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Testicular cancer is one of the rarer types of cancers to affect men. Approximately one percent (1%) of male cancers can be attributed to malignancy of the testes. The American Cancer Society predicted that roughly 8,500 new cases of testicular cancer would be diagnosed in 2015 in the USA, as well as 380 deaths because of it. They also estimate 1 in every 263 men to be diagnosed with testicular cancer – that’s less than 0.5% risk (exactly 0.38%). Despite this, testicular cancer hits men at the worst possible time, because it typically targets males earlier in life – from their teens up to their mid-thirties – the prime years where a man’s potential is at its highest. So don’t ignore the following symptoms if you have them; prevention is your best weapon against cancer. 
#1: Testicular lump
By definition, cancer is the rapid growth and proliferation of abnormal cells in the body. These cells form masses of tissue called “tumors” that disrupt the body’s normal function depending on where they are formed. When a person is diagnosed with testicular cancer, a tumor/s can develop on one or both testicles, called germ cell tumors (GCTs). Research has consistently shown that the risk of developing a GCT increases with familial history of testicular cancer. Risk increases four to six-fold if you have a parent with GCT and eight to ten-fold if you have a sibling with GCT. 
#2: Swelling And / Or Hardness
In some cases, the testicles may swell and grow in size in the absence of a tumor. While testicles aren’t the same size (one is typically larger than the other), the abnormal growth of one or both can be indicative of testicular cancer. However, it can be hard to detect swelling in the testicular area since swelling can also occur in the scrotum or epididymis (a duct that runs behind the testes). Another sign is that one of the testes appears “stone hard” compared to the other one. It may not necessarily be painful.
#3: Breast Development
When tumors develop on the testes, they are more than just a mass of cells. They are highly vascularized (meaning the body basically feeds them oxygen and nutrition through blood vessels) and can secrete certain hormones. Some testicular tumors in particular produce HCG or human chorionic gonadotropin, a hormone that can stimulate breast growth in men (a.k.a. gynecomastia). Several cases have been studied and found out that 35 to 65 percent of men become affected by gynecomastia in their lifetime and 2 percent of these have been directly linked to testicular cancer. Gynecomastia presents as swelling and tenderness of the breasts. 
#4: Early Puberty
The onset of puberty is brought about by the production of the body’s sex hormones – which in boys is testosterone produced by the testicles. A kind of testicular tumor called Leydig cell tumors (LCTs) produce testosterone and stimulates the onset of early puberty. Boys affected with LCTs and undergo puberty present with pubic hair, penile, and bone and muscle growth earlier than normal. 
#5: Abdominal/Groin Pain
Pain is a common symptom shared by different cancers. The development of tumors causes pain because the growth of a mass on the testicle can compress the organ and its surrounding tissues and structures, firing up the neuronal pathway for pain. In testicular cancer, you may feel pain directly from the testicles or a dull ache in the lower abdomen (when pain radiates or in cases of abdominal metastasis).
#6: Fluid In The Scrotum
The testicles are very delicate organs that need to be contained in an environment with a specific temperature that won’t kill sperm (temperatures 37 degrees and higher can kill or damage sperm). The scrotum, which is basically a sack of skin and muscle, is able to keep the testicles at their optimum temperature. However, when testicular tissue becomes affected by cancer, it can mess with the permeability of the barrier in between the testes and the scrotum, causing an influx of fluid into the scrotal sac. Scrotal edema is dangerous because it can compress the testicle and damage it. In worse cases, the blood supply to the testicle can be cut off and it would have been surgically removed. 
#7: Back Pain
Back pain is one of the late symptoms of testicular cancer, usually manifesting when the cancer has metastasized to the lymph nodes. Metastases occurs when testicular cancer is in its later stages. The most common part of the body where testicular cancer spreads is the tissue in the back of the abdominal cavity (retroperitoneal cavity), an area rich in lymph nodes. In fact, research conducted by the Memorial Sloan Kettering Cancer Center found out that the more lymph nodes are surgically removed after chemotherapy in cases of testicular cancer reduces the risk of cancer recurrence. 
