Testicular cancer affects around 2,300 men each year in the UK, making it relatively rare. However, unlike many cancers that are more common in older adults, testicular cancer is the most common cancer in males aged 15–49, with cases being highest in men aged 30–34.
Testicular cancer is one of the most treatable types of cancer when diagnosed early, with around 97% of men surviving for 10 years or more. Finding it early can make treatment easier, which is why checking your testicles regularly and knowing what is normal for you is so important.
What is testicular cancer?
Testicular cancer occurs when cells in one or both of your testicles grow abnormally. The testicles are 2 oval-shaped organs that are part of the male reproductive system. They are located in a pouch called the scrotum, just under the penis.
Most cases of testicular cancer start in the germ cells, which are responsible for making sperm. These cancers are usually classified into 2 main types: seminomas and non-seminomas. The type of cancer can affect which treatment is most suitable.
Symptoms of testicular cancer
A painless lump or swelling in one testicle is the most common symptom of testicular cancer, but there are other symptoms to look out for, including:
- A swollen testicle or a testicle that has become larger than usual
- A change in the shape, size or firmness of a testicle
- An ache, pain or feeling of heaviness in your scrotum
- Pain in your testicle
Less common symptoms can include:
- Pain in your lower back or lower abdomen
- Tenderness or swelling in your chest or around your nipples
In most cases, these symptoms are caused by something other than cancer. They may be due to an infection, cyst or another condition. However, it's still important to have any symptoms or unusual changes checked by your GP as soon as possible.
When to seek emergency help
Sudden, severe testicular pain can be a sign of testicular torsion, a serious condition where a testicle twists and its blood supply is interrupted.
If you experience sudden, severe testicular pain, testicular pain accompanied by nausea or abdominal pain, or testicular pain that lasts more than an hour or continues while resting, go to A&E immediately or call 999.
Testicular torsion requires urgent medical treatment.
Performing a self-exam
Checking your testicles is easy to do and doesn't take long. The best time to do it is either in the shower or just after you have a warm bath or shower. This is because your scrotum will be relaxed, making it easier to feel your testicles.
The NHS recommends checking your testicles regularly, around once a month from puberty onwards. Checking regularly helps you get to know what is normal for you, so you're more likely to notice if something changes.
The first few times you check your testicles, you will be getting to know what feels normal for you. Everyone is different and most men have one testicle that is slightly larger than the other. It is also normal for one testicle to hang lower than the other. A normal testicle should feel smooth and quite firm but not hard.
Hold your scrotum in your palm and use your other hand to gently roll one testicle at a time between your thumb and fingers. Move your fingers around so that you check the whole testicle, feeling for any lumps, swellings, changes in firmness or pain. Repeat this with your other testicle.
Behind each testicle, you will find the epididymis, which is a soft, coiled tube that stores and transports sperm. You may be able to feel this during your examination. This is a normal part of your anatomy.
Harmless cysts can sometimes develop in the epididymis. However, if you notice a new lump, swelling, pain or any other change in this area, you should still see your GP to find out what is causing it.
Remember, the most important thing is to know what feels normal for you. If you notice anything unusual, don't wait until your next monthly self-exam to get it checked.
When should you see your GP?
If you notice a lump, swelling, pain or any unusual change in your testicles, it's important to arrange an appointment with your GP as soon as possible.
Most lumps and changes are not caused by cancer, but getting checked can help identify any problems early. If testicular cancer is diagnosed, early detection increases the chances of successful treatment.
Getting a diagnosis of testicular cancer
If your GP thinks testicular cancer is a possibility, they may arrange an urgent ultrasound scan or refer you to a specialist for further tests.
An ultrasound scan of your testicles is usually one of the first tests carried out. This uses a handheld device that produces high-frequency sound waves to create images of the inside of your testicles. This helps doctors identify any unusual lumps or changes.
You may also have blood tests to measure substances called tumour markers, which can sometimes be raised in people with testicular cancer. However, not all testicular cancers produce raised tumour markers, so normal blood test results do not necessarily rule out cancer.
If cancer is suspected, you may also need to have a CT scan of your chest, abdomen and pelvis. This uses X-rays and computer technology to create detailed images of the inside of your body. It helps doctors check whether cancer has spread.
Treating testicular cancer
In most cases, the affected testicle is removed surgically during a procedure called an orchidectomy. The removed tissue is then examined to confirm the diagnosis and identify the type of cancer.
For some men, surgery is the only treatment needed. However, regular follow-up appointments, blood tests and scans are usually recommended to check for any signs of the cancer returning. This is called surveillance.
A prosthetic testicle (testicular implant) can also be inserted for cosmetic reasons, if you choose to have one.
For other men, further treatment may be needed depending on the type and stage of cancer and whether it has spread. This may include chemotherapy, radiotherapy or additional surgery.
Radiotherapy is only used for certain types and stages of testicular cancer, while chemotherapy may be recommended to reduce the risk of cancer returning or to treat cancer that has spread.
Your specialist will discuss the most appropriate treatment options with you based on your individual circumstances.
Testicular cancer treatment and fertility
Some treatments for testicular cancer can affect your fertility, particularly chemotherapy and certain types of radiotherapy.
If only one testicle needs to be removed, the remaining testicle can usually continue to produce sperm and enough testosterone. This means that many men can still have children naturally.
However, testicular cancer itself and some treatments can affect sperm production. Before starting treatment, your healthcare team will discuss any potential effects on your fertility and offer you the option of sperm banking.
Sperm banking involves collecting and freezing sperm so that it can be stored and potentially used for fertility treatment in the future.
If you're concerned about your fertility or are planning to have children, it's important to discuss this with your specialist before treatment begins.
Sources
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Cancer Research UK (n.d.) Testicular cancer statistics. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/testicular-cancer
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Cancer Research UK (n.d.) Testicular cancer survival statistics. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/testicular-cancer/survival
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National Institute for Health and Care Excellence (NICE) (2015) Suspected cancer: recognition and referral (NG12) – Recommendations organised by site of cancer. https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer
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NHS (n.d.) How to check your testicles. https://www.nhs.uk/tests-and-treatments/how-to-check-your-testicles/
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NHS (n.d.) Testicular cancer. https://www.nhs.uk/conditions/testicular-cancer/
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Spire Healthcare (n.d.) Testicular cancer. https://www.spirehealthcare.com/conditions/testicular-cancer/
