Symptoms and Diagnosis of Testicular Cancer

The Testicles

The testicles (also called testes or gonads) are the male sex glands. They are located behind the penis in a pouch of skin called the scrotum. The testicles produce and store sperm, and they are also the body's main source of male hormones. These hormones control the development of the reproductive organs and other male characteristics, such as body and facial hair, low voice, and wide shoulders.

What Is Cancer?

Cancer is a group of more than 100 diseases. Although each kind differs from the others in many ways, every type of cancer is a disease of some of the body's cells.

Healthy cells that make up the body's tissues grow, divide, and replace themselves in an orderly way. This process keeps the body in good repair. Sometimes, however, some cells lose the ability to limit and direct their growth. They grow too rapidly and without any order. Too much tissue is produced, and tumors are formed. Tumors can be either benign or malignant.

• Benign tumors are not cancer. They do not spread to other parts of the body and are seldom a threat to life. Benign tumors can often be removed by surgery, and they are not likely to return.

• Malignant tumors are cancer. They can invade and destroy nearby healthy tissues and organs. Also, cancer cells can spread, or metastasize, to other parts of the body and form new tumors.

Cancer that develops in a testicle is called testicular cancer. When testicular cancer spreads, the cancer cells are carried by blood or by lymph, an almost colorless fluid produced by tissues all over the body. The fluid passes through lymph nodes, which filter out bacteria and other abnormal substances such as cancer cells. Surgeons often remove the lymph nodes deep in the abdomen to learn whether testicular cancer cells have spread.

Symptoms

Testicular cancer is one of the most common cancers in young men between the ages of 15 and 34. But the disease also occurs in other age groups, so all men should be aware of its symptoms.

Most testicular cancers are found by men themselves, by accident or when doing testicular self-examination (TSE). The testicles are smooth, oval-shaped, and rather firm. Men who examine themselves regularly become familiar with the way their testicles normally feel. Any changes in the way they feel from month to month should be reported to a doctor.

Testicular cancer can cause a number of symptoms. Listed below are warning signs that men should watch for:

• A lump in either testicle.
• Any enlargement of a testicle.
• A feeling of heaviness in the scrotum.
• A dull ache in the lower abdomen or the groin.
• A sudden collection of fluid in the scrotum.
• Pain or discomfort in a testicle or in the scrotum.
• Enlargement or tenderness of the breasts.

These symptoms are not sure signs of cancer. They can also be caused by other conditions. However, it is important to see a doctor if any of these symptoms lasts as long as 2 weeks. Any illness should be diagnosed and treated as soon as possible. Early diagnosis of testicular cancer is especially important because the sooner cancer is found and treated, the better a man's chance for complete recovery.

Diagnosing Testicular Cancer

When a man's symptoms suggest that there might be cancer in a testicle, the doctor will ask about his personal and family medical history and do a complete physical exam. In addition to checking general signs of health (temperature, pulse, blood pressure, and so on), the doctor will carefully examine the scrotum. Also, the patient will usually have a chest x-ray and blood and urine tests. If the physical exam and lab tests do not show an infection or another disorder, the doctor is likely to suspect cancer because most tumors in the testicles are cancer.

The only sure way to know whether cancer is present is for a pathologist to examine a sample of tissue under a microscope. To obtain the tissue, the affected testicle is removed through the groin. This operation is called inguinal orchiectomy. The surgeon does not cut through the scrotum and does not remove just a part of the testicle because, if the problem is cancer, cutting through the outer layer of the testicle might cause local spread of the disease.

The most common types of testicular cancer are seminoma and nonseminoma.

• Seminomas make up about 40 percent of all cases.
• Nonseminomas are actually a group of cancers. They include choriocarcinoma, embryonal carcinoma, teratoma, and yolk sac tumors.

Each of these two major types of testicular cancer grows and spreads differently -- and they are treated differently (information about testicular cancer treatment is covered in another article).

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.