Testicular Cancer: Frequently Asked Questions

What is testicular cancer?

Testicular cancer is cancer that starts in the testicles. The testicles are two male reproductive organs that hang below the penis in a sac called the scrotum.

In adult males, each testicle is usually slightly smaller than a golf ball. The testicles make several hormones, mainly testosterone. They also make reproductive cells called sperm. There are different kinds of cells in each testicle, each of which can grow into one or more types of cancer.

Overall, testicular cancer is not that common. However, it is the leading cause of cancer in men in their twenties and thirties. Some doctors recommend performing testicular self-exams to help find testicular cancer in its early stages, when it is most treatable, although it's not clear if testicular self-exams lower the death rate for this cancer. 

Who gets testicular cancer?

This disease most commonly occurs in men in their 20s and 30s, although it can happen at any age.

White men are more likely to get testicular cancer than black men. Men in Europe and the United States have the highest risk of getting testicular cancer. African and Asian men have the lowest risk. Researchers do not know what accounts for these differences.

What causes it?

Doctors are not sure what causes testicular cancer. The rate of testicular cancer is slightly higher in white men, as well as in higher income groups. Doctors do not know if this is because a lifestyle factor plays a part in who gets testicular cancer. Doctors do know, however, some risk factors for testicular cancer. For example, an undescended testicle (a testicle that does not move from the abdomen into the scrotum) increases a man's risk for the disease. Also, a man who has had cancer in one testicle is more likely to get it in the other testicle. A man who has a family history is slightly more at risk for getting testicular cancer.

If you have any of the risk factors for testicular cancer, talk to your doctor about the need for monthly testicular self-exams.

What are the symptoms of testicular cancer?

Men with early testicular cancer may or may not notice symptoms. Symptoms of testicular cancer can include:

• A lump on a testicle. The lump may be painless but uncomfortable.

• Enlargement of a testicle.

• Feeling of heaviness or aching in the scrotum or lower abdomen.

• Rarely, men may have swelling in the breasts.

• Pain in the lower back may be a symptom of later-stage testicular cancer.

• If the cancer has spread to the lungs, men may experience shortness of breath, pain in the chest, and a cough.

In rare cases, men may have no symptoms but may be infertile. Tests to figure out why the man is infertile may lead to finding the testicular cancer.

If I have testicular cancer, does this mean I'm infertile?

Although it is rare for testicular cancer to cause sterility, it may cause low sperm counts. Treatments for testicular cancer, such as surgery (to remove the affected testicle or retroperitoneal lymph nodes), chemotherapy, and radiation therapy, may affect fertility. If a man has both testicles removed, he will not be able to produce sperm and will therefore be sterile. Men who are about to be treated for testicular cancer should talk to their doctor about their options, in case they want to have children in the future. One of these options is sperm banking, but this must be done before treatment starts.

What is the difference between seminoma and nonseminoma cancer of the testicles?

Although there are many kinds of testicular cancer, most of these can be placed in two categories: seminoma and nonseminoma. These two types occur about equally. Both are known as germ cell cancers because they begin in germ cells. Germ cells are cells that have the potential to grow and develop into large numbers of different tissues and organs in a developing fetus.

There are several different types of nonseminomas. Nonseminomas are faster growing than seminomas and have a higher tendency to spread to other parts of the body.

There are other kinds of testicular cancer, but they are rare.

What is sperm banking?

Before being treated for testicular cancer, many men go to a sperm bank to give a sample of their sperm. Sometimes you need to do this sperm collection more than once to be able to preserve enough healthy sperm. This sample is then preserved at very cold temperatures. It remains alive for many years, even decades, and can be used to start a pregnancy. Since testicular cancer often strikes men who have not yet begun families but who may want to in the future, sperm banking is something that each man should think about and discuss with his doctor if fertility and having children is an issue for him.

How is testicular cancer diagnosed?

