Testicular cancer
Testicular cancer represents only 1 per cent of all cancers in men, but it is the single biggest cause of cancer-related deaths in men aged 15-35 years in the UK. Currently, about 1500 men a year (around 1 in 400) develop the disease in the UK. Unfortunately, the number of UK cases has trebled in the past 25 years and is still rising. Signs to watch out for include:

a lump in one testicle.

pain and tenderness in either testicle.

discharge or pus from the penis.

blood in the sperm at ejaculation.

a build-up of fluid inside the scrotum.

a heavy or dragging feeling in the groin or scrotum.

an increase in size of a testicle (one testicle is normally larger then the other but the size and shape should remain more or less the same).

an enlargement of the breasts with or without tenderness.

it is a good idea to regularly check your testicles - click here to find out how.

What causes testicular cancer?
The causes of testicular cancer and reasons for the recent increase in frequency in some countries are unknown. Exposure to female hormones in the environment, in water (possibly from the oral contraceptive pill in water supplies) has been suggested. Undescended testicles (in which one or both testicles stay inside the body after birth and never sit in the scrotum) are a major risk factor. Men with one or both testicles undescended have a greatly increased risk - 1 in 44 will develop testicular cancer. Your risk increases if your father or brother suffered from testicular cancer.

What are the types of testicular tumour?
The term 'germ cell' is applied to cells that are capable of developing into sperm (in the male) or eggs (in the female). Thus the general term 'germ cell tumours' basically means tumours of either the testicle or the ovary.

There are two main types of testicular tumour - seminomas and non-seminomatous germ cell tumours (NSGCT, often also called 'teratomas'). The two types are about equally common. Seminomas are fairly smooth tumours but teratomas are more complex and may contain different types of tissue.

Both types of tumour are capable of producing hormones (or proteins) that are detectable in the blood. Human chorionic gonadotrophin (hCG) is produced by both teratomas and seminomas (hCG is the hormone produced by a woman during pregnancy, and is what is detected in a pregnancy test). Teratomas can produce alpha-fetoprotein (AFP). Often the level of these proteins in the blood is useful in the diagnosis, treatment and follow-up of men who have had testicular cancer.

How is testicular cancer treated?
Testicular cancer can be cured in about 96 per cent of cases if caught at an early stage. Even when these tumours spread, they can still be cured in 80 per cent of cases, and large tumours can be cured in 60 per cent of cases. Late diagnosis increases the risk of a poorer response to treatment.

Seminomas are usually diagnosed before they have spread to other parts of the body (metastasised) and radiotherapy (X-ray treatment) is the treatment of choice. If the seminoma has spread, then either radiotherapy or radiotherapy plus chemotherapy (anticancer medicine) is used. The original tumour and testicle is removed surgically.

With teratomas, provided there is no evidence of spread on examination and scans, and blood tests show none of the protein markers then a closely-observed 'wait and see' policy can be taken following tumour removal. If there is any sign of recurrence then chemotherapy may be started.

One of the great successes of modern chemotherapy has been the treatment of germ cell tumours. Usually four courses are given, at three-weekly intervals, of bleomycin, etoposide and cisplatin (BEP).

Where there are remaining tumours following chemotherapy (for example within the lymph nodes - the commonest site for the tumour to spread first) these are removed surgically in the case of teratomas. In seminomas they can be observed, and usually will not cause further trouble.

Although the affected testicle is removed during treatment, an artificial testicle (prosthesis) can be inserted to disguise the fact almost completely. Treatment with radiotherapy or chemotherapy can affect the ability to father children but in many cases fertility is not affected. Sperm can be stored before treatment for later use.

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