What Is Usually the First Symptom of Testicular Cancer?

The first signs of testicular cancer may be a painless lump, unusual firmness in the affected testicle or dull pain in the groin.

Testicular cancer arises from the testes. The testicles are responsible for the production of male sex hormones and sperm for reproduction. They are located within the scrotum, a loose bag of skin below the penis. Testicular cancer is the most common type of cancer occurring in American males between the ages of 15 and 35.

The exact cause of testicular cancer is not known. Some factors increase the risk of testicular cancer, such as: 

• Age: Testicular cancer usually occurs between the age of 20 to 35.
• Race: It is more common in white men than other races.
• Undescended testes (cryptorchidism): Surgical correction of undescended testes before puberty reduces the risk of testicular cancer. 
• Genetic conditions like Klinefelter syndrome causing abnormal development of the testes  
• Family history 
• Human immunodeficiency virus (HIV) infection

The initial signs and symptoms of testicular cancer include:

• A painless lump in the testicular area
• The affected testicle feels firmer and harder than the other 
• Dull aching in the scrotum or the groin

The other signs and symptoms that may develop later include:

• Formation of blood clots in the blood vessels which can travel to the lungs causing chest pain and breathlessness.
• Varicocele (swollen blood vessels) appearing as enlarged, dark blue veins
• Hydrocele (Fluid around the testicle) causing swelling
• Infection of the testicle, causing pain
• Injury of the testes
• Twisting of the testicle  (torsion)

Most testicular cancers are germ cell (cells that produce sperm) tumors. There are two main types of testicular cancer:

Seminomas grow and spread slowly. There are two subtypes: 

• Classical seminoma: This is the most common and usually happens in men ages 25 to 45.
• Spermatocytic seminoma: Commonly occurs in older men and usually does not spread.

Nonseminomas grow and spread more quickly. They usually consist of multiple types of cancer cells, including: 

• Embryonal carcinoma: Contains cells look like cells from embryos under microscopic examination.
• Yolk sac carcinoma: These cells look like the sac that surrounds the embryos and usually occurs in children.
• Choriocarcinoma: Usually rare and spreads to the rest of the body quickly.
• Teratoma: A rare tumor that contains other tissue and organs, including teeth and hair.

Self-examination can help in early diagnosis and treatment. Affected testes are enlarged, firm and usually painless. 

The physician performs a complete physical assessment if their patient complains of these testicular symptoms. Complete blood and radiological assessment is performed. 

• Blood Tests
  • Alpha Fetoprotein levels (Alpha FP)
  • Human Chorionic Gonadotrophin levels (hCG)
  • Lactate Dehydrate Hydrogenase levels (LDH)
• Testicular USG
• Testicular CT Scan
• Lymphangiography to study tumor spread in lymph node
• A biopsy is usually performed to confirm the diagnosis. It is a minimally invasive procedure that involves obtaining a small sample of the testicle and examining the cells for cancer.

Testicular cancer is highly treatable, even when cancer has spread beyond the testicle. The treatment may involve one or a combination of multiple treatment modalities, which depends on the extent of the disease.

The treatment options include the following:

• Surgery
  • Orchiectomy: Removal of the testicle. A prosthetic may be placed.
  • Testes-sparing surgery (TSS): The tumor is carefully removed and the healthy part of testis is left behind. This is ideal for patients with small tumors or benign/ non-cancerous tumors. 
  • Retroperitoneal lymph node dissection: Surgical removal of the lymph nodes which the cancer commonly spreads to. 
• Radiation therapy: This targets and selectively kills cancer cells and shrinks tumors using radiation. 
• Chemotherapy: The tumor cells are killed with cancer medication. 
• Targeted therapy: This treatment uses medication to target certain genetic, protein, or other changes in and around cancer cells.
• Stem cell therapy may be a treatment option in some cases