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| Symptoms Involving The Testicles |
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The testicles are a part of the male reproductive system. These two organs, each normally somewhat smaller than a golf ball in adult males, are contained within a sac of skin called the scrotum, which hangs beneath the penis. The testicles manufacture the several male hormones. The most abundant is testosterone. They also produce sperm, the male reproductive cells. Sperm cells are carried from the testicle by the vas deferens to the seminal vesicles where they are mixed with fluid produced by the prostate gland. During ejaculation, sperm cells, seminal vesicle fluid, and prostatic fluid enter the urethra, the tube in the center of the penis through which both urine and seminal fluid exit the body.
Signs and symptoms
There are a number of conditions that can produce symptoms involving the testicles, for example such as a painless or an uncomfortable lump on a testicle, sensation of heaviness or aching in the lower abdomen or scrotum or a testicular enlargement or swelling. Inflammation of the testicle, known as orchitis, can cause painful swelling. Causes of orchitis include viral or bacterial infections. About 1 man in 5 who contracts mumps as an adult experiences orchitis in one or both testes. An injury involving a testicle can also produce these symptoms.
In about 90% of cases of testicle cancer, men have a painless or an uncomfortable lump on a testicle, or they may notice testicular enlargement or swelling. Men with testicular cancer often report a sensation of heaviness or aching in the lower abdomen or scrotum.
Testicle (or testicular) cancer is cancer that develops in one or both testicles in men or young boys (also called the testes; a single testicle is also called a testis). Testicular cancer is a highly treatable and usually curable form of cancer.
In rare cases, men with one type of testicular cancer called germ cell cancer notice breast tenderness or breast growth. This symptom results from the fact that certain types of germ cell tumors secrete high levels of a hormone called human chorionic gonadotropin (HCG), which affects breast development. Blood tests can measure HCG levels; these tests are important in diagnosis, staging, and in follow-up of some testicular cancers.
Two other types of testicular cancer, testicular Leydig cell tumors and Sertoli cell tumors, often result in a mass that can be distinguished from a germ cell tumor only by examination of the tumor under a microscope. However, some Sertoli cell or Leydig cell tumors produce androgens (male sex hormones) or estrogens (female sex hormones). These hormones may cause symptoms that provide clues to the correct diagnosis. Estrogen-producing tumors of men may cause breast growth and/or loss of sexual desire. Androgen-producing tumors may not cause any specific symptoms in men, but in boys they can cause growth of facial and body hair at an abnormally early age.
Even when testicular cancer has spread to other organs, only about 1 man in 4 may experience symptoms related to the metastases prior to diagnosis. Lower back pain is a frequent symptom of later-stage testicle cancer. If the cancer has spread to the lungs and is well advanced, shortness of breath, chest pain, cough, or bloody sputum may develop.
Some men with testicular cancer have no symptoms at all, and their cancer is found during medical testing for other conditions. Sometimes, imaging tests done to find the cause of infertility can uncover a small testicular cancer. Or, testicular biopsies to evaluate infertile men may find carcinoma in situ.
If you have any of the signs or symptoms described above, discuss them with your doctor without delay. Remember your symptom might not be testicular cancer but if it is, the sooner you can start treatment, the more effective your treatment will be.
Testicular examination
Doctors agree that examination of a man's testicle is an important part of a general physical examination. The American Cancer Society includes the examination in its recommendations for routine cancer-related checkups.
The issue of regular testicular self-examination is more controversial. The American Cancer Society believes it is important to make men aware of testicular cancer and remind them that any testicular mass should be evaluated by a doctor without delay. Some doctors feel that delay in seeking medical attention after discovering a mass is the most common reason for a delay in treatment. Other doctors feel that not noticing masses promptly is also an important factor in delaying treatment, and they recommend monthly testicular self-examination by all men after puberty. The ACS does not feel that there is any medical evidence to suggest that, for men with average testicular cancer risk, monthly examination is any more effective than simple awareness and prompt medical evaluation. However, the choice of whether or not to perform this examination should be made by each man, so instructions for testicular examination are included in this section. Because men with certain risk factors (cryptorchidism, previous germ cell tumor on one side) have an increased risk of developing testicular cancer, monthly examinations should be seriously considered for these men and the ACS suggests they discuss this issue with their doctor.
If you plan to perform the self-exam the best time to do so is during or after a bath or shower, when the skin of the scrotum is relaxed. Stand in front of a mirror and hold the penis out of the way. Examine each testicle separately. Hold the testicle between the thumbs and fingers with both hands and roll it gently between the fingers. Look and feel for any hard lumps or nodules (smooth rounded masses) or any change in the size, shape, or consistency of the testes. Contact your doctor if you detect any troublesome signs. Be aware that the testicles contain blood vessels, supporting tissues, and tubes that conduct sperm and that some men may confuse these with a cancer. If you have any doubts, ask your doctor.
