A Patient Journey for Testicular Health

The testicles are part of the male reproductive system; they are the two oval shaped organs which are found inside the scrotum (also referred to as the ball sack) on either side of the penis. They play a vital role in the male reproductive system because they produce sperm and testosterone (a hormone which is responsible for male sexual characteristics).

In most men the testicles are about the same size, are smooth to touch with no lumps or bumps and are firm but not hard. It is not uncommon for one of the testicles to hang slightly lower than the other. Familiarising yourself with your testicles and learning what is normal for you is important. Any changes should be reported to your doctor.

There are many reasons for lumps or swelling in your testicles and although testicular cancer is a concern it is relatively rare (about 4 in 100 lumps are cancerous).

Reasons for lumps or swellings in the testicles:

• Hydrocele - a swelling caused by fluid around the testicle
• Epididymal cyst - a lump caused by the fluid in the epididymis (coiled tube at the back of each testicle which stores and carries sperm)
• Varicocele - caused by enlarged veins in the testicles
• Epididymitis - a chlamydia infection in the epididymis (coiled tube at the back of each testicle which stores and carries sperm)can cause inflammation, swelling and tenderness inside the scrotum (ball sack)
• Testicular cancer

Testicular cancer

Testicular cancer is a significant concern for many men.  Unlike most other cancers, it is more common in younger males than older men and recent statistics from Cancer Research UK show that almost half of cases of testicular cancer were diagnosed in males under the age of 35.

Incidence rates of testicular cancer have also been rising in recent decades, so it is increasingly important to be aware of the disease, how to regularly self-examine and be ready to visit a doctor if you notice any changes to your testicles.

Testicular cancer is not clearly linked to any specific risk factors, so the focus should be on detection rather than prevention. Men are more likely to notice lumps and other irregularities if they check their testicles regularly - signs of testicular cancer can include (in addition to lumps) general swelling or enlargement of a testicle, increased firmness, pain in the testicle or scrotum, and unusual differences between the two testicles. Some signs can occur without others e.g. a lump without pain.  Some men can also experience a heavy or aching feeling in the lower belly or scrotum, breast growth or soreness and a loss of sexual desire. Some testicular cancers can make male sex hormones, which may not cause any specific symptoms in men but can cause signs of puberty in boys at an early age.  It is normal for one testicle to be slightly larger and hang lower than the other so it is important to know your own body and regularly self-examine and know your baseline so when you do examine you have a comparison to what is normal for you.  A monthly self-examination of the testicles is a way that you can become familiar with this area and be able to detect any abnormalities. This would enable any abnormalities to be picked up quicker as it is likely these will be noticed earlier than when performing less frequent checks. A guide to self-examination can be found at www.cancerresearchuk.org and search for ‘testicular cancer’.

Only a doctor can make a diagnosis, so if you experience any changes or are concerned about anything relating to the above symptoms, it is advisable to make an appointment with your doctor. Try not to worry until you have had any symptoms examined; testicular cancer is a relatively rare type of cancer. Around 2,200 men each year in the UK are diagnosed with testicular cancer, which is 1% of all cancers that occur in men. Most testicular lumps are not cancerous, fewer than 4 in 100 are. If you are too embarrassed to speak with your doctor you are also able to make an appointment to visit your local sexual health clinic, where a qualified health care professional will be able to examine you. When you go to see your healthcare professional, he or she will ask you about your symptoms including the nature of any physical lumps or irregularities you have noticed, as well as whether you are experiencing any other symptoms. You will also be asked about both your medical background and any history of related conditions in your family. Your doctor will usually also perform a physical examination of your testicles, which can include a test where a torch or light is held against any lumps in order to establish whether light passes through them. If it is a harmless, fluid filled cyst the light will pass through, if it is a solid lump, the light will not pass through.

If your doctor suspects that you may have cancerous abnormalities in your testicles, you will usually be referred to a specialist. Specialists have a number of tests at their disposal, including ultrasound scans, blood tests, and biopsies. In some cases, they may want to do further tests, such as MRI and CT scans. Remember that is possible to cure testicular cancer at all stages, even if it has spread.

Depending on how early testicular cancer is detected, doctors can use surgery, chemotherapy or radiotherapy. For lower level cancer (stage 1) surgery is used; this is where the affected testicle is removed (also known as an orchidectomy or orchiectomy).  After removal of an affected testicle, you should still be able to have an erection and to father children. If both testicles are removed, it would mean you are no longer able to father children, however the chances of having cancer in both testicles is very rare. If the cancer is more advanced (stage 2 or 3), chemotherapy or radiotherapy is often given after surgery has taken place.

The survival rates of men with testicular cancer are very high: 98% of men diagnosed with the condition survive for 5 years or more, making testicular cancer one of the most treatable types of cancer.

 

If you have been previously diagnosed with testicular cancer it is very important that you regularly self-examine. It is four-to-twelve times more likely to develop in the other testicle than for someone who has not previously had testicular cancer. For this reason, attending follow up appointments is very important as recurrence, often happens between 5-10 years after having testicular cancer.

talkhealth suggests a number of charities that can provide support for men suffering from testicular cancer – Orchid deals with all forms of male cancer; and the Men’s Health Forum deals with men’s health concerns more generally.

Sources used in writing this article are available on request.

_{Last revised: 13 October 2016}

_{Next review: 13 October 2019}