Symptoms in the testicles can be caused by cancer or by other, less serious problems, such as inflammation in the testicle (orchitis) or in the epididymis, which is tissue surrounding the testicle through which sperm passes. To find out the cause of any of the signs or symptoms, a man's doctor will do a careful physical exam and ask about the man's family medical history. During the physical exam, the doctor will feel the testicles for any swelling or tender areas, as well as feel a lump, if one is present, to note its size and location. The doctor may also do one or more of the following tests:

• Ultrasound of the testicles. This may be done if a lump is present. An ultrasound uses sound waves to find out if a lump is solid or fluid-filled. Solid lumps are more likely to be cancerous. 

• Blood tests. These tests can help find out if certain proteins, called tumor markers, that can signify cancer are present. Some testicular cancers raise blood levels of proteins, such as alpha fetoprotein (AFP) or human chorionic gonadotropin (HCG). Doctors may be able to tell what kind of testicular cancer a man has depending on if and what protein levels are higher. Blood tests can also help in follow up care, to make sure the cancer has not come back.

• Surgery to remove the testicle. If a suspicious lump is found, a surgeon will remove the tumor so that a pathologist can see if it is cancerous. The surgeon will try to remove the whole tumor, along with the testicle and the spermatic cord. This is done through an incision just above the pubic area. The testicle and spermatic cord are removed to help make sure the cancer cells do not spread.

If cancer is found, a man will need more tests so doctors can learn details about the cancer. These may include:

• CT scan. In this test, an X-ray beam takes pictures of the inside of the body from many angles. A computer puts the images together, providing a detailed cross section image. A CT scan can help a doctor learn if the cancer has spread to the lymph nodes or to organs, such as the lungs, liver, or brain. 

• Other tests. Chest X-rays, MRI scans, PET scans, and other tests may be done to look for metastasis or spread.

What are the treatments for testicular cancer?

Treatment for testicular cancer is either local or systemic. Local treatments remove, destroy, or control the cancer cells in one certain area. Surgery and radiation are local treatments. Systemic treatments are used to destroy or control cancer cells throughout the entire body. Chemotherapy is a systemic treatment. A man may have just one treatment or a combination of treatments:

• Surgery. The goal of surgery is to remove the tumor. This is called a radical inguinal orchiectomy. This requires removing one of the testicles (or both testicles if both have cancer). If both testicles are removed, a man will not be able to produce sperm and will be infertile. In some cases, lymph nodes in the back of the abdomen may need to be removed as well, which is called retroperitoneal lymph node dissection (RPLND). Surgery is almost always the first step in treating testicular cancer.

• Radiation therapy. Radiation uses X-rays to kill cancer cells. Most often, the goal of radiation for testicular cancer is to kill cancer cells that have spread to lymph nodes.

• Chemotherapy. Chemotherapy uses medicine to kill cancer. In testicular cancer, chemotherapy may be given before surgery to shrink a tumor or after to make sure all cancer cells are gone. It may be given alone to treat testicular cancer that has spread to other parts of the body.

What's new in testicular cancer research?

Researchers are trying to learn more about the changes in the DNA of testicular cancer cells. Recent studies have helped doctors learn which patients may need lymph node surgery or radiation and which ones may not. Studies have also found ways to determine which men may need more aggressive treatment. Doctors are studying the use of stem cell transplant in treating testicular cancer. This treatment allows men with poor prognoses to have more aggressive chemotherapy and then be "rescued" with healthy cells to replenish their bone marrow stem cells. New combinations of chemotherapy drugs are always being studied.

What are clinical trials?

Clinical trials are studies of new kinds of cancer treatments. Doctors conduct clinical trials to learn about how well new treatments work and what their side effects are. If they look promising, they are then compared with the current treatments to see if they work better or have fewer side effects. People who participate in these studies may benefit from access to new treatments before the FDA approves them. Participants also help further our understanding of cancer and help future cancer patients.

Should everyone get a second opinion?

Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion, including if the person is not comfortable with the treatment decision, if the type of cancer is rare, if there are different ways to treat the cancer, or if the person is not able to see a cancer expert.

How can I get a second opinion?

There are many ways to get a second opinion:

• Ask a primary care doctor. He or she may be able to recommend a specialist such as a surgeon, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or programs.

• Call the National Cancer Institute's Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.

• Seek other options. Patients can get names of doctors from their local medical society, a nearby hospital, a medical school, or local cancer advocacy groups, as well as from other people who have had that type of cancer.