Cancer of the Testical: A Male Issue!

Epoch Health Article

Testicular cancer occurs when malignant cells form in the tissues of one or, less commonly, both testicles. It affects approximately one in 250 males at some point in their lifetimes.

In the United States, the American Cancer Society estimates approximately 9,760 new cases of testicular cancer and around 500 deaths from the disease in 2024. Since testicular cancer is typically treatable, the lifetime risk of a man dying from it is very low, roughly one in 5,000. The exact cause of testicular cancer is unknown, but most tumors originate in the germ cells contained in the testicles, in the seminiferous tubules.

Testicular cancer pisture

What Are the Types of Cancer of the Testical?

Germ cells in the testicles produce immature sperm, which is stored there until ejaculation. Although non-germ cell cancers exist, nearly all testicular cancers arise when these germ cells become malignant. Below are the most common types of testicular cancer.

Seminomas

Seminomas are the most common type of germ cell cancer, accounting for 54 percent of all testicular cancer cases. They typically occur in men between 20 and 45 and grow more slowly than nonseminomas.

Nonseminomas

Nonseminomas account for about 43 percent of all testicular cancers and primarily affect men in their late teens to 30s. Under a microscope, nonseminoma cells appear distinct from seminoma cells, and their treatments differ from those of seminomas. There are four main types of nonseminomas, including:

Embryonal carcinoma: This nonseminoma grows quickly and can spread beyond the testicle. Under a microscope, these tumors resemble very early embryos, hence their name.

Yolk sac carcinoma: This type is rare in adults but the most common testicular cancer in children and babies. It generally responds well to treatment in children.

Choriocarcinoma: This is a rare and aggressive testicular cancer that can rapidly spread to distant organs such as the lungs, bones, and brain. It is often part of a mixed germ cell tumor.

Teratoma: Teratoma contains tissue resembling all three layers of a developing embryo (endoderm, mesoderm, and ectoderm). Pure teratomas are rare and more commonly found as part of a mixed germ cell tumor.

Mixed Germ Cell Tumors

This type of germ cell tumor consists of both seminoma and nonseminoma components. They are treated in the same manner as nonseminomas.

Germ cell tumors can sometimes develop outside the testicles. These are known as extragonadal germ cell tumors. These can originate in various parts of the body, most commonly in the mediastinum (area between the lungs), retroperitoneum (abdomen), lower spine, or the pineal gland in the brain.

What Are the Symptoms and Early Signs of Testicular Cancer?

Cancer of the testical typically starts as a scrotal mass, which is usually painless or causes dull, aching discomfort. Occasionally, bleeding within the tumor may lead to sharp local pain. Many patients notice the mass after minor scrotal injury. Symptoms related to metastases, such as abdominal or back pain, confusion, headaches, shortness of breath, or chest pain, are rare.

Symptoms

Testicular cancer has a very favorable prognosis when detected early. Men who regularly perform self-examinations are more likely to find the cancer at its earliest stage. Its common symptoms include:

Swelling, a lump, hardening, or fluid accumulation in the testicles: Most testicular cancers consist of a painless mass in the testicle, typically palpable and several centimeters in size. Some do cause pain, however. Small, nonpalpable, asymptomatic masses without signs of distant disease are more likely to be benign. Studies show up to 80 percent of nonpalpable, asymptomatic tumors 2 centimeters or smaller are benign.

Unusual changes in testicular size.

Irregular or lumpy texture of the testicles: For instance, swelling that causes the testicle to become larger than usual.

A dull ache in the abdomen or groin: Abdominal, flank, or back pain may be caused by invasion or obstruction of muscles, blood vessels, or the ureters.

Decreased sexual activity.

Presence of blood in the semen.

Gynecomastia: Breast tenderness or growth.

A feeling of heaviness in the scrotum or abdomen.

Fluid buildup in the scrotum.

Enlarged lymph nodes in the neck.

Difficulty breathing or shortness of breath: This may be caused by pulmonary metastases.

Hemoptysis: Coughing, occasionally with blood.

Chest pain: This may be caused by pulmonary metastases.

Difficulty swallowing.

Swelling in the chest.

Pleural effusion: Fluid accumulation around the lungs.

Weight loss.

Early signs of puberty in boys: Examples include deepening voice and facial and body hair growth.

Infertility.

Headache.

What Causes Testicular Cancer?

Testicular cancer occurs when cells divide more rapidly than normal, eventually forming a lump or tumor. The exact cause of testicular cancer is not known, but family history and environmental factors have been linked to it.

