How to Perform a Testicular Self-Examination

Testicular cancer is a rare form of cancer, affecting 1 in 5000 men. It can develop at any age, though 50% of cases are in men between 20 and 35 years old. Fortunately, testicular cancer has a very high cure rate, with a success rate ranging from 95-99%. As with all cancers, early detection is key to successful treatment. Understanding the risk factors, recognizing symptoms, and regularly checking your testicles are essential for early detection.

Recognize Symptoms. To accurately self-examine, you must know what to look for in case of cancer. This self-exam requires you to identify the following symptoms:

• A lump in the testicle. The lump doesn't need to be large or painful to warrant concern, as early testicular cancer lumps can be as small as a pea or a grain of rice.
• Enlarged testicle. This may occur in one or both testicles. It is normal for one testicle to hang lower or appear slightly larger than the other. However, if one testicle is noticeably larger or has an abnormal shape or hardness, you should see a doctor.
• Changes in firmness or texture. Does one testicle feel harder or have an unusual lump? Healthy testicles have smooth, even surfaces. Note that both testicles are connected to the epididymis by a small, soft tube at the top. If you feel this tube during your examination, there's no need to worry, as it’s a normal part of the anatomy.

Find a Mirror and a Private Place. Choose a room where you won’t be disturbed, and select a mirror of suitable size (preferably one that doesn’t require holding). A bathroom mirror or full-length mirror works well. Ensuring you can observe your testicles properly is a key part of the self-examination process, and you should remove all clothing below the waist, including your underwear.

Examine the Skin Condition. Stand in front of the mirror and inspect the skin of the scrotum. Are there any lumps or swellings? Any discoloration or other abnormalities? Be sure to check all areas of the scrotum, including the back.

Palpate for Irregularities. Continue standing and hold the scrotum with both hands, using your fingers to palpate the area in a cupping motion. Hold one testicle between the thumb and index finger of one hand. Gently press to check the consistency and smoothness of the surface, then gently roll the testicle between your thumb and index finger. Repeat the same for the other testicle with your other hand.

• Take your time during the examination. You should spend enough time checking the entire surface of each testicle.

Schedule an Annual Check-Up. In addition to performing a self-exam every month, you should schedule an annual testicle exam with your doctor. The doctor will examine your testicles along with other tests as part of your overall health check-up. However, if you notice any symptoms, don’t wait for the next scheduled exam—seek medical attention immediately.

It is crucial to understand the risks you are facing. Early detection plays a vital role in successfully treating cancer, so being aware of all potential risks enables quicker reactions when symptoms appear. Below is a list of risk factors you should be mindful of:

• Family history of testicular cancer.
• Undescended testicles (also known as ectopic testicles). Three out of four testicular cancer cases occur in individuals with undescended testicles.
• Germ cell neoplasia in situ (IGCN). Commonly referred to as "carcinoma in situ" (CIS), IGCN occurs when cancer cells manifest as germ cells forming in the seminiferous tubules. IGCN and CIS are precursors to testicular tumors, and in 90% of cases, CIS is observed in the tissue surrounding the tumor.
• Ethnicity. A study in the U.S. found that Caucasian men are more likely to develop testicular cancer than other ethnic groups.
• Previous diagnosis. If you've previously been diagnosed with testicular cancer and successfully treated, you are at a higher risk for the remaining testicle.

Recognizing risks doesn't mean you're destined to develop cancer. Research has shown that managing environmental risks such as diet and exercise, as well as avoiding smoking and alcohol consumption, can help prevent carcinogens from forming, which is the process through which healthy cells turn into cancerous ones.

Consult with your doctor about preventive therapies. If you're at risk for testicular cancer, there's no need to worry, as clinical trials are ongoing to expand preventive options. Some proactive treatments have already shown effectiveness in preventing the cancer from developing and/or recurring. Your doctor will determine if these options are suitable for you.

See a doctor. If you notice any lumps, swelling, pain, unusual hardness, or any other warning signs during self-examination of your testicles, it's essential to get checked immediately. Although these symptoms don't necessarily mean you have testicular cancer, you should still see a doctor for a thorough examination and accurate results.

• Inform your doctor about these symptoms during the consultation, as it will help them perform a quicker diagnosis.

Note down all accompanying symptoms. If you notice any other symptoms affecting your testicles or any other part of your body, make a list. Include symptoms that may seem unrelated to testicular cancer. Additional information will help your doctor make a more accurate diagnosis and create a treatment plan tailored to you. Some symptoms to watch for include:

• Feeling of heaviness or pain in the lower abdomen or scrotum.
• Lower back pain, unrelated to muscle stiffness or injury.
• Swollen breasts (rare).
• Infertility. In some rare cases, the only symptom may be infertility.

Stay calm and optimistic. Once you’ve seen a doctor, you can feel assured. Remember, 95% of cases are completely treatable, and early detection increases that rate to 99%. Furthermore, these symptoms could be caused by a less serious issue, such as:

• Testicular cyst (located in the epididymis, the tube at the top of the testicle), also known as an epididymal cyst.
• Enlarged veins in the testicles, known as varicocele.
• Fluid buildup in the scrotum, referred to as hydrocele.
• Strain or rupture of abdominal muscles, commonly called a hernia.

Get a medical checkup. When you visit a doctor, they will conduct an examination similar to what you did at home and ask about any additional symptoms you've experienced. The doctor may also examine other areas of your body, such as the abdomen or groin, to assess the spread of cancer. If they detect anything unusual, they may recommend additional tests to confirm whether a tumor is present.

• The best time to examine your testicles is after a warm shower, when the scrotum has relaxed.
• Don't panic if you notice any of the symptoms described here, as what you find may be completely normal. However, use this opportunity to see a doctor for a more thorough checkup.

• This article is not a replacement for professional medical advice. You should schedule regular medical checkups and consult a healthcare expert for more information about your condition so they can perform any necessary tests to diagnose the issue accurately.

• A mirror