Can testicular cancer be found early?
Most cases of testicular cancer can be found at an early stage. In some cases, early testicular cancers cause symptoms that lead men to seek medical attention. A smaller number of testicle cancers may not cause symptoms until after reaching an advanced stage, and others may cause symptoms that appear to be due to a disease other than cancer.
What are the risk factors for testicular cancer?
A risk factor is anything that increases a person's chance of getting a disease such as cancer. Different cancers have different risk factors. For example, unprotected exposure to strong sunlight is a risk factor for skin cancer, smoking is a risk factor for lung cancer and several other cancers, and a diet high in fat and low in fiber is a risk factor for colorectal cancer.
Scientists have found certain risk factors that make a person more likely to develop testicle cancer. Even if a man does have one or more risk factors for this disease, it is impossible to know for sure how much that risk factor contributed to developing the cancer. And, many men with testicular cancer do not have any of the known risk factors.
Age: Most testicular cancers occur between the ages of 15 and 40. But, this cancer can affect males of any age, including infants and elderly men.
Cryptorchidism: The main risk factor for testicular cancer is a condition called cryptorchidism, or undescended testicle(s). This term comes from the Greek words kryptos meaning hidden and orchis meaning testicle. In a fetus, the testicles normally develop inside the abdomen and descend into the scrotum before birth. In about 3% of boys, however, the testicles do not make this descent. Sometimes the testicle remains in the abdomen; in other cases, the testicle starts to descend but remains stuck in the groin area. About 14% of cases of testicle cancer occur in men with a history of cryptorchidism. The risk of testicle cancer is somewhat higher for a testicle that was positioned in the abdomen, as opposed to one that descended at least part way. In men with a history of cryptorchidism, most cancers develop in the testicle that did not descend, but up to 25% of cases occur in the normally descended testicle. Based on these observations, some doctors conclude that cryptorchidism is not the direct cause of testicular cancer, but that some other disorder is responsible for increasing the testicular cancer risk and preventing normal positioning of one or both testicles.
Most cryptorchid testicles will eventually descend on their own in the child's first year. Sometimes a surgical procedure known as orchiopexy is necessary to bring the testicle down into the scrotum. Some experts believe that performing orchiopexy before puberty may reduce the risk of developing certain types of germ cell tumors.
Family history: A family history of testicular cancer increases the risk. If one man has the disease, there is an increased risk that one or more of his brothers will also develop it.
Occupational risks: A recent study, found that nonseminoma germ cell tumors occur more frequently among men with certain occupations (miners, oil and gas workers, leather workers, food and beverage processing workers, janitors, and utility workers). It may be that exposure to certain chemicals contributes to development of the disease. Studies have not yet identified any specific chemicals as being responsible. No association was found between occupation and risk of seminoma tumors. One study found a slightly higher risk of germ cell tumors among men with prolonged occupational exposure to extremely hot or cold temperatures. However, these occupational associations need to be confirmed in other studies before it can be concluded they represent a significant component of testicular cancer risk.
Injury: There is no convincing evidence that injury to the testicles increases the risk of developing cancer.
HIV Infection: There is some evidence that men infected with the human immunodeficiency virus (HIV), particularly those with AIDS, are at increased risk. No other infections have been shown to increase testicular cancer risk.
Carcinoma in situ: This condition does not produce a mass or cause symptoms. Carcinoma in situ (CIS) in the testicles almost always progresses to cancer. In some cases, CIS is detected in men who undergo a testicular biopsy during medical evaluation of infertility.
Cancer of the other testicle: A history of testicle cancer is another risk factor. Men who have been cured of cancer in one testicle have an increased risk of developing cancer in the other testicle.
Race and ethnicity: The risk of testicular cancer is higher among white Americans than it is among African-American, Hispanic, or Asian-American men.
Maternal hormone use: Although men whose mothers took the synthetic estrogen, diethylstilbestrol (DES), during pregnancy have an increased risk of certain congenital (present at birth) reproductive system malformations, there is no convincing evidence that DES exposure significantly increased men's risk for developing testicle cancer.
Vasectomy: Some earlier studies raised the possibility that vasectomy (an operation to produce sterility) might increase the risk for testicle cancer. However, recent studies have not found any increased risk among men who have had this operation.
For additional information about testicular cancer refer to our Cancer Reference Information on Testicular Cancer.
Revised: 05/07/99
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