What Are the Stages of Testicular Cancer?

Staging of testicular cancer includes the following:

Stage 1: Cancer is confined to the testicles.

Stage 2: Cancer has spread to lymph nodes behind or beyond the membrane lining the abdomen and pelvis (retroperitoneal) or near the aorta (paraaortic).

Stage 3: Cancer has spread beyond the retroperitoneal or paraaortic lymph nodes.

Who Is at Risk of Testicular Cancer?

Although testicular cancer can occur at any age and in any ethnicity, certain factors put a man more at risk, including the following:

Age: Testicular tumors are most commonly found in young men aged 15 to 45. It is the second most common cancer in young men aged 15 to 19, with about 6 percent of cases occurring in children and teens and around 7 percent in men over 55.

Race: In the United States, testicular cancer is most common in white men. Testicular germ cell tumors are currently the most common cancer among young men of white Northern European ancestry but are less so among Asians and Africans. However, the incidence is increasing among Hispanic or Latino men and Asian and Pacific Islander men, who may also develop the disease at a younger age.

Cryptorchidism: The most common risk factor is a history of cryptorchidism (undescended testicle). Normally, testicles descend from the abdomen into the scrotum before birth, but in around 3 percent of boys, one or both testicles fail to do so. This condition increases cancer risk, particularly in the undescended testicle (a risk that is four to six times higher), although the risk is also increased in the normally descended testicle. The increased risk isn’t directly due to the failure of the descent itself but instead suggests an underlying abnormality in the testicle that makes cancer more likely. The higher the undescended testicle remains (such as in the abdomen), the greater the cancer risk. Surgery to move the testicle into the scrotum reduces but does not eliminate cancer risk. The risk is higher if the condition remains uncorrected or in men who haven’t undergone surgery by puberty.

Personal history: Men who have had testicular cancer are at the highest risk of developing it again, with a 12 times higher risk compared to those without a history of the disease. However, only 2 percent of men will develop cancer in both testicles.

Family history: A family history of testicular cancer significantly increases the risk; men have an eight-to-12 times higher risk if a brother has the disease and a two-to-four times higher risk if their father does. Although no specific gene is linked to testicular cancer, it is highly heritable. Men with a first-degree relative who has the disease are typically diagnosed two to three years earlier than the general population. However, since testicular cancer is rare, it is uncommon for it to run in families.

Low sperm count: One retrospective cohort study found that men with poor semen quality had a 50 percent higher risk of multiple types of cancer, including testicular. However, those with azoospermia (no sperm count) had no increased risk. The researchers pointed out that this finding could be due to small sample size. Research has shown that sperm counts have been declining globally. While many factors are likely at play, two proposed theories relate to endocrine disruption caused by the increasing ubiquity of microplastics and a growing influx of electromagnetic radiation (EMF) exposure due to wireless devices.

Extra X chromosome: Klinefelter syndrome (often referred to as KS, XXY, or Klinefelter’s) is a condition where boys and men are born with an extra X chromosome.

Germ cell neoplasia in situ: Most testicular cancers develop from a precursor lesion called germ cell neoplasia in situ (GCNIS). It is found near testicular cancer in 80 percent to 90 percent of cases. If GCNIS is detected for other reasons, there’s a 50 percent risk of developing testicular cancer within five years and a 70 percent risk within seven years, making GCNIS a significant risk factor.

Down syndrome: Testicular cancer is more common in men with Down syndrome, possibly because they are more likely to have cryptorchidism.

Low birth weight or preterm birth: Males born with low birth weight have a 34 percent higher risk of testicular cancer than men born with normal weight. Preterm males have an increased risk of 31 percent compared to those born at term.

Inguinal hernia: An inguinal hernia occurs when a part of the abdomen pushes through a weak spot in the lower abdominal wall, causing a bulge. Men with this condition have a 63 percent higher risk than men without the condition.

Hypospadias: Hypospadias is an abnormality that affects the penis and urethra.

Marijuana: Since the 1950s, the incidence of seminoma and nonseminoma—particularly affecting men in their 30s and 40s—has increased by 3 percent to 6 percent annually in the United States, Canada, Europe, Australia, and New Zealand. This rise has coincided with an increase in marijuana use in these regions. Research has shown that using marijuana for over 10 years is linked to an increased risk of developing testicular cancer, specifically the nonseminoma type. The study found that long-term marijuana use was associated with a 36 percent higher risk of testicular cancer overall and an 85 percent higher risk of the nonseminoma subtype.

