Testicular Cancer

testicular-head


Every man should know how to check his balls.

What are testicles?

Testicles are where sperm and testosterone are made in the body. They are an essential part of a man’s body because the testosterone they make gives men the hair on their chests, causes their balls to drop and their penises to grow during puberty.

The testicles- or ‘balls’ as most of us prefer to call them-hang on the outside because they need to be at a lower temperature than the rest of your body so they can make sperm.

One of my testicles is hanging lower than the other. Is that normal?

Yes. All men have one testicle that hangs a bit lower than that other. It's 100% normal. It helps to stop them bashing into each other giving that 'kicked in the balls' feeling.

What is testicular cancer?

Testicular cancer is relatively rare. However, it is the most common cancer found in young men aged between 15 and 34 years. Each year about 176 men are diagnosed with testicular cancer in Ireland.  It usually affects one testicle.

What are the main symptoms of testicular cancer?

The most common symptom for testicular cancer is a lump or swelling in either testicle- it can be as small as a pea or it may be much larger.

Remember that most testicle lumps are NOT cancer. However, you should still ask your GP to look at any lump in your balls to be sure.

Other symptoms to look out for are:

  • any enlargement of the testicle
  • a feeling of heaviness in the scrotum (ball sack)
  • a dull ache in the abdomen or groin
  • a sudden collection of fluid in the scrotum
  • enlargement or tenderness of the breasts

Any of these symptoms can also have benign (i.e. non-cancerous) causes, but if you have any of them, go to your GP to get them checked out.

It's important to remember that testicular cancer may not cause any discomfort or pain, especially in the early stages. They may also not be obvious which is why it’s important to check your balls every month.

How do I check my testicles?

It's pretty quick and easy to check your testicles. It's best to examine your testicles after a warm bath or shower when your ball sack (scrotum) is relaxed.

Support your balls in the palm of one hand. It’s important to get hands on so that you know what the normal size and weight of your balls is. This will help you to detect any changes in the future.

  • Your balls should be smooth, firm and comfortable to touch. They shouldn’t be painful or lumpy.
  • You should be able to feel a soft tube at the top and back of both of your balls. This tube (epididymis) carries the sperm. It may be slightly tender but don’t worry, this is supposed to be there.
  • Now examine each testicle more carefully by rolling it between your fingers and thumb. Press firmly but gently to feel for any lumps, swellings or changes in firmness.
  • Examine yourself every month or when you remember to do it. Testicular cancer is rare so you don’t need to do this too often- once every month or so is fine. But if you do find anything unusual, don't wait for it to disappear or start throbbing – talk to your GP straight away.

What's the risk?

Testicular cancer is the most common cancer affecting men aged 15—34 in Ireland but the lifetime risk of developing the disease is still only 1 in 169. However it is important to always remain vigilant and check your testicles. That way if you do find something you find it early so that it is curable without too much treatment.

Other risk factors include being born with undescended testicles. Men with a brother or father who had a testicular tumour have a much higher risk of developing this cancer.

What causes it?

  • Undescended testicles- This is the most important risk factor. In the womb, the testicles develop in a male baby's abdomen. They usually move down into the scrotum at birth, or within the first year of life. If they move down later, or need surgery to bring them down this is called undescended testicle.
  • Fertility problems- There is a significant link between infertility and testicular cancer risk but doctors are still not really sure why this is. It’s possible that it’s because testicular cancer and fertility problems share some of the same risk factors.  But as the overall risk of testicular cancer is small, so there is only a small increase in risk for men with fertility problems.  
    Previous cancer-
    Men who have had testicular cancer have a 12 times increase in their risk of developing a second testicular cancer in the other testis. So it is important for them to attend follow up appointments after treatment and continue to examine the remaining testicle monthly.
  • Family history- Brothers or sons of men who have had testicular cancer have an increased risk of testicular cancer. 
  • Carcinoma in situ of the testicle (CIS)- CIS means that there are abnormal cells in the testicle. But these cells are completely contained and so cannot spread to other parts of the body the way cancer cells can. CIS of the testicle is not cancer, but if left untreated, it will develop into cancer in about half the men who have it (50%). There is no lump and usually no other symptom. CIS is most often found when a man has a testicular biopsy to investigate infertility. CIS can be treated by removing the testicle to prevent testicular cancer from developing.

How can I prevent it?

You can't. Testicular cancer can’t be prevented so the best thing you can do for you and your balls is to check them every so often to make sure they are smooth, firm and comfortable to touch. They shouldn’t be painful or lumpy.

Should I see a doctor?

If you have any of the symptoms listed above or you are generally feeling unwell you should see your doctor as soon as possible.

Your doctor will examine your testicles and, if he or she suspects a problem, you'll probably be referred to a consultant (normally a urologist which is a doctor who specialises in the urinary tract and sexual organs). Your testicles will be examined again and you may be asked to have an ultrasound (a painless procedure) and a blood test.

What are the main treatments for testicular cancer?

  • If your doctor suspects that you might have testicular cancer, the testicle will almost always have to be surgically removed so that a detailed biopsy (diagnostic test) can be performed. Unfortunately it isn't possible to do a biopsy on a testicular tumour without removing the testicle. Normally it will be reasonably certain before surgery that the testicle contains a tumour, and most surgeons will therefore remove the testicle without taking a further biopsy during the operation.
  • If your cancer has been caught early, and hasn't spread to other parts of the body, removing your testicle may be the only treatment required. There are two types of testicular cancer known as a seminoma or teratoma. Seminoma is usually treated by a short course of radiotherapy. Teratoma is usually treated by chemotherapy. Your case will be presented and discussed at a Multidisciplinary Team meeting and you will be offered the treatment that provides the best cure rate for you. This could also mean a policy of surveillance (keeping a close eye on things) only.
  • If the cancer has spread to other parts of the body, however, further treatment will usually be required. The first place that testicular cancer usually spreads to are the lymph nodes in the back of the abdomen. If follow-up X-rays/ CT scan suggest that cancer is in these lymph nodes then surgery to remove them may be necessary to get a better picture of the stage the disease has reached. Chemotherapy or radiotherapy may also be necessary as discussed earlier.
  • Because the treatment can sometimes affect fertility, you should always be offered the opportunity to store a supply of sperm first. This is a free service if you have been diagnosed with testicular cancer.
  • If you have a testicle removed, you may be given the option of having an artificial replacement fitted, to make your scrotum (ball sack) look normal. This can be done at the same time as the testicle is being removed. The artificial testicle has no function but it is mainly done for cosmetic reasons.

What's the outlook?

Generally the outlook for men with testicular cancer is excellent. Testicular cancer is one of the easiest cancers to treat. So, if you do find a lump, don’t panic, but do go and talk to your GP as soon as possible. The earlier testicular cancer is treated the better!


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