Testicular Cancer
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Most cases of testicle cancer can be found at an early stage. In some cases, early testicle cancers cause symptoms that lead men to seek medical attention. Unfortunately, however, some testicle cancers may not cause symptoms until after reaching an advanced stage, and others may cause symptoms that appear to be due to a disease other than cancer.
Signs and Symptoms of Testicular Cancer
In about 90% of cases, men have a painless or an uncomfortable lump on a testicle, or they may notice testicular enlargement or swelling. Men with testicle cancer often report a sensation of heaviness or aching in the lower abdomen or scrotum.
In rare cases, men with germ cell cancer notice breast tenderness or breast growth. This symptom results from the fact that certain types of germ cell tumor secrete high levels of a hormone called human chorionic gonadotropin (HCG), which affects breast development. Blood tests can measure HCG levels; these tests are important in diagnosis, staging, and in follow-up of some testicular cancers.
Testicular Leydig cell tumors and Sertoli cell tumors often result in a mass than can be distinguished from a germ cell tumor only by examination of the tumor under a microscope. However, some Sertoli cell or Leydig cell tumors produce androgens (male sex hormones) or estrogens (female sex hormones). These hormones may cause symptoms that provide clues to the correct diagnosis. Estrogen-producing tumors of men may cause breast growth and/or loss of sexual desire. Androgen-producing tumors may not cause any specific symptoms in men, but in boys they can cause growth of facial and body hair at an abnormally early age.
Even when testicle cancer has spread to other organs, only about 1 man in 4 may experience symptoms related to the metastases prior to diagnosis. Lower back pain is a frequent symptom of later-stage testicle cancer. If the cancer has spread to the lungs and is well advanced, shortness of breath, chest pain, cough, or bloody sputum may develop.
Some men with testicular cancer have no symptoms at all, and their cancer is found during medical testing for other conditions. Sometimes, imaging tests done to find the cause of infertility can uncover a small testicular cancer. Or, testicular biopsies to evaluate infertile men may find carcinoma in situ.
There are a number of non-cancerous conditions, such as testicle injury, that can produce symptoms similar to those of testicle cancer. Inflammation of the testicle, known as orchitis, can cause painful swelling. Causes of orchitis include viral or bacterial infections. About 1 man in 5 who contracts mumps as an adult experiences orchitis in one or both testes.
If you have any of the signs or symptoms described above, discuss them with your doctor without delay. Remember, the sooner you receive an accurate diagnosis, the sooner you can start treatment and the more effective your treatment will be.
Doctors agree that examination of a man's testicle is an important part of a general physical examination. The American Cancer Society includes the examination in its recommendations for routine cancer-related checkups.
The issue of regular testicular self-examination is more controversial. The American Cancer Society believes it is important to make men aware of testicular cancer and remind them that any testicular mass should be evaluated by a doctor without delay. Some doctors feel that delay in seeking medical attention after discovering a mass is the most common reason for a delay in treatment. Other doctors feel that not noticing masses promptly is also an important factor in delaying treatment, and they recommend monthly testicular self-examination by all men after puberty. The ACS does not feel that there is any medical evidence to suggest that, for men with average testicular cancer risk, monthly examination is any more effective than simple awareness and prompt medical evalution. However, the choice of whether or not to perform this examination should be made by each man, so instructions for testicular examination are included in this section. Because men with certain risk factors, such as undescended testicle (cryptorchidism), previous germ cell tumor on one side, have an increased risk of developing testicular cancer, monthly examinations should be seriously considered for these men and the ACS suggests they discuss this issue with their doctor.
If you plan to perform the self-exam the best time to do so is during or after a bath or shower, when the skin of the scrotum is relaxed. Stand in front of a mirror and hold the penis out of the way. Examine each testicle separately. Hold the testicle between the thumbs and fingers with both hands and roll it gently between the fingers. Look and feel for any hard lumps or nodules (smooth rounded masses) or any change in the size, shape, or consistency of the testes. Contact your doctor if you detect any troublesome signs. Be aware that the testicles contain blood vessels, supporting tissues, and tubes that conduct sperm and that some men may confuse these with a cancer. If you have any doubts, ask your doctor.
Related Services at the Tang Center
For Students:
- Advice Nurse: (510) 643-7197
- Appointments: (510) 642-2000
- Self Care Resource Center: (510) 642-7202
For Faculty and Staff:
- Please refer questions to your health plan or primary care provider.
- CancerNet
http://www.cancer.gov/cancerinfo/pdq/treatment/testicular/Patient - University of Pennsylvania Cancer Center
http://www.oncolink.upenn.edu/types/
Disclaimer: The information provided here is not intended to diagnose, treat or provide a second opinion on any health problem or disease. It is meant to support, not replace, the relationship that exists between an individual and his/her clinician.
Last revised: September 2005