Leather tanning: Leather tanners who are exposed to dimethylformamide (DMF) have an increased risk of developing testicular cancer, and DMF is known to cause testicular damage.

HIV/AIDS: Men with HIV appear to have an increased risk of developing testicular cancer, with the risk potentially being even higher for those with AIDS.

Muscle-building supplements: A study published in 2015 found that muscle-building supplement use is a potentially adjustable risk factor that may be linked to testicular germ cell cancer.

Radar guns: A 1993 study observed that all six police officers out of a cohort of 340 who developed testicular cancer had routinely used hand-held radar guns, holding them close to their testicles, which was the only common risk factor among them.

Natural and synthetic hormones: Animal studies have shown that synthetic hormones and endocrine disruptors can affect hormone levels and the development of early germ cells, potentially leading to cancer. Endocrine disruptors are natural or synthetic chemicals that can mimic, block, or disrupt hormones. However, more research is needed to determine if these substances are linked to the increase in testicular cancer cases. Human studies are challenging due to the long time between early exposure and cancer development and the many factors that can complicate results, such as contaminants in food, packaging, and cosmetics. Currently, there is limited evidence connecting endocrine disruptors directly to testicular cancer, although some studies have found higher levels of certain toxins in the mothers of men with the disease.

How Is Testicular Cancer Diagnosed?

Some doctors advise young men to perform a self-exam of their testicles for lumps once a month. Testicular self-examinations are most effective after a warm bath or shower when the scrotum is relaxed, making detecting abnormalities easier. To perform the exam, stand facing a mirror and place your index and middle fingers under the testicle with your thumb on top. Gently roll the testicle between your fingers, checking for lumps, hardness, swelling, or size differences. Both testicles should be similar in size but not identical. Also, identify the soft, tube-like structure behind the testicle (epididymis), which typically isn’t cancerous but should still be checked by a doctor if lumps are found.

A hard mass within the testicle is typically considered testicular cancer until proven otherwise. However, other conditions have similar symptoms to testicular cancer that should be ruled out, so a timely evaluation is essential.

Screening

There is no standard screening test for early detection of testicular cancer. Men discover cancer most often by chance, during self-exams, or by a doctor during a routine physical exam. Early detection can make treatment easier and may reduce the need for extensive chemotherapy or surgery. If a lump is found, further tests may be needed.

Exams

To diagnose and stage testicular cancer, a series of exams and tests are often required. The doctor will examine the testicles for swelling, tenderness, and lumps and will also check the abdomen, lymph nodes, and other areas of the body for signs of cancer spread. The exam results are typically normal except for any changes in the testicles.

Transillumination may also be performed. This is a physical exam in which the doctor holds a flashlight up to the scrotum. In the case of a tumor, the light does not pass through the lump. If a lump or other indication of testicular cancer is detected, further tests will be required to determine the cause. It’s crucial to accurately determine whether scrotal masses are testicular (often malignant) or extratesticular (usually benign), as distinguishing between them can be challenging during a physical exam.

 Scrotal ultrasound is an imaging test that looks at the scrotum. It can confirm the scrotal mass’s origin. If a testicular mass is confirmed, a blood test for tumor markers will be needed.

 Many testicular cancers produce increased levels of tumor markers, such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG), in the blood. For instance, nonseminomas often increase AFP or HCG levels; pure seminomas may raise HCG levels but never AFP levels. Therefore, an increase in AFP indicates a nonseminoma component in the tumor, though tumors can be mixed. Sertoli and Leydig cell tumors do not produce these markers, and some cancers may be too small to affect marker levels. Additionally, increased levels of the enzyme lactate dehydrogenase (LDH) can indicate widespread disease but can also be raised by noncancerous conditions.

 The most promising new serum marker for testicular cancer is micro-RNA (miRNA) 371a-3p. It is highly effective in detecting seminomas and nonseminomas in children and adults, except for differentiated pure teratomas. The miRNA 371a-3p test has better specificity than traditional serum markers and is particularly useful for detecting and monitoring seminomas that do not produce HCG or AFP.

 If testicular cancer is suspected, instead of a biopsy, doctors typically recommend a radical inguinal orchiectomy, where the entire testicle is removed. A pathologist then examines the removed testicle to confirm the presence of cancer and determine its type and extent. This approach is often based on ultrasound and blood tumor marker tests, which provide enough evidence to proceed directly to surgery.

 If cancer is confirmed, computed tomography (CT) scans are necessary to determine the clinical stage using the standard tumor, node, and metastasis (TNM) system (discussed in the staging section).

What Are Possible Complications of Testicular Cancer?

