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Column originally published Apr 24, 2001

Monthly Self-Examination Is The Best Way To Detect Testicular Cancer Early

Question: My nephew was recently diagnosed with cancer of the testis. Fortunately it was detected early, and he made a full recovery. I am worried about our two sons. They are in their early teens. Can they develop the same cancer? Is there any test they can do to check this out?


There is a small chance that your sons can develop cancer of the testis (also called testicular cancer). The good news is: it is possible to detect this cancer early.

Overall, testicular cancer is an uncommon cancer in men. It is responsible for about 1% of all male cancers. However, it is the most common cancer in men between 15 to 35 years of age. At such young age, cancer in general is quite rare, except for cancer of testes. If the cancer is detected early, the chance of full recovery is excellent.

Although this is an uncommon cancer, it occurs much more frequently in those who testes did not get into the scrotum at or shortly after birth. Normally, when boys are born, parents would find two testes inside the scrotum. Once in a while, one or both testes may stay inside the abdomen, or in the groin, at birth. This condition is called undescended testes (also known as cryptorchidism).

Many of these undescended testes would go into the scrotum within the first few months of life. If they don’t, there are two concerns. Firstly, these testes may not produce sperms when the man reaches adulthood, because of the higher temperature inside the abdomen (compared with the scrotum). Secondly, undescended testes have 10 to 40 times greater chance of developing cancer later in life than normal testes.

Undescended testes need surgical operation to bring them into the scrotum. When the operation is done early, the testes may be able to produce sperms normally in adulthood. Because of increased chance of caner, it is a lot easier to detect this when the testes are inside the scrotum instead of inside the abdomen.

Although undescended testes have a much higher chance of cancer, they only account for about 10% of all testicular cancer. Around 90% of this cancer arise from completely normal testes. For those readers who are interested in human genetics and chromosomes, genes on chromosome number 12 have been linked with some testicular cancers. However, we are not ready to use genetic tests for early diagnosis (or prediction) of this condition.

Testicular cancer always presents as enlargement of the testis. About half of the time, the person would feel some pain or discomfort in the testis. That means half of the time there is totally no symptom, and the cancer is detected quite accidentally. This often happens in a shower. The muscle that normally suspends the testes would relax, allowing them to go to the bottom of the scrotum and much easier to be examined.

Whenever a young man discovers an enlarged or painful testis, he should immediately see his family doctor. The doctor will perform a careful examination of the testes and surrounding tissues, as well as the abdomen and lymph nodes. Most likely, an ultrasound of the scrotum is necessary to examine the structures in detail.

If it is determined that the enlarged testis is likely cancerous, a surgeon who is familiar with this condition will be consulted. Additional investigations will be done to ensure that the cancer has not spread elsewhere. Complete removal of the testis and affected lymph nodes would be the primary treatment.

Depending on the type of cells that had turned cancerous, chemotherapy (treatment with cancer drugs) and radiotherapy (treatment with special X-ray) are often required to make sure that all the cancerous cells are destroyed. With early detection and treatment, it is possible to achieve complete cure in over 90% of patients.

Most of the testicular cancers have ‘markers’ which can be detected by blood tests at the time of diagnosis. Once present, they can be followed by repeated blood tests to monitor the progress of treatment and to watch for recurrence of tumour.

However, it is not effective to use these blood tests for early diagnosis. These markers are not specific for testicular cancer, and blood tests are not always positive in those who have cancer. The best way to detect this cancer early is still regular examination.

Like self examination of breasts by women, young men between 15 to 35 years of age should check their scrotum and testes once a month. As I have mentioned earlier, the best time to do this is in the shower.

Both testes should be about the same size, and have a fairly smooth surface. Squeezing the testes gently should produce mild discomfort. If one testis is significantly larger than the other, and especially if it has a rough surface, this should raise a concern, and the doctor should be consulted as soon as possible. About half of the cancerous testes can produce some pain or discomfort.

There are many other conditions inside the scrotum which can mimic an enlarged testis. I cannot discuss them here in detail. Just like a woman finding a lump in her breast, she should not attempt to determine whether it is cancerous or not. She should consult her doctor immediately. The same is true for men. Anyone who finds an abnormal testis should consult his physician right away.

I hope this information can alleviate some of your anxiety. You may want to ask your doctor to explain to your teenage sons the importance of self-examination when they have their next check-ups.