Dear Dr G,

As Dr G is featuring a testicular cancer awareness campaign for the month of Movember, I hope to use this opportunity to raise concerns about testicular swellings that have been bothering me.

I am in my late twenties and have experienced painless swelling of my left testicle over the last few months.

My parents told me I was born prematurely with an undescended testicle, so I am paranoid about any abnormalities in the scrotum.

I was reassured the swelling was painless, so I observed for a few more weeks before seeing the doctors.

As the swelling continued to worsen, I eventually went to the doctors.

To my horror, the doctor said it is likely to be cancer and requires surgical removal to confirm the diagnosis.

I underwent two ultrasound scans and sought another medical opinion, all of which came to the same conclusion of cancer.

I am now convinced the operation is inevitable, but I would like to put Dr G on the spot for last-ditch clarifications.

Why is testicular cancer more common in young men?

Am I wrong in assuming cancer risk tends to increase with age?

Can you tell me how testicular cancer is diagnosed?

Shouldn’t a cancerous testicle be painful, rather than painless?

Is testicular cancer genetic in origin, and will it affect my younger son too?

Finally, do you think I have harmed myself by delaying the diagnosis by a few weeks?

Yours truly,

Painless Pete

Testicular cancer is a malignant growth that develops in the testes. It is well recognised to occur predominantly in younger men, with peaks around ages 25 and 35. The risk is highest among Caucasians in Northern Europe and the United States. It is relatively uncommon among Asian and African men.

Although the exact causes in younger men are unclear, genetic changes during active spermatogenesis likely play a role. The exact aetiology remains uncertain, but key risk factors include undescended testicles and male infertility. Men born with an undescended testicle expose the gland to a warmer body temperature. This temperature difference increases malignancy risk by up to fifty fold.

Around ten percent of testicular cancers occur in men with a history of undescended testicle. The testes form in the abdomen of the foetus and normally descend into the scrotum before birth. Failure of descent may leave a testis in the abdomen or groin. Higher temperature is thought to impair spermatogenesis and trigger malignant transformation of germ cells.

Genetic defects also appear to contribute, especially with a family history of testicular cancer or infertility. Early testicular cancer often presents as a painless lump in the testicle. Some men report a dull ache due to a heavier scrotum that aches with movement. Because most lumps are painless, men can be falsely reassured, delaying diagnosis and treatment.

Late disease may cause systemic symptoms such as malaise, weakness, headaches or body aches as metastases develop. Diagnosis is usually straightforward with an ultrasound scan and blood tests. Scrotal ultrasound is typically definitive for identifying a testicular tumour.

Tumour markers help assess type and burden of disease. These include alpha fetoprotein, beta hCG and lactate dehydrogenase. A positive urine pregnancy test in a man can sometimes indicate elevated beta hCG from a germ cell tumour. Staging scans may follow to guide treatment and prognosis.

Testicular cancer deserves attention because it affects adolescents and young adult men. On a positive note, it is among the most curable cancers, with five-year survival rates approaching 100% in early stages. Early detection relies on regular self examination and prompt medical review of any new lump.

The key lesson is that a painless lump can still be serious and must not be ignored. Self awareness, tenderness for your own health and timely action save lives.