Signs & symptoms

Early Detection of Testicular Cancer

When testicular cancer is detected and treated early, the chances of successful treatment are better. Recognizing symptoms and getting regular checkups are the best ways to detect testicular cancer early. The sooner symptoms are reported, the sooner a doctor can diagnose and treat the cancer.

Most testicular cancers are first found by men themselves. Some are discovered by routine physical examination. There is not enough evidence to recommend regular testicular exams, but it is important for men to know what is normal for them. Knowing what normal  testicles feel like helps a man  recognize when something may be wrong. Men should report any changes to the testicles to a doctor.

High-risk individuals

There are some men who are at higher risk than average of developing testicular cancer and may need to be more aware than men at average risk.  A man at higher than average risk includes men who have:

  • a history of cryptorchidism (undescended testicle – often as an infant or child)
  • a family history of testicular cancer
  • a personal history of testicular cancer
  • Klinefelter’s syndrome

Men who are at higher than average risk should talk to their doctor about a personal plan for screening. A personal plan for screening may include regular physical exam with a healthcare professional that includes checking the testicles.

Factors known to increase the risk of developing testicular cancer.

Undescended testicle (cryptorchidism)

Men with a history of undescended testicle (cryptorchidism) have a higher risk of testicular cancer. While a boy is a fetus in the womb, the testicles form in his abdomen. Normally they move down (descend) into the scrotum before birth. Sometimes this process fails and boys are born with an undescended testicle on one or both sides. The exact cause of this abnormality is still unclear. If the testicle does not descend on its own, usually during the first year of life, a surgeon will do an operation to bring the testicle into the scrotum (orchiopexy).

Family history of testicular cancer

The brothers and sons of a man diagnosed with testicular cancer have a higher risk of developing this cancer themselves. Genetics may play a role in the development of testicular cancer.

Personal history of testicular cancer

Having testicular cancer or carcinoma in situ in one testicle increases the chances that testicular cancer could develop in the other testicle.

Klinefelter syndrome

Klinefelter syndrome is a rare genetic condition that affects male sexual development. Men with Klinefelter syndrome have an increased risk of testicular cancer.


Possible Risk Factors

The following factors have some association with testicular cancer, but there is not enough evidence to say they are known risk factors. Further study is needed to clarify the role of these factors for testicular cancer.

Testicular microlithiasis (calcium specks in the testicle) – Studies show that men with testicular microlithiasis are more likely to develop testicular cancer.

HIV infection or AIDS – Studies suggest that men with a weakened immune system due to HIV or AIDS (acquired immune deficiency syndrome caused by the HIV virus) have a slightly higher risk of developing testicular cancer.

Early puberty – Some studies suggest that men who enter puberty at an early age have a higher incidence of testicular cancer. Other studies have not shown a link between early puberty and testicular cancer.

Height – Several studies suggest an increased risk of testicular cancer in men who are taller than average. Other studies show no link between height and testicular cancer.

Decreased fertility – Decreased fertility (subfertility) is associated with testicular cancer. It is not clear if subfertility is a cause of testicular cancer or if the same disease process causes both decreased fertility and testicular cancer.

Pesticides – Some studies suggest that exposure to certain pesticides, such as organochloride pesticides, increases the risk of testicular cancer.

Marijuana – Some studies suggest a possible link between marijuana use and testicular cancer.

Prenatal exposure to estrogens – Some studies suggest that the sons of mothers who took diethylstilbestrol (DES) have a higher risk of developing testicular cancer. DES is a form of estrogen used between 1940 and 1971 to treat women with certain problems during pregnancy (such as miscarriages).

Factors not associated with testicular cancer

The following are not considered to be risk factors for testicular cancer because there is enough evidence showing that there is no association:

  • vasectomy
  • trauma or injury to the testicle
  • tobacco
  • alcohol


Unknown Risk Factors

The following are factors for which there is not enough evidence or the evidence is inconclusive. In other words, it can’t be determined for sure whether these risk factors are or are not associated with testicular cancer.

  • low or high birth weight
  • diet
  • environmental factors


It is not known if exposure to the following is associated with testicular cancer:

  • petroleum products
  • preservatives
  • naturally occurring toxins like mycotoxin ochratoxin A (OTA)
  • viral infections – including infection with Epstein-Barr virus (EBV)

Signs & symptoms

Noticeable physical changes

The signs and symptoms of testicular cancer can also be caused by other health conditions. Many of the signs and symptoms of testicular cancer are vague and often mild. It is important to have any unusual symptoms checked by a doctor, especially if they happen frequently and last longer than 2–4 weeks.

Experiencing any of these symptoms? Don’t freak out, but get to a physician to get yourself checked out immediately. Other health problems can involve the same symptoms, but at the same time, some males get testicular cancer without showing these signs, so testing is necessary to make a diagnosis.


