Sudden, severe pain in a testicle is an emergency. Go to the emergency room now. It can be testicular torsion, a twisted testicle that cuts off its own blood supply. Torsion needs surgery within hours to save the testicle. Don’t wait to see if it gets better.
What is testicular cancer?
Testicular cancer is a disease in which cancer cells form in the tissues of one or both testicles. The testicles are the male sex glands. They make testosterone and sperm.
Inside the testicles, germ cells make immature sperm. The sperm travel through a network of tiny tubes into the epididymis, a long coiled tube next to each testicle, where they mature and are stored. Almost all testicular cancers start in the germ cells.
There are two main types of these germ cell tumors. They grow and spread differently and are treated differently, so knowing which one you have shapes your plan.
Seminoma
Tends to grow and spread more slowly than nonseminoma. Seminomas are more sensitive to radiation.
Nonseminoma
Tends to grow and spread more quickly. A tumor that contains both seminoma and nonseminoma cells is treated as a nonseminoma.
Who is at risk?
Testicular cancer is the most common cancer in men 20 to 35 years old. Your risk is higher if you:
- Had an undescended testicle (one that did not move down into the scrotum)
- Had abnormal development of the testicles
- Have had testicular cancer before
- Have a family history of testicular cancer, especially in a father or brother
- Are White
Signs and symptoms
Testicular cancer often causes swelling or discomfort in the scrotum. Make an appointment if you notice any of these:
- A painless lump or swelling in either testicle
- A change in how a testicle feels
- A dull ache in the lower belly or the groin
- A sudden build-up of fluid in the scrotum
- Pain or discomfort in a testicle or in the scrotum
Many lumps in the scrotum turn out not to be cancer. Fluid collections (hydroceles), enlarged veins (varicoceles) and cysts are common. But a firm lump in the testicle itself needs to be checked promptly. Knowing how your testicles normally feel makes it easier to notice a change. Other testicular conditions Dr. Su treats.
How is it diagnosed?
Physical exam
Dr. Su checks the testicles for lumps, swelling or pain.
Ultrasound of the testicles
Sound waves bounce off the tissue inside the scrotum and make echoes, which form a picture called a sonogram. It is painless, and it shows whether a lump is solid or filled with fluid and whether it is inside the testicle.
Blood tests for tumor markers
Some testicular cancers release proteins into the blood. The main markers are alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (beta-hCG), and another test called LDH is often checked too. Marker levels are measured before surgery to help diagnose the cancer, and again afterward to follow it.
Treatment
Surgery is the main treatment for testicular cancer. Depending on the type and stage, other treatments may be offered. Testicular cancer is usually very treatable, even when it has spread beyond the testicle.
Thinking about children in the future? Treatment can affect fertility. Talk with Dr. Su about it before surgery. Many men choose to bank sperm first.
Orchiectomy
Orchiectomy is the surgery used to both diagnose and treat testicular cancer, whether it is early or later stage. Dr. Su removes the entire testicle and the tumor through a small cut in the groin, along with the spermatic cord (which holds the testicle’s blood vessels and the tube that carries sperm). A pathologist then identifies the cell type, and scans show whether the cancer has spread. Together these set the stage.
If the other testicle is normal, it usually makes enough testosterone on its own. If you are concerned about how you look, a testicular prosthesis (an artificial testicle) is an option. Routine surveillance after surgery makes sure the cancer doesn’t return.
Other treatments
Testis-sparing surgery
Removes just the tumor, not the whole testicle. It is recommended only for some men: the mass must be very small and the tumor markers must be normal. It is best for tumors that turn out to be benign. If the tumor is cancer and the other testicle is normal, it is not recommended. Close follow-up afterward is important.
Retroperitoneal lymph node dissection (RPLND)
A complex operation that removes lymph nodes at the back of the abdomen. It is typically used for nonseminoma tumors that may come back, and can be used instead of chemotherapy for stage IIA or IIB nonseminoma. Afterward, either chemotherapy or surveillance is offered, based on where the cancer was found, its type and the risk that it will return.
Radiation
Kills cancer cells in the testicle area or in nearby lymph nodes. It is used mainly for seminoma, because some forms of nonseminoma resist radiation. It may also be an option for either type if the cancer has spread to distant organs, such as the brain.
Chemotherapy
Used when cancer has spread beyond the testicle, or if tumor markers rise after surgery. Markers and imaging guide how much is needed and whether it is working. One, two or three drugs may be combined, usually given in three or four cycles of three weeks each. Sometimes surgery follows to remove any remaining tumors.
Follow-up care
Even when testicular cancer is found early and treated, follow-up tests are recommended. These usually include regular checkups, tumor marker blood tests and imaging, on a schedule that depends on the type and stage of your cancer. If the cancer ever returns, more treatment will be needed, and recurrences are often still treatable.
Questions patients ask
Does a painless lump mean I have cancer?
Not always. Many scrotal lumps are fluid collections, cysts or enlarged veins. But a firm lump in the testicle itself should be seen soon. An exam and an ultrasound usually give a clear answer quickly.
What should I do about sudden testicle pain?
Go to the emergency room right away. Sudden, severe pain can mean testicular torsion, which needs surgery within hours to save the testicle.
Will losing one testicle affect my testosterone or sex life?
If the remaining testicle is normal, it usually makes enough testosterone, and erections and sex drive are usually not affected. If your levels are low, testosterone can be checked and treated. See low testosterone.
Can I still have children?
Many men can father children with one healthy testicle. Treatments such as chemotherapy or lymph node surgery can affect fertility, though, so talk with Dr. Su before surgery. Banking sperm ahead of time keeps your options open.
How long will I need follow-up?
Usually for several years, with checkups, tumor marker blood tests and scans. Visits are more frequent at first and spread out over time. The exact schedule depends on your type and stage of cancer.