Undescended Testicle

Dear Lisa,

My son, almost 13 yrs old, just informed us that he has a testicle that is not descended, and does not know how long it has been that way. We got him right in to our doctor, and we have a consultation on a surgery this next month to move it down. However, at his age, how great is his risk of testicular cancer? And will they be able to tell during surgery if there is cancer present?

“Concerned Mom”

Dear “Concerned Mom”,

Cryptorchidism or undescended testicle is a condition where the testes fail to descend to the scrotal sac where they belong. Surgery is needed in order to prevent the consequences of undescended testes. An undescended testes is unable to produce mature sperm, which is thought to be due to the higher temperature in the abdominal cavity or inguinal canal. (1) Undescended testes are also associated with hernias and are a risk factor for Testicular Cancer. According to the American Cancer Society, about 14% of cases of testicular cancer occur in men with a history of undescended testes. The risk of testicular cancer is somewhat higher for men whose testicle stayed in the abdomen as opposed to one that has descended at least partway. (2)

Men from the age 15 to 35 years old are at risk for developing testicular cancer. This means that most testicular cancers occur between the ages of 15 to 35 and are less common in younger boys. Just because your son has a risk factor for testicular cancer doesn’t necessarily mean that he is going to get it. Actually most men with testicular cancer have no risk factors. (2) It is good that you discovered the undescended testicle and are taking steps to correct it. Your son would have been at more risk if the undescended testicle was left undiscovered and not corrected. Now that you know that your son has a risk factor for testicular cancer you and your son are at an advantage because you are aware of the need to look for signs and have him carefully monitored for the disease.

At puberty your son should be taught how to perform a monthly testicular self exam, looking and feeling for masses or changes in his scrotum and testes. He also should have a complete physical examination including a testicular exam by his doctor yearly. Usually the first sign of testicular cancer is a lump on the testicle. Nine out of ten men with testicular cancer find a lump on the testicle which is usually painless but may be uncomfortable. Other signs of testicular cancer include a fullness or ache in the scrotum, enlarged testicle, swelling in the groin area, lower back pain, or changes in the breast tissue such as pain, swelling or discharge. In some cases of testicular cancer there are no symptoms at all. The important thing to remember is that although most cancers develop in the undescended testicle, up to 25 % of cases develop in the normal or descended testicle. Therefore careful measures should be taken to assess both testicles, not just the undescended one.

In response to your question about cancer being found during surgery, unless your doctor mentioned that there was a concern, be assured that testicular cancer is not commonly seen in younger children. Additionally, in most cases of testicular cancer, one of the symptoms described above would have been noticed. If you have not discussed your concerns with your doctor it would be important to do so. The doctor who examined your child will be able to explain if there were any suspicious findings of your son’s physical examination. During a physical exam on a child with an undescended testicle , the doctor feels the testicles for any sign of swelling, tenderness, or lumps. The doctor also feels the child's belly for enlarged lymph nodes and would be able to reassure you if everything looks and feels normal. Generally speaking, if the surgeon sees suspicious tissue during an operation, a biopsy or sample is taken and sent to the lab for examination by a pathologist. The pathologist then examines the sample and determines if the cells are cancerous. You can ask your surgeon if he is suspicious of cancer and what his approach is.

Testicular Cancer is one of the most curable forms of cancer. According to the National Cancer Institute, the 5 year relative survival rate for all men with testicular cancer is over 96%. (2) The American Cancer Society is a great resource for information about testicular cancer as well as other types of cancer. For more detailed information about testicular cancer you can log on to www.cancer.org/docroot/home/index.asp .

(1)Vigneux, A., Hunsberger, M. (1994) Altered Genitourinary/Renal Function. In Nursing Care of Children. (2nd Ed., pp 1520-1521). Philadelphia: WB Saunders.
(2)Detailed Guide: Testicular Cancer. What are the risk factors for testicular cancer?American Cancer Society Website available at: http://www.cancer.org/docroot/hom/index.asp. Accessed June 2006.

Lisa Kelly R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

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