Testicular Cancer Awareness

What are the testicles and what do they do 

The testicles are two small oval shaped organs (they can also be called testes or gonads), and are the male sex glands. They are located behind the penis in a pouch of skin called the scrotum. The testicles produce sperm and testosterone. The testicles are located outside the body because sperm develop best at a temperature several degrees cooler than normal internal body temperature. 

The germ cells inside the seminiferous tubules create sperm. The sperm move into the epididymis where they mature. They are stored there for a few weeks until they eventually move up the vas deferens to combine with fluids from the prostate and seminal vesicles to form what you normally think of as semen. The whole process takes about seven weeks.

The leydig cells distributed throughout the testicle are the body's main source of testosterone. Testosterone, the male sex hormone, is essential to the development of the reproductive organs and other male characteristics such as:

• body and facial hair
• low voice
• muscle development
• the ability to have an erection
• sex drive (libido)

Without enough testosterone, a man may lose his sex drive and suffer from fatigue, depression, hot flushes and osteoporosis (thinning of the bones).

Causes and prevention

As with most cancers there are no clear cut causes. However, the risks are increased by:

• Testicle failing to get into the scrotum (undescended)
• A brother or father with testicular cancer
• A sedentary life style increases risk but regular exercise reduces risk
• Mumps or repeated trauma increases risk

There is no proven link between injury or sporting strains (i.e. being hit in the testes by a football) and testicular cancer. There is some evidence to suggest that an increase in hormone levels after an injury may accelerate precancerous changes. However, more significantly, an injury can produce a swelling, which may mask a tumour.

What to look out for

The most common symptoms are swelling in part, or a small lump on the side of the testicles. There may also be an ache in the lower abdomen or in the affected testicle although this is quiet rare. In a few men the testicle may suddenly become swollen and very tender.

A few patients who have very small tumours, occasionally may be diagnosed because they become generally unwell, possibly with night sweats, loss of appetite, weight loss, stomach ache, backache, a cough or develop tenderness in the breast due to tumour spreading outside the testicle. It is because of these cases that the doctors should routinely check the testicle as part of a routine examination of the abdomen.

However all of the above symptoms do not necessarily mean that the patient has testicular cancer, but if a patient does find a swelling in a testicle or any other symptom it is important that he goes to a GP as soon as possible to be checked over.

From the time of puberty onwards, it is important that all men are aware of what is normal for themselves (there are slight differences in everybody). It is picking up changes such as areas of hardening or swelling that indicate a need to do something.

The best time to check is in a warm bath or shower as the muscles of the scrotal sac are more relaxed.

Cradle the scrotum in the palm of both hands and use the thumb and fingers to gently squeeze the testicle, one at a time. Learn to differentiate between the main body and the epididymis collecting tubes (see fig.1). Lumps in the collecting tubes are more common and almost invariably benign. Lumps in the body are rarer but more important and need to be acted on quickly.

One testicle may hang lower than the other and be different in size and even have areas of discomfort without having testicular cancer.

The critical issue is looking for changes in consistency and areas of hardening and swelling, which are usually painless.

What to do if you are worried

If you do notice any changes, particularly hardening or heaviness, you should not allow your natural embarrassment to delay discussing this with your doctor as soon as possible.

As most lumps are benign, most patients with testicular discomfort don't have cancer. However, if your doctor is worried he may arrange for you to see a surgeon or organise an ultrasound or blood tests first.

If the tests suggest cancer, the affected testicle is usually removed surgically. If there is spread elsewhere, the diagnosis can be made by examining a biopsy under the microscope. In the rare instance that a tumour develops in a man with only one testicle it is sometimes possible to use chemotherapy to avoid losing it. If you are worried about the loss of a testicle a prosthesis can be inserted, your surgeon will advise you on the best time to have this procedure.

If the test suggests cancer, the affected testicle is usually removed surgically. If there is spread elsewhere, the diagnosis can be made by examining a biopsy under the microscope. In the rare instance that a tumour develops in a man with only one testicle it is sometimes possible to use chemotherapy to avoid losing it.

X-rays and scans are then performed to check for spread. If caught early enough, no further treatment may be needed. If it has spread, chemotherapy (drug treatment) is usually given for 2-3 months.

Different types of testicular cancer

Most lumps in the testicles are benign cysts, which are caused by a blockage in one of the tubes, these are not cancer. They do not spread to other parts of the body and are seldom a threat to life. Benign tumours can be removed by surgery if they become large and/or uncomfortable, and they are not likely to return. Malignant tumours (cancers), can invade and destroy nearby healthy tissues and organs. Cancerous cells can also spread, or metastasise, to other parts of the body and form new tumours.

The two main types of testicular cancer are – seminomas and teratomas, (occasionally testicular tumours can be a mix of both types). These tumours are also known as Germ Cell Cancers as they develop in germ cells within the testis. Seminomas account for about 40 percent of all testicular cancer. Usually, seminomas are slow growing and tend to stay localised in the testicle for long periods and occur in men between 25 and 55 years of age. Teratomas usually affect a younger group of men from 15 to 35 years old and tend to be more aggressive than seminomas. Less commonly, cancers can develop within other cells within the testis, these are known as Non-Germ Cell Cancers.