Testicular cancer

Cancer that develops in a testicle is called testicular cancer or cancer of the testis. Usually only one testicle is affected, but in some cases both are affected. About 90–95% of testicular cancers start in the cells that develop into sperm – these are known as germ cells.

Sometimes testicular cancer can spread to lymph nodes in the abdomen, or to other parts of the body.

Learn more about:

• The testicles
• Who gets testicular cancer?
• What causes testicular cancer?
• What types are there?

The testicles

The testicles are two oval glands that sit behind the penis in a pouch of skin called the scrotum. They are part of the male reproductive system and are also called testes (or a testis, if referring to one).

Role of the testicles

The testicles produce and store sperm. They also produce the male hormone testosterone, which is responsible for the development of male characteristics, such as facial hair, a deeper voice and increased muscle mass, as well as sexual drive (libido).

Epididymis, spermatic cord and vas deferens

A tightly coiled tube at the back of each testicle called the epididymis stores immature sperm. The epididymis connects the testicle to the spermatic cord. The spermatic cord runs through the groin region into the pelvis and contains blood vessels, nerves, lymph vessels and a tube called the vas deferens. The vas deferens carries sperm from the epididymis to the prostate gland.

Seminal vesicles and prostate gland

Two small glands called seminal vesicles sit above the prostate gland. The seminal vesicles and prostate gland produce fluids that make up a large part of semen. Semen also contains sperm from the testicles and is ejaculated from the penis during sexual climax.

Lymph nodes and vessels

There are many lymph nodes (also called lymph glands) and lymph vessels around the testicles and in the abdomen. These are part of the lymphatic system and are important for resisting and fighting disease (immunity). The nodes and vessels also drain lymphatic fluid (lymph) from the tissues back into the bloodstream.

The male reproductive system

Who gets testicular cancer?

Testicular cancer is not a common cancer, but it is the most commonly diagnosed cancer after skin cancer in men aged 20–39. In Australia, about 850 men are diagnosed with testicular cancer each year, accounting for about 1% of all cancers in men. It occurs most often in men aged 25–40.

What causes testicular cancer?

The causes of testicular cancer are unknown, but certain factors may increase a man’s risk of developing it:

Personal history

Men who have previously had cancer in one testicle are more likely to develop cancer in the other testicle. ITGCN is also a risk factor.

Undescended testicles

Before birth, testicles develop inside the abdomen. By birth, or within the first six months of life, the testicles should move down into the scrotum.

If the testicles don’t descend by themselves, doctors perform an operation to bring them down. Although this reduces the risk of developing testicular cancer, men born with undescended testicles are still more likely to develop testicular cancer than men born with descended testicles.

Family history

Sometimes gene mutations are passed on in families. A man with a father or brother who has had testicular cancer is slightly more at risk of cancer. However, family history is only a factor in a small number (about 2%) of men who are diagnosed with testicular cancer. If you are concerned about your family history of testicular cancer, you can ask your doctor for a referral to a urologist. The urologist can provide advice on self-examination for you and your family members.

Infertility

Having difficulty conceiving a baby (infertility) is associated with ITGCN, undescended testicles and, occasionally, genetic abnormalities. Because these are risk factors for testicular cancer as well, infertility is also considered a risk factor for testicular cancer.

HIV and AIDS

There is some evidence that men with HIV (human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome) have an increased risk of testicular cancer, although the reasons are unknown.

Some congenital defects

Some men are born with an abnormality of the penis called hypospadias. This causes the urethra to open on the underside of the penis, rather than at the end. Men with this condition are at increased risk of testicular cancer in the future. Likewise, there may be an increased risk for men born with a lump in the groin known uinal hernia, even when it has been repaired.

What types are there?

The most common testicular cancers are called germ cell tumours. There are two main types, which look different under a microscope.

Germ cell tumours

Sometimes a testicular cancer can include a mix of seminoma cells and non-seminoma cells, or a combination of the different subtypes of non-seminoma cells (mixed tumours). When there are seminoma and non-seminoma cells mixed together, doctors treat the cancer as if it were a non-seminoma cancer.

A small number of testicular tumours start in cells that make up the supportive (structural) and hormone-producing tissue of the testicles. These are called stromal tumours. The two main types are Sertoli cell tumours and Leydig cell tumours. They are usually benign and are removed by surgery.

Other types of cancer, such as lymphoma, can also involve the testicles. For information about lymphoma, call Cancer Council 13 11 20 or see Hodgkin lymphoma and non-Hodgkin lymphoma.

Intratubular germ cell neoplasia (ITGCN)

Some germ cell cancers begin as a condition called intratubular germ cell neoplasia (ITGCN or IGCN). In this condition, the cells are abnormal, but they haven’t spread outside the area where the sperm cells develop. ITGCN is not cancer but it has about a 50% risk of turning into testicular cancer within five years. About 5–10% of men diagnosed with testicular cancer have ITGCN.

ITGCN has similar risk factors to testicular cancer. It is hard to diagnose because there are no symptoms and it can only be found by testing a tissue sample. Once diagnosed, some cases of ITGCN will be carefully monitored (surveillance). Other cases will be treated with radiation therapy or with surgery to remove the testicle.