TESTICULAR LUMPS

What are the signs of testicular cancer?

A hard lump in either testis is the usual symptom of testicular cancer.  This can be painful or tender in 10 to 20% of affected men.

In a few men, constant backache, cough or breathlessness, and enlarged or tender breasts may also mean that the cancer has spread. Medical advice should be sought straight away.  However, there may be many other reasons for these symptoms.

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Can testicular cancer spread?

If a tumour is malignant (cancerous), the cancerous cells often break away from the primary tumour and are carried up in the bloodstream or via the lymphatic vessels to nodes elsewhere in the body.  Quite often this is to neighbouring tissue, but the tumour can also move to distant parts of the body such as the liver, bones, lungs or brain.  When it reaches the new site, the secondary cancer cells form another tumour in the new location.  This is called metastatic or advanced cancer.

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What are the different forms of testicular cancer?

The two main types of testicular cancer are called seminomas and non-seminoma germ cell tumours (NSGCT).  There are other types of testicular cancer but they are quite rare.

• Seminoma
  is a form of testicular cancer containing only one type of cancer cell.  It is normally found in men between the ages of 30 and 60 years.
• A non-seminoma germ cell tumour (NSGCT, commonly known as a non-seminoma)
  can contain many different types of cancer cells grouped together.  It is more common in younger men.  It is usually found in men between their late teens and early 40s.

Other types of testicular cancer are:

• Carcinoma in-situ
  is a type of ‘pre-cancer’.  Men with this condition have a 50% chance of developing testicular cancer within five years.  When men are diagnosed with cancer in one testis, carcinoma in-situ is sometimes found in the other unaffected testis.  This means that the remaining testis needs to be regularly checked for cancer.
• Teratoma
  is a non-cancerous (benign) growth that can be part of a non-seminoma or is sometimes identified following chemotherapy for testicular cancer.  It is recommended to take out a teratoma after chemotherapy as it has the potential to grow and become cancerous and spread through the body.

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Is a lump in the testis always cancer?

There are other lumps that can be found in the testis that can be non-cancerous.  It is important to see a doctor to make sure any lumps felt are not testicular cancer.  An ultrasound examination of the testis can find out what type of lump it is.  The main types of non-cancerous lumps are:

• Epididymal cyst
  Epididymal cysts are fluid-filled cysts that come from the epididymis, and are very common.  Often discovered when about the size of a pea, they feel slightly separate from the top of the testis.  These lumps can slowly increase in size and can feel like a third testis.  Epididymal cysts can happen at any age and should be left alone when still small, but can be removed with surgery if they become larger.
• Spermatocele
  Spermatocele are similar to epididymal cysts.  The only differences are that the lump is usually connected to the testis, and the swelling is filled with fluid containing sperm and sperm-like cells.
• Hydatid of Morgagni
  Found at the top of the testis, a Hydatid of Morgagni is a small cyst that is separate from the epididymis and sometimes found on a thin strand of tissue.  These common cysts are moveable and can cause pain if they twist.  There is no risk of cancer from these cysts, and unless they are causing pain, should be left alone.

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Who should I see for help?

If you notice a hard lump or any change in your testes you should see a local doctor straight away.  The local doctor may then give a referral to a specialist (urologist).  A urologist deals specifically with problems in the genital and urinary tracts of both men and women.

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