According to research, testicular cancer can strike even in the teenage years. (Credit: iStock)
Before they even turn 20 years old, women are taught that one of the healthiest things they can do for themselves is a breast self-examination to catch breast cancer early. Men, however, are rarely reminded about doing a self-exam for testicular cancer, which should also start at age 20.
Most young adult males think testicular cancer, which develops in the testicle or testis, will develop in their 60s (if at all), like prostate cancer. But the average age for men diagnosed with testicular cancer is 33 years old. Moreover, according to research published in the International Journal of Cancer, it can strike even in the teenage years: testicular cancer was the most common cancer in men ages 15 to 44 in 62 countries worldwide in 2020.
The average incidence of testicular cancer globally is 1.5 cases per 100,000 people. Testicular cancer, the 20th leading cancer type, had the highest incidence observed in Europe (7.2 – 8.7), followed by North America (5 – 5.6) and the lowest in Asia (0.4 – 1.7) and Africa (0.3 – 0.6).
How to prevent testicular cancer
Men with a father or brother who have developed testicular cancer are at high risk of the disease. (Credit: Getty Images)
Testicular cancer cannot be prevented, which makes early detection vital. Most men won't know they have it until they feel a lump in their testicle. More research is needed to determine when and why the cells that produce sperm can sometimes become a cancerous mass.
Men who are known to have the highest risk have:
- Male relatives who have developed testicular cancer
- Undescended testes or cryptorchidism (testes that did not drop before birth)
- Abnormal cells in the testicle called germ cell neoplasia (which are often discovered during an infertility test)
However, having a risk factor does not mean one will get testicular cancer. Also, men who have the disease may not always have a risk factor. This is why self-examination is vital.
How to do testicular self-examination
Testicular cancer needs to be caught early to prevent cancer cells from spreading. It can metastasise to the lungs and lymph nodes of the chest, pelvis and even the base of the neck.
Here are the following steps to conduct a testicular self-exam, ideally performed at least once a month. These are best performed while in the shower or bath and in warm water to keep the scrotum relaxed.
1. Examine one testicle at a time by holding and rolling it between the thumb and forefingers.
2. Feel the back of the testicles. The spermatic cord, which collects and carries the sperm, feels like a soft tube.
3. Feel for any bumps or hard, smooth or rounded lumps.
4. Pay attention to any changes in size, shape or consistency (firm or soft).
5. Pay particular attention to any painful areas.
6. Repeat the examination steps for the other testicle.
Six warning signs you may have testicular cancer
Self-exams are necessary to get to know the body. Familiarization with one's body through these regular checks is helpful when it comes to identifying an abnormal mass or noticing if something doesn't feel right. If a self-examination results in any of the following, do not hesitate to consult it with a doctor.
- A painless lump in the testicle.
- Swelling in the testicle (regardless of whether there is pain).
- Pain or a dull ache in the testicle, scrotum or groin.
- Tenderness or changes in the male breast tissue.
- A sudden build-up of fluid in the scrotum.
- Enlarged lymph nodes in the abdomen and/or neck.
Most men tend to shy away from medical check-ups for their penis, scrotum or testicles unless there is discomfort. But patients with testicular tumours overlook their condition precisely because there is no pain, further delaying a doctor's visit.
Tests to confirm testicular tumour
Apart from an ultrasound, diagnosing testicular cancer may include a chest x-ray to check if the cancer has spread to the lungs. Doctors may also order scans like CT, CAT, MRI or PET to check internal organs for any presence of cancer.
Blood tests will include the Serum Tumour Marker Test, according to the guidelines of the American Urological Association. This blood test will check the proteins that have been linked to specific types of cancer. The blood test measures the levels of these tumour markers:
- AFP (Alpha-fetoprotein)
- β-hCG (Beta-human chorionic gonadotropin)
- LDH (Lactate dehydrogenase)
If tumour markers for hCG and AFP are normal and findings on a physical exam or ultrasound are inconclusive, the best advice is to repeat the ultrasound in six to eight weeks.
