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Testicular cancer isn't something you can wait to get treated. There is one kind of testicular cancer called testicular choriocarcinoma that causes only a small tumor in (usually) one testicle, but quickly metastasizes to the brain. There is another kind of testicular cancer called testicular seminoma that is more survivable and easier to treat.

There is one trait that identifies men as at high risk for testicular cancer. It's a condition called cryptoorchidism, a failure of one or both testicles to descend.

Men who have undescended testicles are up to 40 times more likely to develop testicular cancer. About 10 percent of men who have cryptoorchism develop cancer. 

What are the symptoms of testicular cancer?

Most often a man presenting this condition:

  • Is between the ages of 15 and 35,
  • Has had a painless lump in one testicle for several days to several months (men tend to be very slow to go to doctors about this condition),
  • May have hydrocele, or "drooping balls" due to fluid build up, and
  • Isn't in an advanced stage of the disease.

About 75 percent of men are diagnosed with testicular seminoma before the tumor has spread. However, sometimes the cancer spreads to the lungs and/or brain even when the tumor in the testicle is small. In testicular choriocarcinoma, the tumor in the testicle remains tiny even while the cancer spreads so widely it is essentially untreatable. However, this form of testicular cancer is rare. Men are much more likely to have seminoma.

Although either form of cancer is treated with radical orchidectomy, the surgical removal of a testicle, men are much more likely to lose their testicles to a condition called testicular torsion, a twisting of the spermatic cord that cuts off the blood supply to the testicle. This problem can occur in men of any age, even in male infants. It is also most common in younger men, under 35. Testicular torsion is more of a medical emergency than testicular cancer. If it is not treated right away, the tissues around the testicle can die and the testicle can become gangrenous.

Testicular torsion is most common in adolescents who are just getting their full production of sex hormones. The problem comes about when the protective "ball sac," known as the tunica vaginalis, is connected to the torso too high relative to the weight of the testicle. If the connection is too high, the spermatic cord can rotate inside the tunica vaginalis in a motion something like the clapper inside a bell. It can become tangled around an artery, and cut off blood flow. This intravaginal testicular torsion ("vagina" referring to a male structure, not a female structure or sex) causes intense pain in just one testicle. As the testicular tissue begins to die, the pain subsides. Only 4 to 8 percent of cases of testicular torsion are caused by a "kick in the balls" or similar injury. Usually, it's a gradual process that is traced to development of the testicles rather than any particular use of them.

Sometimes testicular torsion can come and go. There can be intense pain that resolves on its own, and everything seems to go back to normal. This is just a sign that the placement of the tunica vaginalis is not high enough to cause complete rotation of the spermatic cord. It's important to see a doctor, preferably a urologist, as soon as possible when there is intense testicular pain, even if it goes away, to determine whether the underlying problem is anatomical or possibly cancerous.

Men who wait more than 24 hours for treatment of testicular torsion have less than a 10 percent chance of saving the testicle. Similarly, men who get treatment for testicular cancer before it reaches stage IV (spread throughout the body) have an 86 percent chance of survival, but men who don't go to the doctor before the cancer reaches the brain are very unlikely to survive.

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