Testicular Cancer Screening
Testicular cancer has been increasing in the U.S. and many other countries for several decades. Despite this increase, testicular cancer is not common: About one of every 250 males will develop testicular cancer at some point during their lifetime.
The testicles, also called testes, are made up of many types of cells, and each can develop into one or more types of cancer. It is important to know the type of cell and cancer because cancers differ in how they are treated.
More than 90% of testicular cancers start in germ cells, which make sperm. The main types of germ cell tumors (GCTs) in the testicles are:
- Seminomas: There are two types of seminomas. They tend to grow and spread slowly.
- Non-seminomas: There are four types of non-seminomas. These tumors tend to grow rapidly and spread outside the testicles.
How to Get Screened for Testicular Cancer
Most doctors agree that a testicle examination should be part of a routine checkup.
Some doctors recommend that after puberty all males examine their testicles monthly. Each man must decide for himself whether to do this, either by self-exam or with a doctor. Talk with your doctor and seriously consider monthly self-exams if you have certain risk factors that increase your chance of developing testicular cancer, including:
- An undescended testicle
- A previous germ cell tumor in one testicle
- A family history of testicular cancer
There are several ways to screen for testicular cancer, including doing regular self-exams.
The best time to examine your testicles is during or after a bath or shower, when the skin of the scrotum is relaxed.
- Hold your penis out of the way and examine each testicle separately.
- Hold your testicle between your thumbs and fingers with both hands and roll it gently between your fingers.
- Look and feel for any hard lumps or nodules (smooth rounded masses) or any change in the size, shape or consistency of your testicles.
It is normal for one testicle to be slightly larger than the other and for one to hang lower than the other.
You should also be aware that each testicle has a small, coiled tube called the epididymis that can feel like a small bump on the upper or middle outer side. Testicles also contain blood vessels, supporting tissues and tubes that carry sperm. Some men may confuse these with abnormal lumps at first. If you have any concerns, ask your doctor.
An ultrasound is often the first test done if a doctor thinks you might have testicular cancer. It uses sound waves to produce images of the inside of your body. It can be used to see if a change is noncancerous (like a hydrocele or varicocele) or a solid tumor that could be a cancer.
Some blood tests can help diagnose testicular tumors. Many testicular cancers make high levels of certain proteins called tumor markers, such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). When these tumor markers are in the blood, it suggests that there is a testicular tumor.
Most types of cancer are diagnosed by removing a small piece of the tumor and looking at it under a microscope for cancer cells. This is called a biopsy. But a biopsy is rarely done for a testicular tumor because it might cause the cancer to spread. If testicular cancer is found, your doctor will order imaging tests of other parts of your body to check for spreading outside the testicle. These tests may also be done before a diagnosis is confirmed by surgery.
Imaging tests use X-rays, magnetic fields, sound waves or radioactive substances to create pictures of the inside of your body. Ultrasound of the testicles, described above, is a type of imaging test. Other imaging tests may be done for several reasons after a testicular cancer diagnosis, including:
- To learn if and how far the cancer might have spread
- To help determine if treatment worked
- To look for signs of cancer returning after treatment
Many men with testicular cancer have no known risk factors. And some of the known risk factors cannot be changed: having undescended testicles, being a white male and having a family history of the disease. For these reasons, it is impossible to prevent most cases of the disease now.
One of the main risk factors for testicular cancer is a condition called cryptorchidism, or undescended testicle. This means that one or both testicles didn’t move from the abdomen into the scrotum before birth. Males with cryptorchidism are many times more likely to get testicular cancer than those with normally descended testicles.
Having a father or brother with testicular cancer increases the risk that you will get it. But only a small number of testicular cancers occur in families. Most men with testicular cancer do not have a family history of the disease.
Some evidence has shown that men infected with the human immunodeficiency virus (HIV), particularly those with AIDS (acquired immunodeficiency syndrome), are at increased risk of testicular cancer. No other infections have been shown to increase the risk.
Testicular germ cell cancers can start as a non-invasive form of the disease called carcinoma in situ (CIS), or intratubular germ cell neoplasia. In testicular CIS, the cells look abnormal under the microscope, but they have not yet spread outside the walls of the seminiferous tubules (where sperm cells are formed). Carcinoma in situ does not always become invasive cancer.
Know the facts, risk factors and screening options for testicular cancer. View and download this educational material by the American Cancer Society: Testicular Cancer Fact Sheet