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The testicles, or testes, lie in a loose fold of skin (scrotum), just beneath the male penis. This pair of organs is responsible for producing the male sexual hormones and sperm necessary for reproduction.

Though testicular cancer is relatively rare, it is the most frequent cancer among American males, ages 15 to 34. Fortunately, testicular cancer is usually quite treatable, even when it has spread beyond the immediate area. As is the case with virtually all cancers, early detection is the key to successful treatment.  By performing regular self-examinations, you can help spot unusual growths early, when treatment has the greatest chances for a positive outcome.

Causes

Like many cancers, the root causes are elusive. It is known that mutations to the DNA can start the process, programming some testicular cells to grow and divide in a very rapid manner. It is known that almost all testicular cancers start in the germ cells. These are the cells that produce immature sperm. Cancer cells continue living far past their normal lifespan, forming a tumor. When cancer cells break off of the main body of the mass, they can migrate to other distant sites, or metastasize.

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Prevention

To date, there is no definitive way known to prevent testicular cancer.  Self-examinations may help spot problems early. The best time to perform a self-exam is immediately following a shower or warm bath, when the testicles have relaxed and descended within the scrotum due to the heat.

How to do a self-exam:

 

  • While standing in front of a mirror, look for any signs of swelling on the scrotum.
  • Use both hands to examine each testicle. Put your index and middle fingers underneath, with your thumbs on top.
  • Roll each testicle between your thumb and fingers. Gently. It's not unusual for one testicle to be larger than the other. The surface of the testicles is typically smooth, firm, and shaped like an oval. You'll also feel a thin cord attached to the top of testicles. That's the epididymus - a normal part of the scrotum. After you've done a self-exam a few times, you'll come to know what's normal. By becoming aware of your own anatomy, you'll be better able to detect any changes.
  • Found a lump? Call your doctor. When identified early, testicular cancer is quite treatable.
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Reducing Risks

As always, the risk of developing any type of cancer is reduced by living a healthy life style.  Many carcinogens are present in our everyday lives, so reducing exposure to them will lower your overall cancer risk.

Don't Smoke

Smoking is the single most implicated risk factor involving cancers of all kinds.   Many of the carcinogens in cigarette smoke are filtered by the kidneys and excreted in the urine. If you smoke, speak with your doctor about plans to quit. A number of very effective medications and strategies are available to greatly increase your chances of successfully quitting.

Eat plenty of fruits and vegetables

Colorful fruits and vegetables are high in antioxidants and fiber, and low in fat.  All three factors help your immune system fight cancer and lower your overall risk.

Healthy weight and blood pressure

Combining a proper, nutritional diet and a regular program of exercise is the best strategy for managing weight and reducing high blood pressure. Obesity places a tremendous load on the vascular system and predisposes patients to a variety of health risks, including cancer.  When diet and exercise fail to correct high blood pressure, your doctor may recommend a specialized medication to help bring it down.

Avoid chemical exposure

If you work in a profession that requires working with chemical compounds, be sure to follow all recommended safety precautions to avoid direct exposure. Even household chemicals carry some degree of risk that should be minimized wherever possible. And like the carcinogens in cigarette smoke, environmental chemical toxins find their way to the kidneys, where they can have cancerous consequences.

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Symptoms

Cancer usually affects one testicle, not both at the same time. Be on the lookout for any of the following signs:

  • Any lump or enlargement of either testicle
  • Sense of heaviness or fullness in the scrotum
  • Aching in the abdomen or groin
  • Sudden fluid collection in the scrotum
  • Pain or discomfort in the scrotum or testicles
  • Enlarged or tender breasts
  • Overall fatigue, or general feeling of ill health

When to call your doctor

Pain, swelling or unexplained lumps are all good reasons to see your doctor, especially if they have been present more than a couple of weeks. You don't have to be in pain.  Most testicular tumors aren't painful in the beginning.

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Diagnosis

Whether a lump is discovered as a result of a self-exam or a routine physical, your doctor will recommend various tests to either confirm or rule out the presence of cancer.

  • Ultrasound

Since the testicles and surrounding structures are soft tissues, ultrasound is a very effective method of examination.  Sound waves generated by the ultrasound probe produce a graphic image that can be studied in detail.  For this test, you'll lie on your back with legs spread.  A clear gel will be applied to your scrotum.  The hand-held probe will moved over your scrotum to generate the digital image.  Ultrasound can help your doctor distinguish between a solid or fluid-filled lump, and whether the lump lies within the testicle or outside it.

  • Blood tests

Tumor markers are substances that occur naturally in your blood.  High values don't necessarily mean cancer, but they can help guide the diagnostic process. 

  • Surgical removal of a testicle

If your doctor strongly suspects cancer in one of your testicles, he or she may recommend its removal.  A detailed biopsy can then be performed to determine the cancer's specific type.  This information is essential to creating a treatment plan. 

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Testicular Cancer Types

Generally speaking, there are two types of testicular cancer.  Both m,ay be present in a single tumor.

  • Seminoma

This form of cancer is more prevalent in men between 25-40 years of age.  Typically, seminomas aren't as aggressive as their counterparts and respond well to radiation therapy.

Nonseminoma

This cancer type tends to develop earlier in a patient's life.  It's also faster growing, more aggressive and has the ability to spread rapidly.  There are several sub-types of nonseminoma cancer: choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumor.

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Staging

If testicular cancer is confirmed, your doctor will want to precisely pinpoint its current stage of development.  This is important because different stages of cancer require different treatments. You may undergo a CT scan to look for signs of cancer in the abdominal lymph nodes.  Chest X-rays and bone scans may be included. Additional blood tests may also be ordered to monitor tumor markers, to determine whether the cancer will likely remain in your body after your testicle is removed.

Like all cancers, testicular malignancies are assigned a numeric scale.

  • Stage I

Cancer is confined to the testicle.

  • Stage II

Cancer has spread to abdominal lymph nodes.

  • Stage III

Cancer has spread to other parts of the body (metastasized). Most commonly, to the lungs, liver, bones and brain.

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