Cancer of the testicle (also called testis) accounts for 1%–2% of all cancers in men. There are approximately 1,500 new cases per year in the UK.It occurs predominantly in the younger man and is the biggest cause of cancer-related death in male 15- to 35-year-olds. The number of cases has trebled in the last 20 years and is still rising, but with early detection and new improved treatments the chances of a cure are good.

The causes of testicular cancer are not fully understood. The main risk factor is having had an undescended testicle, where the testicle fails to reach its proper position within the scrotum naturally.

All testicles are formed in the abdomen and descend into the scrotum at birth or in the first year of life. Some young boys have an operation to help their testicles descend if they do not come down naturally.

Testicular cancer is seen more commonly in whites than in blacks, and also in those from more affluent backgrounds. Men who have a brother or father with testicular cancer have a higher risk of developing it (although the risk is still small). A particular gene has been found to be present in many men with testicular cancer and may account for its running in families, just as breast cancer runs in families. Hot baths, sporting injuries and having a vasectomy do not cause testicular cancer.

Treatment

Treatment is easier and more likely to be successful if testicular cancers are found early.

The treatment after surgical removal depends on the type and on whether or not it has spread:

Seminomas are treated best by giving radiotherapy (x-rays) to the lymph glands within the abdomen, even if they look normal on the CT scan. Chemotherapy (anti-cancer drugs) may also be recommended if there are signs of spread.

Teratomas do not respond to radiotherapy, but modern chemotherapy is very effective. A short course of chemotherapy is used when there is no spread (to prevent the cancer coming back), or longer courses if there is evidence of spread. If any cancer remains in the abdomen or chest after chemotherapy, it can be removed surgically by an operation called lymphadenectomy.

Having only one testicle does not affect your fertility or sexuality, as the remaining testicle produces enough sperm and testosterone. Chemotherapy, however, can reduce sperm counts permanently, causing fertility problems. Before starting chemotherapy, your sperm can be tested and, if suitable, stored and used after treatment has finished. This procedure is called sperm banking. Men who undergo lymphadenectomy may sometimes experience ejaculation problems afterwards and are also candidates for sperm banking.