Testicular Cancer and Disorders

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Occasionally—in 2 percent of full term and 10 percent of premature male babies—one or, more rarely, both testes will fail to descend from the abdomen into the scrotum during embryonic development. Often the affected testis will descend on its own within a few months of birth. Undescended testis is sometimes caused by dysfunctional hormones that control the development of the spermatic cord, which is comprised of the vas deferens and supporting nerves and blood vessels. When the hormones do not send the correct signals, the spermatic cord does not lengthen sufficiently for the testis to descend, develop normally, and eventually produce sperm. If neither testis descends, the man will be infertile. The problem may be corrected by surgery within the first few years of life.

A direct blow to the scrotum or twisting of the testis and spermatic cord may cause painful swelling. If pain is accompanied by fever, the swelling may be caused by infection of the testis or epididymis. Swelling without pain may indicate excess fluid or sperm in the epididymis, the presence of varicose veins in the scrotum, or collected blood in the scrotum as a result of injury. Less frequently, painless swelling may be one of the first signs of testicular cancer.

Testicular cancer is often detected by the man himself as a firm, usually painless lump in the testis. A physician conducts a complete medical exam and history, along with blood and urine tests and chest X rays to exclude other causes. If these are ruled out, a biopsy (removal and microscopic examination of cell tissue) is performed on testicular tissue to confirm a diagnosis of cancer. The testicle must then be removed through the groin (a surgical process called orchiectomy). Additional treatment may involve radiation therapy on the remaining testis and lymph glands, or chemotherapy, or a combination of both.

Because early detection is so important in achieving a successful cure, men should perform testicular self-examination once a month, looking for unusual changes in the appearance and feel of the scrotum.

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