Complications arising from testicular cancer may include the following:

Persistent fatigue

Anxiety disorders

Complications from metastasis

Blood clots

There may also be complications due to treatment.

What Are the Treatments for Testicular Cancer?

Testicular cancer is often curable. Depending on the stage, treatment options include surgery, radiation therapy, chemotherapy, active surveillance, and testosterone replacement therapy.

1. Surgery

Radical inguinal orchiectomy: Radical inguinal orchiectomy involves the removal of the testicle and spermatic cord through an incision in the groin to lower the chances of cancer cells spreading to the scrotum. It is the foundation of treatment for testicular cancer. A cosmetic testicular prosthesis, such as a saline implant, may be placed during the procedure. Typically, the removal of one testicle does not significantly affect a man’s sexual performance or fertility. The remaining healthy testicle usually compensates by producing sufficient testosterone and sperm. Most men can still achieve an erection, although the sensation may change.

Partial orchiectomy: Partial orchiectomy is a surgical procedure that involves removing only a portion of the testicle, typically the area containing a tumor, while preserving the remaining healthy tissue. It is usually considered when the tumor is benign, small, or low-risk, if both testicles have tumors, or if there is only one testicle. Some urologists support testis-sparing surgery for men with germ cell tumors, although it is not yet a proven or widely accepted technique.

Retroperitoneal lymph node dissection (RPLND): Testicular cancer typically spreads in a predictable pattern, with the first metastases often occurring in the lymph nodes of the retroperitoneum, near the kidneys. Because of this, retroperitoneal lymph node dissection is a key surgical option for managing testicular cancer.

2. Radiation Therapy

Radiation therapy, commonly prescribed by a radiation oncologist for men with stage 2 seminoma, uses targeted high-energy radiation to shrink tumors and eliminate remaining cancer cells after testicular surgery. While it has a high success rate, it carries potential long-term risks, such as second cancers and early cardiovascular disease. Radiation to the abdominal nodes does not typically affect sexual function or cause infertility.

3. Chemotherapy

Chemotherapy, delivered intravenously, targets cancer cells that may have spread after tumor removal and is effective in curing many men with advanced testicular cancer. It typically includes a platinum-based drug such as cisplatin.

In cases with large nodal masses, metastases, or elevated tumor markers, platinum-based chemotherapy followed by surgery is recommended for long-term control. Chemotherapy can impair fertility, so sperm banking is advised beforehand. While it does not affect sexual function, many men experience a temporary loss of sex drive after treatment. However, no risk to the fetus has been evident if pregnancy occurs.

4. Active Surveillance

Active surveillance is the preferred approach for patients with stage 1 seminoma or nonseminoma germ cell tumors, particularly for those at low risk of relapse. High-risk patients typically receive adjuvant therapy, such as retroperitoneal lymph node dissection or chemotherapy.

5. Testosterone Replacement Therapy

Testosterone replacement therapy may be needed if the remaining testicle does not produce enough testosterone or, in rare cases, if both testicles are removed. Low testosterone can lead to symptoms such as reduced sex drive, erectile difficulties, fatigue, low energy, and osteoporosis. If these symptoms occur, a doctor may test testosterone levels to determine if replacement therapy is appropriate. This therapy can be administered through a gel, muscle injection, implant, or skin patch, and it typically helps restore sex drive and energy levels.

Patients with nonseminomas have approximately a 30 percent risk of recurrence, even when the disease seems localized. For seminomas, the recurrence rate is around 15 percent to 20 percent.

The prognosis for testicular cancer depends on the tumor’s histology and extent. The five-year survival rate exceeds 95 percent for patients with localized seminomas or nonseminomas and those with low-volume metastases in the retroperitoneum. For those with extensive retroperitoneal, pulmonary, or other visceral metastases, the five-year survival rate varies from 48 percent to over 80 percent. However, even patients with advanced disease can potentially be cured.

How Does Mindset Affect Testicular Cancer?

While mindset doesn’t directly cause or prevent testicular cancer, it can significantly affect how individuals cope with the disease and their treatment outcomes.

A positive mindset can help patients better manage the emotional challenges of a cancer diagnosis, such as anxiety, depression, and fear. An adaptive mindset may also lead to better adherence to treatment plans, follow-up appointments, and self-care routines, which can improve physical outcomes.

Furthermore, maintaining a positive mindset can reduce stress, potentially indirectly benefiting immune function and overall health. Psychosocial interventions, including Mindfulness-Based Stress Reduction (MBSR) and cognitive behavioral therapy (CBT), may help.