What to look out for ?

  • painless lump on the testicle – can vary in size from a few millimeters to several centimeters
  • persistent lump on the testicle that does not go away
  • feeling of heaviness or aching in the lower abdomen or scrotum
  • painful testicle
  • swelling of a testicle
  • enlarged lymph nodes in the abdomen or neck


Late signs and symptoms

Late signs and symptoms occur as the cancer grows larger or spreads to other parts of the body, including other organs.

  • Back pain – if the cancer spreads to the retroperitoneal lymph nodes.
  • Buildup of fluid in the abdomen (ascites).
  • Cough with or without blood-stained sputum – if the cancer spreads to the lungs shortness of breath due to buildup of fluid around the lungs (pleural effusion).
  • Rare signs and symptoms.


Rare signs and symptoms of testicular cancer are:

  • Excessive hair growth in boys.
    This can be caused by stromal tumours that grow from the Leydig cells. A stromal tumour may produce large amounts of male sex hormones that stimulate growth of facial and body hair at a very young age.
  • Male breast tenderness or enlargement (gynecomastia).
  • Certain types of germ cell tumours produce the hormone human chorionic gonadotropin (HCG), which stimulates breast development.
  • Stromal cell tumours that produce large amounts of female sex hormones cause breast growth and loss of sexual desire.

Courtesy of Canadian cancer society


What changes in the body might you notice or feel if you have testis cancer?

The physical “signs” (what you see) and “symptoms” (what you notice or feel) depend on how far along the cancer has grown or spread before the cancer is discovered, and what part of the body has become affected.

Early on, when the tumour is still inside the testis, you may not have any symptoms or signs. Later on, you may have some aching dull pain or feeling of heaviness in the scrotal sac. You may notice a hard lump in the testis inside the scrotal sac as the tumour grows. Less common is sudden severe pain, due to twisting of the testis around the spermatic cord. The tumour may cause some irritation, resulting in tissue fluid build­up around the testis, inside the scrotal sac. Rarely, there may be bleeding inside the scrotal sac, with buildup of blood in the scrotal sac. The different types of fluid build­up would show up as a large swelling between the legs.


What’s the first sign of trouble? 

The first sign of trouble may be the result of cancer cells which have already spread elsewhere.

  • Spread to the abdominal lymph glands is relatively common and may show up as a large lump felt inside the abdomen.
  • You may feel pressure or pain as the mass presses on other organs inside the abdomen.
  • You may have swollen lymph glands in the neck, near the collar bone or in the armpit areas.
  • You may cough, have bloody sputum and shortness of breath if the cancer has spread to your lungs.
  • You may have headaches, seizures or other brain disturbances if the cancer has spread to your brain.
  • Your breasts may be enlarged, you may have pain or swelling or there may be some milky discharge from the nipples (this is rare).
  • You may experience weight loss, tiredness, loss of energy and a generalized feeling of being unwell, if your cancer is more advanced.

Courtesy of Dr. Joseph Chin

Do you have one of these symptoms? Don’t panic, but consult your physician immediately. The same symptoms can be associated with other health issues; however, some men develop symptom-free testicular cancer. Tests are required before a diagnosis can be made.

Signs & symptoms

Other conditions that can mimic testis cancer

Not too fast – some conditions may be mistaken for testis cancer 

There are several conditions which cause swelling or pain in the scrotum area which may be mistaken as testis cancer.

Fluid buildup in the scrotum area causes the sac to become larger, but it may simply be some harmless tissue fluid (called a “hydrocele”).

If the scrotum area had been hit or injured accidentally, there may be bleeding inside or around the testis, also showing up as a large scrotum (usually with pain and bruising of the scrotal skin).

A hernia shows up as a bulge in the groin (sometimes with some bowel loops in the bulge), but can be felt in the scrotum separate from the testis itself.

An infection in the epididymis (attached to the testis) or testis itself often presents, over a period of a few days, as a painful lump (unlike a testis cancer which is usually not painful), usually on the top or bottom of the testis.

Sudden twisting and winding of the cord from which the testis is suspended will first choke off the blood flow coming out from the testis and eventually shut off blood going into it. This causes the whole testis to become a very tense and firm lump and which causes sudden sever pain.

Sometimes, a collection of semen fluid in a sac near the testis builds up in a ball­like structure (may feel like a separate testis). This usually does not cause any problems and is harmless.


How do we distinguish between testis cancer and these different conditions?

 Your doctor will ask you questions about your medical history and will examine you and order some tests. All the information and clues are used together to decide on the nature of the problem (possible diagnosis of testis cancer). Your family doctor will likely refer you at this point to a surgical specialist (a urologist).

After getting your history and examining you, your doctor may confirm the diagnosis or order more tests.

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Signs & symptoms

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