Testicular malignancy or teratoma is a term used to describe a tumor of the testis, the reproductive organs in males located inside the scrotum and below the penis. They produce an essential male hormone or androgen called testosterone, and it is where the sperms required for reproduction are created. When compared to other types of body cancers, the testicular tumors are rare. However, its incidence is increasing day by day due to certain genetical, dietary and environmental factors.
According to recent statistics, testicular tumors are the most common cause of cancer in American males who have recently reached puberty (9-13 years) and adults. It is estimated that approximately 10,000 new cases of new testicular cancer are being diagnosed in the US every year and about 400 deaths result from it. Surprisingly, testicular tumors are mostly considered innocent because they grow slowly compared to other cancers and are highly treatable, even when the tumor has spread to other organs. Depending on the stage and types of testicular cancer, there are several medications, surgical as well as interventional treatment options available to treat and cure the disease. Before exploring signs and symptoms, let’s have a look at two common types of testicular cancer for a better understanding of the signs and symptoms.
Types of Testicular Cancer
Seminomas and non-seminomas are the two main types of testicular cancers. Both arise from germs cells that produce sperms.
Seminoma is one type of testicular cancer that only involves one cell type. This type constitutes about 35-45% of total testicular cancers and commonly affects a slightly older age group (men above 40 years of age).
These types of testicular cancers are more common (50-55%) and tend to grow more quickly compared to seminomas. They typically involve more than one type of cells and are further sub-categorized as;
- Yolk sac tumor
- Embryonal carcinoma
- Choriocarcinoma (rare)
⇒ Now, we will discuss warning signs and symptoms of testicular cancer.
Warning Signs and Symptoms of Testicular Cancer
It is important to know the early warning signs and symptoms of testicular cancer so that you can check and evaluate yourself ahead of time, and before advancing into a later stage. However, you should remember that the majority of signs and symptoms are similar to other non-cancerous testicular conditions such as testicular injury, infection, inflammation, abscesses or a collection of fluids or blood in the scrotum. For instance, inflammation of the epididymis (epididymitis) or inflammation of the testicle (known as orchitis) due to either bacterial or viral infections can cause swelling, and heaviness of the scrotum, which is also a common sign of testicular cancer. In some cases, testicular cancer does not give out detectable symptoms, especially at early stages. In these patients, their cancer is diagnosed most commonly during medical testing or screening for other conditions. For example, imaging or semen analysis studies to find the causes of infertility sometimes leads to the accidental finding of a small testicular cancer. Next, we are going to list the most common signs and symptoms of testicular cancers.
1) Testicular Lump or Swelling
Swelling of the scrotum or feeling a lump in the testis is most often the first symptom of testicular cancer. As cancer grows, it increases in size and therefore appears as a lump or swelling of the scrotum. Of note, it’s normal to have one testicle slightly larger and hanging lower than the other. The swelling in testicular cancer is massive, much more noticeable than the normal enlargement and may cause pressure symptoms due to its bigger size and weight. Some testicular cancers disrupt hormonal balance in the body (increase estrogen or reduce testosterone) and secrete other chemical substances capable of changing the size, color, and consistency of testis.
2) Heaviness Of The Scrotum
Most testicular cancers are painless and appear as a painless lump; however, scrotum heaviness is one of the hallmarks of testicular cancer. The majority of men describe this condition as heaviness or a dragging sensation in the scrotum. This usually happens when the tumor grows in size and applies pressure on the adjacent tissues as it expands. The size of the testicle increases dragging the scrotum with it and causing heaviness and a dragging sensation. According to the American Cancer Association, an odd dragging sensation or a lingering ache in the scrotum should not be taken casually and must be reported to a primary health care provider.
3) Changes in Shape of the Testicle
As written above, a slight difference in the size of both testis is not a matter of worry, but a significant change in volume (enlargement) of one or both testicles could be a silent sign of testicular cancer. Sometimes, there is unusual swelling or bloating of the testicle without the involvement of the scrotum and other adjacent tissues. In such cases, there may not be a uniform enlargement of the testis, but rather an increase in the globular surface. The majority of seminomas may present in this form. Whether a diffuse enlargement or not, consider making an appointment with your doctor if you feel an unusual change in the size or shape of the testis.
4) Fluid In Your Scrotum
Often, the causes of unilateral or bilateral enlargement of the testis are due to a collection of various fluids in the scrotum like water, pus, blood or lymph node excretions. The causes of fluid collections in the testis may be both cancerous as well as non-cancerous. Non-cancerous causes are more common and include bacterial and viral infections, hydrocele, varicocele, and hematoma of the scrotum.
However, there are major signs to differentiate a fluid collection from cancer and another from non-cancerous conditions.
- First, a non-cancerous fluid collection may go away without any treatment (a classic example of this is hydrocele that goes away after some time without any definitive treatment).
- Second, non-cancerous causes may cause severe pain as compared to most testicular cancers that are usually painless. Classical examples of a painful collection of fluid are hematoma and varicocele.
So, if you have a fluid collection in your scrotum that is not painful and accompanied by other cancerous symptoms, you should not wait to see a health care provider for evaluation and diagnosis.
