Testicular cancer – the symptoms and treatment

Classed as one of the less common cancers, testicular cancer affects around 2,400 men each year.¹ Nicola Collins, team manager of our Cancer Care Team, explores the symptoms to look out for, how it’s diagnosed and the treatment for testicular cancer.

Who does testicular cancer affect?

Testicular cancer can affect anyone with testicles. This includes men, trans (transgender) women, and anyone assigned male at birth. It is most likely to happen between the ages of 25 and 40.²

According to Cancer Research UK, on average, each year only 1% of new cases were in males aged 75 and over, with age-specific incidence rates rising steeply from ages 15-19, peaking at ages 30-34 and then declining rapidly.³

Symptoms of testicular cancer

The most common symptom of testicular cancer is a lump or swelling in the testicle. The lump may be larger but is usually the size of a pea.

Other symptoms can include:

• One testicle becomes larger than the other.
• A difference in appearance.
• An ache or pain in the testicles or scrotum.
• A feeling of heaviness in the scrotum.

Not all lumps mean cancer, but any lump is worth getting checked out by a doctor. The NHS advise that: “These symptoms are very common and can be caused by many different conditions. Having them does not definitely mean you have testicular cancer. But it's important to get them checked by a GP”.⁴

How do you test for testicular cancer?

Macmillan advise that “from puberty onwards, it is important to check your testicles for any changes regularly”⁵

Carrying out a self-examination regularly will allow you to know what’s normal for you. A normal testicle should feel smooth and firm, but not hard.

Hold your scrotum in the palm of your hand. Use your fingers and thumb to examine each testicle. You should feel for:

• lumps or swellings,
• anything unusual,
• differences between your testicles.

It is normal for the testicles to be slightly different in size. It is also normal for one to hang lower than the other. If you’re concerned about anything or notice a lump, then see your doctor.

If you’re getting a lump checked out, then during a physical examination a doctor might shine a strong light through the scrotum (called a transillumination). This is for two reasons:

1. Light shows through a harmless, fluid filled cyst (for example a hydrocoele).
2. Light can't show through a cancer, which is a solid lump.⁶

If there’s any cause for concern, then you would be referred for further testing. Which could include:

• Scrotal ultrasound – a painless procedure that is one of the main ways to determine if a lump is cancerous. If the lump if filled with fluid then it’s usually ruled as harmless, if the lump is however more solid then this could be an indication of cancer being present.
• Blood tests – tests will be carried out to show any markers the blood. The tests are to see if certain hormones are present in the blood which can help confirm a diagnosis. However, it is worth noting that not all people with testicular cancer produce or have raised markers.⁷
• Histology – considered the most definitive way to confirm testicular cancer. This involves the lump to be examined under a microscope, however, a biopsy (removing a small piece of the lump) isn’t usually possible. So, the procedure instead requires the testicle to be removed completely. This is only carried out when a specialist is near certain the lump is cancerous.

How is testicular cancer treated?

Depending on what type of testicular cancer you have and what stage it’s at, depends on what type of treatment you will receive. The three main treatments however, are:

• surgery,
• radiotherapy,
• and chemotherapy.

Regardless of the stage, the first treatment option for all cases is surgery to remove the affected testicle. After this, for very early cancer (stage 1) your doctor will monitor you regularly to see if the cancer comes back – this is known as surveillance. If the cancer has a high risk of coming back, you may have chemotherapy.

The NHS say: “For stage 2 and 3 testicular cancers, 3 to 4 cycles of chemotherapy are given using a combination of different medications.”⁸ Some people with stage 2 testicular cancer are given less invasive radiotherapy, sometimes with a short course of chemotherapy, depending on the type of cancer cell involved.

In some people with stage 3 testicular cancer, further surgery is sometimes needed after chemotherapy to remove any affected lymph nodes or deposits in the lungs or, rarely, in the liver.

A specialist, however, will talk through the best option and outline the processes involved; as well as the advantages and disadvantages of each treatment. Usually, you will also be offered the chance to store 2-3 samples of semen – known as sperm banking; as the treatment can affect fertility.

Is testicular cancer curable?

The survival for testicular cancer is very high, and the outlook is one of the best for all cancers. In England, it’s said that 95% of men will survive their cancer for 1 year or more after they are diagnosed.⁹

If you’re concerned about anything you feel or notice, then it’s worth getting checked out even if it turns out to be nothing, early detection means the treatment is very likely to be successful. As the old saying goes ‘it’s better to be safe than sorry’.

If you do receive a cancer diagnosis, the news can feel overwhelming and you’ll have a lot of questions. Explore our cancer care articles for more information. If you're a member with AXA Health, here's more information on dedicated cancer support you may have access to.

Useful resources for help and support

• Macmillan Cancer Support
• Testicular Cancer UK
• Orchid – fighting male cancer

This information is based on guidance and evidence in men. If you’re a trans woman, male-assigned non-binary or intersex, this information is still relevant to you – but your experience may be slightly different.

References

1. What is testicular cancer? – Cancer Research UK
2. What is testicular cancer – Macmillan
3. Testicular cancer statistics – Cancer Research UK
4. Symptoms – NHS
5. How do I check for testicular cancer – Macmillan
6. Testicular cancer symptoms – Cancer Research UK
7. What are tumour markers? – Macmillan
8. Treating testicular cancer – NHS Inform
9. Survival for all stages of testicular cancer – Cancer Research UK