Five frequently asked questions about testicular cancer
Scan and test results will help diagnose cancer. But surgery will be needed to determine the type of testicular cancer present, which is crucial for developing a treatment plan. Testicular tumours can be seminoma – which often occurs in men aged 30 to 50 – or non-seminoma, which often affects men in their 20s.
Unlike other cancers, though, a biopsy cannot be done for testicular cancer before committing to surgery. Instead, a surgeon needs to perform an orchiectomy or orchidectomy, removing one or both testicles.
1. Is there a way to avoid surgery?
If a doctor suspects testicular cancer, he will discuss treatment and surgical options with the patient.
2. Why can't a biopsy be done before surgery?
A tissue sample cannot be taken from the suspicious growth pre-surgery since it will require cutting through the scrotum. Doctors avoid biopsies done this way because it can cause cancer cells to spread into the scrotum and lymph nodes.
During surgery, a tissue sample is taken from the testicle for biopsy. The biopsy will then reveal if the types of germ cell tumours in the testicles are seminomas or non-seminomas.
3. Does testicular cancer treatment require chemotherapy or radiation therapy?
After an orchiectomy, doctors will recommend chemotherapy or radiation therapy to kill any remaining cancer cells. These are follow-up treatments and cannot replace orchidectomy. Tumour marker tests will be repeated after treatment to track progress over time.
Active sports can continue after testicular cancer treatment. (Credit: Getty Images)
Following surgery, patients must avoid lifting objects over 10 pounds (4.5 kg) for the first two weeks and having sex until fully healed. Doctors also advise against sports for about four weeks after surgery. Full recovery from an orchidectomy can take two weeks to two months.
4. What is the impact on one's sex life?
Many men worry that testicular cancer treatment will result in erectile dysfunction. But there should not be any problems with getting an erection after surgery. If lymph nodes were removed, ejaculation might be problematic.
Low libido is not uncommon, due to the physical side effects of chemotherapy, not to mention the mental toll of cancer in the first place. It can take time to fully recover.
On online support groups, recovering patients and their spouses share that the desire to have sex returns about three weeks post-chemotherapy.
5. Can I still have children?
Men should consult with their healthcare advisor about their chances of fathering children. Fertility should not be affected if there is only one healthy testicle, but cancer increases the risk of infertility, as well as low testosterone and sperm growth. However, these can be temporary as the remaining healthy testicle and lymph nodes will still produce testosterone in time.
While it cannot be prevented, testicular cancer survival is high when it is caught in its early stages. Surgery, coupled with chemotherapy or radiation, can cure almost 100 per cent of low-stage or early disease tumours and 85 per cent of more advanced tumours.
AIA can help one prepare for whatever happens in the future. Its insurance plans can ease the emotional burden by providing critical illness protection covering major illnesses, including early-stage cancer. It has policies to provide life insurance and cover intensive care unit stays, as well as cancer pay-outs.
Insurance is the best bet in preventive care for diseases like testicular cancer. Make sure you and your loved ones will have the financial and medical support you need.
Urology Care Foundation. What is Testicular Cancer? [online] [Accessed on June 6, 2022]
Testicular Awareness Foundation. Monthly Testicular self-exams. [online] [Accessed on June 6, 2022]
Testicular Cancer Foundation Org. Monthly shower self-exam. [online] [Accessed on June 6, 2022]
Wiley Online Library. 2022. International Global patterns in testicular cancer incidence and mortality in 2020. [online] [Accessed on June 6, 2022]
American Urological Association. 2019. Diagnosis and Treatment of Early Stage Testicular Cancer: AUA Guideline (2019) [online] [Accessed on June 6, 2022]
National Cancer Centre Singapore. Testicular Cancer - What it is. [online] [Accessed on June 6, 2022]
Cancer Research UK. 2021. Removing a testicle (orchidectomy) for testicular cancer [online] [Accessed on June 6, 2022]
World Cancer Research Journal. 2018. Testicular cancer in the world: an epidemiological review. [online] [Accessed on 30 June 2022]
Cureus. 2019. Precocious Puberty Associated with Testicular Hormone-secreting Leydig Cell Tumor. [online] [Accessed on 30 June 2022]