 2, the cancer has spread outside the testicle to nearby lymph nodes, most often in the abdomen or pelvis. It has not reached distant organs. Treatment often includes surgery along with chemotherapy or radiation therapy. The exact approach depends on the type of testicular cancer and how many lymph nodes are involved.

Stage 3
Stage 3 means the cancer has spread to distant parts of the body, such as the lungs, liver, brain, or distant lymph nodes. Treatment at this stage is more intensive. It usually involves combination chemotherapy and, in some cases, surgery to remove any remaining cancer after chemotherapy.

The stage of cancer plays a key role in determining the treatment plan. Early-stage cancer (Stage 1) may require less intensive treatment and has excellent cure rates, while more advanced stages (Stage 2 and 3) need stronger, combined treatments.

What Treatment Options are Available?

Testicular cancer is one of the most treatable types of cancer, especially when diagnosed early. The treatment plan depends on the type of cancer, its stage, and overall health of the patient. Common treatment options include:

1. Surgery

Surgery is often the first line of treatment for testicular cancer. The primary procedure is a radical inguinal orchiectomy, which involves removing the affected testicle through a small incision in the groin. This not only helps remove the primary tumour but also provides tissue for accurate diagnosis and staging.

In some cases, lymph node surgery (retroperitoneal lymph node dissection) may be performed if cancer has spread to abdominal lymph nodes.

2. Radiation Therapy

It is most commonly used for seminomas, which are highly sensitive to radiation. This treatment is usually recommended when there is a risk of cancer spreading or after surgery to prevent recurrence.

3. Chemotherapy

It is often used for non-seminomas or when cancer has spread beyond the testicle. Chemotherapy may be given before or after surgery, depending on the stage and aggressiveness of the cancer.

4. Surveillance (Active Monitoring)

In some cases, particularly with early-stage cancer, doctors may recommend active surveillance after surgery. This involves regular follow-ups with blood tests, imaging scans, and physical examinations to monitor for any signs of recurrence. Surveillance is often chosen to avoid unnecessary treatment when the risk of recurrence is low.

5. Fertility Considerations and Sperm Banking

Since treatment for testicular cancer, especially surgery and chemotherapy, can affect fertility, doctors often discuss sperm banking before starting treatment. This allows men to preserve their ability to father children in the future.

Conclusion

Testicular cancer stands out as one of the most curable cancers, particularly when identified in its early stages. Monthly self-examinations, combined with awareness of warning signs and prompt medical attention when concerns arise, can make a life-saving difference. If you discover any unusual lumps, swelling, or other concerning symptoms, book an appointment with Rajiv Gandhi Cancer Institute & Research Centre’s (RGCIRC) uro-oncology and medical oncology specialists for expert assessment and personalised care. Our team provides comprehensive screening, diagnosis, and advanced treatment for testicular cancer and other urologic malignancies. To consult a cancer specialist at Rajiv Gandhi Cancer Institute & Research Centre, call us at +91-11-47022222.

Frequently Asked Questions

What causes testicular cancer to develop in men with no family history?

The exact cause is often unknown. Some factors, such as undescended testicles, abnormal testicular development, or certain genetic conditions, may increase the risk. However, most men who develop testicular cancer have no family history or clear risk factor, which makes regular self-checks important.

Can testicular cancer affect fertility, and is it reversible after treatment?

Yes, treatment can affect sperm production and fertility, especially chemotherapy, radiation, or removal of a testicle. Fertility may recover partially or fully over time, but it can sometimes be permanent. Men planning to have children are usually advised to consider sperm banking before treatment.

How often should men perform testicular self-exams?

Self-exams should be done once a month, ideally after a warm shower or bath when the scrotum is relaxed. This helps men notice lumps, swelling, or changes in size or shape early.

Are there lifestyle factors that can reduce the risk of developing testicular cancer?

No lifestyle changes can guarantee prevention. Maintaining overall health, avoiding harmful chemical exposures, and staying aware of testicular changes are the most effective ways to reduce the risks of delayed diagnosis.

Can testicular cancer come back after treatment, and how is recurrence monitored?

Recurrence is uncommon but possible. Doctors usually monitor with blood tests for tumor markers, regular physical exams, and imaging scans. Early detection of recurrence allows prompt treatment, which improves outcomes.

Is it normal for one testicle to hang lower than the other, or is this a warning sign?

It is normal for one testicle, usually the left, to hang slightly lower. This alone is not a warning sign. Sudden changes in size, shape, firmness, or new lumps should be checked by a doctor.

Do testicular injuries increase the risk of developing cancer later?

Minor injuries or trauma do not cause cancer. Pain or swelling after an injury is usually temporary, but any persistent lump or unusual change should be evaluated by a doctor to rule out other issues.