 A positive mindset can also help patients engage more effectively with their support care networks to better meet their emotional and practical challenges.

What Are the Natural Approaches to Testicular Cancer?

Natural remedies cannot completely cure testicular cancer, as conventional treatments are necessary for effective treatment. However, they may help alleviate symptoms and reduce complications or side effects of treatment. Before using any of the ones listed below, please consult a health care professional since clinical trials are needed to establish safety and efficacy, and some can be toxic.

1. Medicinal Herbs

Green tea (Camellia sinensis): Green tea is rich in natural polyphenols. Epigallocatechin-3-gallate (EGCG) is the main catechin (a type of polyphenol) in green tea and is known for its various health benefits, such as metabolic regulation and antioxidant, anti-inflammatory, and anti-cancer properties. Research has shown that EGCG can inhibit cancers in the male and female reproductive systems, including testicular cancer. A 2007 in vitro study showed that green tea extract has the potential to inhibit the activity of MMPs (enzymes) and regulate testicular cancer cell invasion.

Mayapple (Podophyllum peltatum): Belonging to the Berberidaceae family, mayapple is native to the eastern United States and southern Canada. Chemical tests of the mayapple plant show that it contains several compounds called lignans that have been found to help fight cancer. Etoposide, a drug approved by the U.S. Food and Drug Administration (FDA) for treating testicular cancer, is made from podophyllotoxin, a substance derived from the mayapple plant.

American ginseng (Panax quinquefolius): Cyclophosphamide is a chemotherapy drug for testicular cancer treatment. However, it can cause toxic side effects in multiple organ systems, including the testicles. A 2018 rat model showed that cyclophosphamide treatment caused a significant decrease in testosterone and increased DNA damage in lab rats, along with severe damage to testicular tissue. However, when given with cyclophosphamide, American ginseng helped restore testosterone levels, reduce DNA damage, and improve testicular tissue condition. Thus, American ginseng may improve cyclophosphamide-induced toxicity in some cases, but further evidence of safety and efficacy with clinical trials is needed.

Astragalus (Astragalus membranaceus): A 2012 study showed that astragalus improved testicle weight and sperm quality affected by cyclophosphamide-induced reproductive toxicity in male mice.

2. Diet

Treatments for testicular cancer can cause nutrition-related side effects such as constipation, diarrhea, fatigue, low iron levels, nausea, and weight loss. While there’s no specific diet for treating testicular cancer, the Leukemia & Lymphoma Society recommends the following dietary practices:

Incorporate all food groups to get the most cancer-fighting nutrients.

Aim to eat a variety of colorful fruits and vegetables.

Maintain a healthy weight.

Try to have small, frequent meals throughout the day instead of three large ones.

Choose lean protein sources, as extra protein helps repair cells and tissues, supports recovery, and boosts the immune system.

Drink plenty of fluids like water, milk, or fresh-pressed juice to avoid dehydration and digestive issues.

Opt for plant-based fats such as olive oil, avocados, nuts, and seeds.

3. Supplements

Nutrient mixture: The aforementioned 2007 cell line study found that a specific nutrient mixture composed of lysine, proline, arginine, vitamin C, and green tea extract can significantly lower the activity of enzymes that help testicular cancer cells spread. Increasing its doses led to a near-complete inhibition of these enzymes and reduced the ability of testicular cancer cells to invade through tissue barriers by 84 percent.

Lycopene: Antioxidant lycopene can help prevent weight loss in the testes and epididymis caused by the testicular cancer drug adriamycin, which reduces sperm movement and increases the number of abnormal sperm.

How Can I Prevent Testicular Cancer?

Most men with testicular cancer have no identifiable risk factors, and some known risk factors, such as a family history, are unchangeable. Consequently, preventing most cases of testicular cancer is currently impossible. However, monthly testicular self-examinations may help detect testicular cancer early, which is crucial for effective treatment and survival.

While testicular cancer cannot be prevented entirely, avoiding the risk factors previously discussed is a good place to start. Research has shown that diet and exercise are staples in maintaining general wellness. With this in mind, consider the following for optimal health:

Eat a nutritious diet that emphasizes whole foods and restricts processed ones.

Try to maintain a consistent sleep schedule, minimize screen use a few hours before bedtime, and get seven to eight hours of sleep per night.

Avoid environmental toxins whenever possible, including pollution and endocrine disruptors.

Limit or avoid marijuana use.

Be mindful of factors that may affect sperm count, such as EMF exposure and other sources of radiation, and therefore, testicular cancer risk.