Signs of Testicular Cancer

It's still possible to have kids after testicular cancer

While testicular cancer is relatively rare, it’s the most prevalent cancer among young men, aged 15 to 35. Fortunately, it’s also one of the most treatable cancers.

Testicular cancer develops when abnormal cells begin to grow uncontrollably in one or both testicles — which are responsible for producing sperm and the hormone testosterone — and eventually form a tumor.

When diagnosed in its early stages, testicular cancer is treated successfully in more than 95% of cases, according to the American Cancer Society.

“Catching testicular cancer early before it has a chance to spread and when it’s easiest to treat improves outcomes,” says Jacob Baber, MD, a urologist at Geisinger. “Early detection allows for less aggressive treatment options, which minimizes potential side effects and complications — and its impact on fertility.”

Signs of testicular cancer

The first step in early detection is recognizing symptoms. The telltale sign of testicular cancer is a lump or swelling in a testicle that’s typically painless. It can vary in size, from as small as a pea to as large as a marble.

Other common signs of testicular cancer include:

Pain or discomfort in the scrotum
Feeling of heaviness or pressure in the scrotum
Swelling or sudden fluid buildup in the scrotum
Changes in testicle size and shape
Dull ache in your groin or lower abdomen

“Not all lumps are cancerous,” says Dr. Baber. “A testicle can get larger for many reasons other than cancer, but any new changes should be evaluated by your doctor.”

Testicular cancer risk factors

Testicular cancer is uncommon and largely a disease of young and middle-aged men, with the average age of onset about 33.

“As with other cancers, there are factors that increase your risk,” says Dr. Baber. “If you have immediate family members with testicular cancer, an undescended testicle, HIV or you’ve previously had testicular cancer, your risk increases.”

Contrary to popular belief, research shows that trauma to the testes from injuries or activities like horseback riding do not increase the risk of cancer.

How to perform a testicular self-exam

If caught early, testicular cancer is very treatable. But because signs of testicular cancer can be subtle, it’s important to perform monthly self-checks to watch out for any changes.

“When you examine your testicles often, you can more easily identify abnormalities by getting to know what’s normal and what’s not,” says Dr. Baber. “For instance, it’s normal for one testicle to be larger than the other, and for one to hang lower. A lump or swelling is not.”

The best time to do a testicular self-exam is in the shower when the scrotal skin is relaxed and softer. Using your thumb, index finger and middle finger, gently roll each testicle between your fingers.

If you notice anything different about the size, shape or consistency of one or both of your testes, or pain or discomfort during the exam, talk to your doctor. He or she can perform tests to determine if it’s cancer.

Routine check-ups are also important in prioritizing your health.

Can testicular cancer affect fertility?

If you’ve been diagnosed with testicular cancer, naturally you’re probably wondering: Can I still have children? While testicular cancer is highly treatable, the cancer and its treatment could affect your chances of fathering kids in the future.

Surgery to remove the cancerous testicle is the most common treatment. The good news is most men develop cancer in only one testicle, and the remaining testicle usually can make enough testosterone to have a good quality of life and normal fertility.

However, testicular cancer can silently impact your fertility for months before it’s even diagnosed. It can cause changes in your testosterone levels, as well as genetic damage to sperm cells — both of which make it harder to conceive.

“Tumors from testicular cancer can block or harm the parts of the testes that create sperm,” says Dr. Baber. “In addition, radiation and chemotherapy to kill cancer cells in more advanced cases can both cause a temporary or permanent loss of fertility by damaging the testes and sperm.”

Despite this, it’s still possible to be fertile after treatment. It may take up to 2 years for your fertility to return, but in one recent study, 77 percent of participants were able to conceive naturally after treatment.

Preserving fertility

To reduce fertility risks from testicular cancer, your provider may refer you to a specialist in reproductive medicine to discuss fertility preservation prior to treatment.

You’ll likely undergo testing to determine your overall reproductive health, such as a semen analysis to help determine sperm count, motility and morphology (shape), and hormone tests to evaluate testosterone levels.

Sperm banking is the most common and recommended fertility preservation option. By freezing and storing your sperm for future use, you have a better chance of being able to father a child after cancer treatment.

“In general, sperm collected before cancer treatment is just as likely to start a pregnancy as sperm from men without cancer,” says Lydia Shively, PA-C, a physician assistant specializing in reproductive endocrinology and infertility at Geisinger. “Even if sperm counts are low, men have several fertility options for fathering children, such as in vitro fertilization, or IVF.”

And for men with lower-than-normal levels of testosterone, they can easily undergo testosterone replacement therapy with pills, injections or patches to restore normal levels.

The key is planning ahead and discussing your options with your doctor to increase your chances of conception later.

“Because our first priority is curing your cancer, it’s possible that you could lose your fertility during treatment,” says Dr. Baber. “And if you’ve had cancer in one testicle, you’re at a higher risk of getting it in the other one. So, take time before treatment to think about whether you’d like to have children in the future and if the answer’s yes or even maybe, explore your fertility options to increase those chances.”