5) Breast Growth or Soreness
It may sound strange at first because, what could be the link between testicular cancer and breast growth? However, it is true that the majority of testicular cancers (both non-seminomas as well as seminomas) may cause certain changes in the breasts. Common changes include breast tenderness, enlargement, discharge or small bumpy growths in the breast. The reason behind these changes is either the secretion of hormones by testicular cells or direct metastasis of cancerous cells in the breast. The primary hormone that causes these changes is the high levels of the human chorionic gonadotropin hormone (HCG), which stimulates breast growth and discharge.
Some other testicular cancers may secrete high levels of estrogens and progesterone (female sex hormones), which cause certain changes in the breast size or secretions as well. If you are currently experiencing such changes, take it a warning sign of growing testicular cancer and talk to your health care provider.
6) Early Puberty In Boys
Some testicular cancers, especially Leydig cell tumors (a subtype of seminomas) would usually secrete an excess amount of androgens (male sex hormones, namely testosterone). Of note, Leydig cell tumors are considered silent in adult males and may not cause warning signs and symptoms until the last stages. However, when they occur in pre-adolescent males, they typically cause signs of puberty at an abnormally early age (6-9 years). These early changes include pubic hair growth and masculine features. All parents should be aware of these premature changes in their child in order to protect them from deadly complications.
7) A Persistent Cough or Swelling In the Neck
According to the American Cancer Society, 10-20% of all testicular cancers, especially those of non-seminomatous origin may cause some particular signs and symptoms unrelated to the testis. The most significant is a persistent cough or a lump in the neck (due to inflammation of lymph nodes). Most oncologists suggest that these are not early signs and symptoms of this cancer and only appear after the tumor has spread to other organs. If you are experiencing this along with the aforementioned signs and symptoms of testicular cancer, consult your doctor immediately to find out the underlying cause.
8) Swollen legs
Swelling in the legs, especially in the thigh region could be a late sign of testicular cancer. This happens in relatively advanced stages when tumors spread to the lymph nodes and starts applying pressure on the adjacent blood vessels. Additionally, they may cause clot formation in the vessels which constrict the blood supply of the legs and cause swelling and inflammation. In more advanced stages, patients with metastatic testicular cancer may experience pain and breathing difficulty due to clot formation in the blood vessels. As cancer progresses further, it causes a hypercoagulative state in the body and the formation of multiple blood clots. These clots could occlude the blood supply of any organ and cause damage, e.g., a heart attack if a clot lodged in the heart or a stroke if lodged in the brain.
9) Lower Back Pain and Shortness of Breath
These symptoms are also related to advanced testicular tumors. The lower back pain indicates that cancer has spread to the lymph nodes on the back or the stomach. Similarly, when cancer spreads to the lungs, they usually cause shortness of breath, which is originated by the difficult entry of air in the lungs. An additional reason for this includes pulmonary embolism which occurs after the formation or lodging of a blood clot in the lungs.
10) Stomach Ache
An advanced testicular cancer may also cause lower belly pain that radiates towards the testis. Along with other silent signs of testicular cancer, a radiating pain located in the lower portion of the belly may indicate that something is wrong with the testis. The cause of this pain is the same, i.e., the spread of cancer through lymphatic channels.
11) Neurological symptoms
Neurological symptoms such as headaches, dizziness, sleep disturbances, behavioral disorders, and confusion are some non-specific symptoms of any cancer in the body. They may appear as a result of the formation of a secondary tumor in the brain. The specific neurological symptoms related to a testicular tumor may include unexplained weight loss and fatigue.
12) Metastatic Cancer Signs and Symptoms
Some of the signs and symptoms that appear due to metastasis (spread) of the testicular tumor in the other organs have been already discussed. According to ACA (American Cancer Association), around 5 – 10% of people with testicular cancer may experience signs and symptoms due to metastasis. The most common place of metastatic testicular cancer is nearby lymph nodes, i.e., lymph nodes of the groin, brain, legs, colon, liver, stomach, and back. Less commonly, it may also include bones and brain. Depending on the site of metastasis, the signs and symptoms may include;
- Swelling and enlargement of male breasts
- Coughing or spitting up blood
- Shortness of breath
- Lower back pain
- A lump or swelling in your neck
Sexuality and Testicular Cancer
As the testis are the reproductive organs in males, a common concern men affected by testicular cancer have is whether their sex life will be affected or not. The answer is yes. Testicular cancers may affect your sexual desire or power. Many oncologists agree that the real causes behind a declining sexual desire in testicular cancer are emotional, rather than physical. So it may depend on the multiple factors such as the way you see your changed body, and how you and your partner communicate, your self-confidence, current treatment, and side effects of the cancer therapy.
Although all types of testicular cancers are rare and their incidence is low in many parts of the world, knowing the warning signs and symptoms of both types of cancer will help you detect and take necessary measures against the disease. In the case of yolk sac tumor, it is of particular importance that you know the early signs and symptoms that appear in your child before puberty. The good news is that most of the testicular cancers are highly treatable and have the highest cure rates among all body cancers in men. Depending on the type of cancer and the stage, the average survival rate in patients with testicular cancer is 5 years.