Testicular cancer & other testicular pathologies

Testicular cancer often presents with subtle or painless symptoms, which is why regular self-checks are important. Common signs include:

• A painless lump or swelling in one testicle

• A feeling of heaviness in the scrotum

• Dull ache or discomfort in the lower abdomen, groin, or testicle

• Enlargement or tenderness of the testicle

• Sudden fluid buildup in the scrotum

• Breast tenderness or growth (in rare cases, due to hormone changes)

Less commonly, if the cancer has spread, symptoms might include back pain, shortness of breath, or swollen lymph nodes.

Any change in the size, shape, or feel of your testicles should be checked by a doctor promptly. Early detection offers the best chance for a cure, with testicular cancer being one of the most treatable types of cancer.

Not all testicular lumps are cancer — in fact, many are benign and treatable. Common non-cancerous causes include:

• Epididymal cyst (spermatocele)
  A fluid-filled sac near the top of the testicle, usually painless and harmless.

• Hydrocele
  A collection of fluid around the testicle causing swelling, often in newborns but also in adults.

• Varicocele
  Enlarged veins in the scrotum, often described as feeling like a "bag of worms." May affect fertility.

• Epididymitis or orchitis
  Inflammation of the epididymis or testicle, often due to infection. Can cause pain, swelling, and redness.

• Inguinal hernia
  Part of the intestine bulges into the scrotum, causing a noticeable lump that may increase with standing or straining.

• Haematoma or trauma
  A lump caused by recent injury or bleeding in the scrotum.

Although most testicular lumps are not cancerous, any new lump or change should be checked by a doctor to rule out serious conditions and ensure proper treatment.

The exact cause of testicular cancer is not always known, but several risk factors have been identified that may increase a man's chance of developing it:

• Undescended testicle (cryptorchidism)
  Men whose testicles did not move down into the scrotum before birth have a higher risk, even if surgery was done to correct it.

• Family history
  Having a father or brother with testicular cancer slightly increases your risk.

• Personal history
  If you’ve had cancer in one testicle, you’re at greater risk of developing it in the other.

• Abnormal testicular development
  Conditions like Klinefelter syndrome may increase the risk.

• Age
  Most testicular cancers occur in men aged 20 to 40, though it can occur at any age.

• Ethnicity
  Testicular cancer is more common in Caucasian men compared to men of African or Asian descent.

• Infertility
  Some studies suggest a possible link between infertility and increased risk of testicular cancer.

While these factors can raise risk, many men who develop testicular cancer have no clear risk factors. Fortunately, it’s one of the most treatable cancers, especially when detected early.

Diagnosis of testicular cancer usually starts with a physical examination and a discussion of your symptoms. If a lump or abnormality is found, your doctor may order the following tests:

1. Scrotal Ultrasound

   • A painless, non-invasive scan that uses sound waves to create images of the testicles. It helps determine if a lump is solid (more likely cancer) or fluid-filled (more likely benign).

2. Blood Tests (Tumour Markers)

   • Certain types of testicular cancer release substances into the blood called tumour markers, such as:

     • AFP (alpha-fetoprotein)

     • β-hCG (beta-human chorionic gonadotropin)

     • LDH (lactate dehydrogenase)

   • These help confirm the diagnosis and guide treatment.

3. Imaging Scans (CT Scan or X-ray)

   • Used to check if the cancer has spread to other parts of the body (staging), especially the lungs, abdomen, or lymph nodes.

4. Surgical Removal (Orchiectomy)

   • If testicular cancer is strongly suspected, the affected testicle is usually surgically removed and sent to the lab for a definitive diagnosis. This is both a diagnostic and initial treatment step.

Treatment for testicular cancer is highly effective, even in cases where the cancer has spread. The choice of treatment depends on the type of cancer, its stage, and your overall health. Common treatment options include:

1. Surgery (Orchiectomy)

• The first step in treatment is usually the removal of the affected testicle through a procedure called an orchiectomy.

• This helps confirm the diagnosis and, in many cases, may be the only treatment needed if the cancer is caught early.

2. Surveillance

• For early-stage cancers, especially seminomas, active surveillance may be recommended after surgery — involving regular blood tests, scans, and check-ups without further immediate treatment.

3. Chemotherapy

• Used when the cancer has spread or is at higher risk of returning.

• It destroys cancer cells throughout the body and is highly effective, even in advanced cases.

4. Radiation Therapy

• Mainly used for seminomas, a type of testicular cancer that responds well to radiation.

• It targets lymph nodes to kill any remaining cancer cells.

5. Retroperitoneal Lymph Node Dissection (RPLND)

• A specialised surgery to remove lymph nodes in the abdomen if there’s a higher risk of spread, particularly in non-seminoma cases.

With early diagnosis and proper treatment, testicular cancer has one of the highest cure rates of any cancer.