Undescended Testicle and Testicular Cancer Risk: How Much, and What Changes?

The literature reports that testicular cancer risk is roughly 2 to 8 times higher in men with a history of an undescended testicle compared with the general population; the difference between studies varies with the age at surgery and the testicle's location.

Two explanations hold together. First, the testicle remaining in a warm environment leads to a maturation defect in germ cells (the precursor cells of sperm); some of these cells may later form the start of a tumor. Second, the developmental process that leaves the testicle undescended in the first place may itself affect the testicular tissue from the outset.

Large-scale studies have shown that orchiopexy (fixing the testicle in the scrotum) performed before puberty reduces cancer risk; risk remains markedly higher with repair done after puberty or not done at all.

An intra-abdominal testicle that has reached beyond puberty is in the highest-risk group for cancer, and sperm production has usually been lost. For this reason, in adults with an intra-abdominal testicle, especially if the other testicle is healthy, removal (orchiectomy) gains weight as an option; if the testicle's size and function are good, descent with close follow-up is also discussed.

Monthly testicular self-examination is taught starting in adolescence; any painless firmness, growth, sensation of heaviness, or change in consistency in the testicle is evaluated without delay. Treatment success for early-stage testicular cancer is very high; this is why not delaying is the most important protective measure.

• A new, painless firmness or nodule in the testicle
• Noticeable growth of the testicle or hardening in consistency
• A sensation of heaviness in the scrotum, dull pain in the groin
• Tenderness or enlargement of breast tissue (rare, seen in hormone-secreting tumors)

• Regular physician checkups continue yearly in childhood and at the intervals recommended by the physician in adolescence and adulthood; on this team, this continues under one roof from pediatric urology to adult urology.