#8: Swelling Of The Legs
Similar to how testicular cancer spreads to the lymph nodes in the back, they can also easily affect the lymph nodes in the inguinal area (the area between the pubic area and the leg). When this happens, tumors may block the normal flow of lymph fluid in and out of the nodes, causing a build-up in the lower extremities. You can start to experience severe edema in the legs because of this; edema that is not relieved by elevation or medication (or is relieved but recurs repeatedly). 
#9: Erectile Dysfunction
Before you get ahead of yourself, keep this in mind – if you suffer from erectile dysfunction it doesn’t mean that you have testicular cancer. However, add this symptom to others previously mentioned on the list and the possibility for a testicular cancer diagnosis increases. Problems with sexual function and performance are very common in cases of testicular cancer since the testicles are responsible for producing and housing the body’s sperm. Changes in testicle size accompanied by pain can greatly affect sexual performance. 
Given the symptoms and explanations previously mentioned on this list, it’s a no-brainer that cancer that affects the testicles can cause infertility. Symptom nine and ten often go hand in hand, with men presenting with problems of infertility having an increased risk for testicular cancer. In a study published in 2005, the researchers found out that infertile subjects with abnormal semen analyses were 20 times more likely to be diagnosed with testicular cancer than members of the general population. 
Because of its rarity, a lot of research has been done on testicular cancer and how to survive it. Today, there is a 95 percent chance of surviving testicular cancer within the next five years. Localized testicular cancer has a near-perfect chance of survival (99.2 percent) as long as it’s diagnosed early. Keep these symptoms and protect yourself and your loved ones.
It is advised that men perform regular self-checks (for example monthly) for testicular abnormalities such as lumps, swelling or unusual hardness and any unusual condition reported to their physician. These checks can also be performed by the physician.
 Trabert, B., et. al. (2014). International patterns and trends in testicular cancer incidence, overall and by histologic subtype, 1973-2007. https://ncbi.nlm.nih.gov/pmc/articles/PMC4410839/
 American Cancer Society. What are the key statistics about testicular cancer? https://cancer.org/cancer/testicularcancer/detailedguide/testicular-cancer-key-statistics
 Ehrlich, Y., et. al. (2015). Advances in the treatment of testicular cancer. https://ncbi.nlm.nih.gov/pmc/articles/PMC4708227/
 Harris, M., et. al. (2006). Testicular tumour presenting as gynaecomastia. https://ncbi.nlm.nih.gov/pmc/articles/PMC1432188/
 Al-Agha, O., et. al. (2007). An In-Depth Look at Leydig Cell Tumor of the Testis. https://archivesofpathology.org/doi/pdf/10.1043/1543-2165%282007%29131%5B311%3AAILALC%5D2.0.CO%3B2
 US National Library of Medicine. Scrotal swelling. https://www.nlm.nih.gov/medlineplus/ency/article/003161.htm
 Benjamin, K. (2014). Conservative Management of Acute Scrotal Edema. https://medscape.com/viewarticle/828275
 Memorial Sloan Kettering Cancer Center (2010). Lymph Nodes Removal and Prognosis in Testicular Cancer. https://www.mskcc.org/announcements/lymph-node-removal-and-prognosis-testicular
 Bermudez, D. & Groh, J. (2014). Metastatic testicular cancer presenting as lower back pain in a pilot. https://pubmed.ncbi.nlm.nih.gov/25329948
 American Cancer Society. Understand Lymphedema – For Cancer Other Than Breast Cancer. https://cancer.org/acs/groups/cid/documents/webcontent/002928-pdf.pdf
 Tal, R., et. al. (2014). Erectile dysfunction in men treated for testicular cancer. https://pubmed.ncbi.nlm.nih.gov/24053222
 Raman, J., et. al. (2005). Increased Incidence Of Testicular Cancer In Men Presenting With Infertility And Abnormal Semen Analysis. https://sciencedirect.com/science/article/pii/S0022534701687883
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