Testicular cancer (TC) is a relatively uncommon malignancy, yet it stands as the most frequently diagnosed cancer in males between the ages of 15 and 35. This cancer originates in the testicles, which produce sperm and testosterone. While true prevention strategies do not exist, the disease has an extremely high cure rate when detected and treated early. The most effective approach involves understanding individual susceptibility and practicing consistent self-monitoring.
Identifying Established Risk Factors
Susceptibility to testicular cancer is largely tied to non-modifiable factors related to development and genetics. The single most significant risk factor is cryptorchidism, or an undescended testicle, where one or both testicles fail to move into the scrotum before birth. Even if surgically corrected, this history increases the risk in the affected testicle by four- to six-fold, and slightly increases the risk in the normally descended testicle.
Other factors include age, with most cases occurring between 15 and 35, and race, as Caucasian males have higher incidence rates. A personal history of testicular cancer in one testicle significantly increases the likelihood of a new cancer developing in the remaining testicle. Family history also plays a role; having a brother with TC increases risk by an eight- to twelve-fold factor, while a father with the disease results in a two- to four-fold increase.
Early Detection Through Self-Examination
The most direct action a man can take toward ensuring the earliest possible diagnosis is performing a regular Testicular Self-Examination (TSE). This monthly check allows an individual to become familiar with the normal size, shape, and texture of their testicles, making any new changes easier to notice. The best time to conduct the exam is immediately after a warm shower or bath, as the heat relaxes the scrotal skin and muscles, allowing the testicles to drop and making them easier to feel.
To perform the self-exam, stand and gently examine each testicle separately using both hands. Place your index and middle fingers underneath the testicle and your thumbs on top, then gently roll it between your fingers to feel the entire surface. A normal testicle feels smooth, firm, and slightly oval, and it is common for one testicle to be slightly larger or hang lower than the other. You should also locate the epididymis, a soft, cord-like structure at the back and top of the testicle, to avoid mistaking it for an abnormal lump.
Men should check for any new, hard lumps or nodules, which can be as small as a pea, or any noticeable change in the size or consistency of the testicle. Most cancerous lumps are found on the sides or front of the testicle and are often painless. While most lumps discovered are not cancerous, finding an abnormality during a monthly TSE warrants a prompt consultation with a healthcare provider.
Clarifying Lifestyle Myths
Unlike many other cancers, testicular cancer risk is not strongly influenced by lifestyle choices. Physical trauma, such as an injury to the scrotum, is not supported by evidence as a cause of testicular cancer. Similarly, wearing tight clothing, engaging in vigorous physical activity, or having a vasectomy have not been scientifically linked to an increased risk.
Modifying daily habits has a very minor role, if any, in the primary prevention of this specific cancer. The disease is primarily linked to developmental and genetic factors, meaning the most effective measure is vigilance and early detection.
Medical Correction of High-Risk Conditions
For individuals with a history of cryptorchidism, orchiopexy is the surgical intervention available to address this high-risk condition. Orchiopexy involves surgically moving the undescended testicle from the abdomen or groin into the scrotum and permanently fixing it in place. The procedure is typically recommended in infancy or early childhood, ideally before 18 months of age, to reduce the risk of future complications.
Performing this surgery early significantly lowers the lifetime risk of developing testicular cancer, although it does not eliminate the risk entirely. Studies suggest that delaying the surgery until after age 10 or 11 results in a much higher risk, indicating that the timing of the intervention is important. Beyond reducing cancer risk, the surgery also facilitates easier testicular self-examination and helps decrease the chance of future infertility.
Recognizing Warning Signs
Beyond the routine monthly self-exam, it is important to recognize specific symptoms that require immediate medical attention. The most common warning sign is the discovery of a painless lump or swelling in either testicle. This abnormality may be accompanied by a change in the way the testicle feels, such as an increase in firmness or a noticeable shrinking.
Other signs include a feeling of heaviness in the scrotum, or a dull ache in the groin or lower abdomen. Less common symptoms can involve the sudden collection of fluid in the scrotum (hydrocele) or, in rare cases, breast tenderness or growth due to hormone production by the tumor. Any instance of a new lump, discomfort, or change in testicular size should be promptly evaluated by a doctor.