Testicular Cancer Awareness and Self Examination Techniques for Africans
By: Favour Okere. BNSc. RN. Freelance Health Writer. Medically reviewed by: A. Odutola, MBBS, PhD, FRCSEd.
Purple bowtie with two hanging balls to depict testicular cancer awareness.
Testicular cancer is a major health challenge for men and it is most common in 15–40-year-old men. [1] Globally, testicular cancer has a distinct geographic distribution with higher rates of occurrence reported in predominantly white populations. [2] In Africa, research shows low testicular cancer occurrence rates, but an advanced stage at presentation and high death rates. [3, 4]
Despite being relatively rare, this condition demands heightened awareness, early detection, and proactive health management in African populations.
If left untreated, the natural course of testicular cancer is to spread to other parts of the body uncontrollably (metastasis) and eventually lead to death. [5]
This article aims to provide African men and their partners with vital information about testicular cancer, its risk factors, prevention and self-examination techniques; as well as debunk myths about the disease.
But first, a description of the what the testes are, where to find them and what they do is necessary
The Testes, also called Testicles, are pair of organs that form part of the male reproductive system. A testicle (also referred to as testis), is normally a little smaller than a ping-pong (table tennis) ball in adult males. They're held outside the body within a sac of skin called the scrotum. The scrotum hangs under the base of the penis (see fig, 1).
Fig. 1: Cartoon drawing of the human male reproductive system. Click on image to enlarge.
The testicles have two main functions as follows:
Sperm cells are made in long thread-like tubes inside the testicles (called seminiferous tubules). They're then stored and mature in another small and coiled collecting tube behind each testicle, called the epididymis.
During intercourse and ejaculation, sperm cells are carried from a series of tubes to the seminal vesicles. There, they mix with fluids made by the vesicles, prostate gland, and other glands to form semen. The semen then enters another tube within the centre of the penis, called the urethra. The urethra is also the passage way for voiding urine out of the body from the bladder (fig. 1).
Testicular cancer is a complex medical disease that originates in the testicles, the male reproductive glands responsible for producing sperm and testosterone. [6, 7] Located within the scrotum, these small, oval-shaped organs are important to male reproductive health.
The disease develops when cells within the testicles begin to grow uncontrollably, forming a mass that can potentially spread to other body parts if left untreated.
The development of testicular cancer is a complex process involving hereditary (genetic), environmental, and physiological factors.
Unlike many other cancers, testicular cancer is unique in its occurrence among younger men aged 15 - 40 years. This therefore makes early detection and awareness important for successful treatment.
Testicular cancer, while relatively rare compared to other forms of cancers, arise primarily from germ cells (i.e. sperm producing cells) and less so from non-germ cells of the male reproductive organs.
There are two primary types of testicular cancers arising from germ cells and they are known in medical terms as Seminomas and Non-seminomas.
The types differ significantly in their features, development, and treatment approaches. It is important to be aware of these differences in determining the most effective treatment strategies.
Seminomas account for approximately 40-50% of all testicular cancer cases and are generally considered the less aggressive form of the disease. These tumors typically exhibit slower growth patterns, making them more likely to be discovered in earlier stages of development. This characteristic, combined with their high sensitivity to radiation treatment, often results in a more favourable treatment outcome for patients [7].
Seminomas most commonly affect men in their 30s and 40s. The relatively predictable behavior of seminomas and their excellent response to treatment have contributed to high survival rates among affected patients.
2. Non-seminomas
Non-seminomas represent about 50-60% of testicular cancer cases and demonstrate more complex and aggressive behavior. These tumors grow and spread more rapidly through the body, often requiring more intensive treatment approaches [8].
Non-seminomas include several distinct subtypes and each has its own characteristics that can make treatment more challenging.
Non-seminomas typically affect younger men between 15 and 40 years old, and their aggressive nature means that prompt detection and treatment are vital.
While testicular cancer accounts for approximately 1% of all male cancers worldwide, its incidence rates in Sub-Saharan Africa have historically been lower compared to Western countries [9]. However, these statistics may not tell the complete story due to significant challenges in data collection and reporting throughout the region.
Several factors contribute to potential underreporting of testicular cancer cases in Sub-Saharan Africa. These include: [10, 11]
1. Primary Risk Factors
Early detection relies on recognising potential warning signs. These signs include:
The diagnosis of testicular cancer begins with your doctor taking a history of your present illness. In doing so, your doctor will ask you about your complaints, its duration, what you think may have caused it, what you have done to take care of it, your past medical condition, your family history, what medications you are taking, etc. Your doctor will then follow up the history with a physical examination.
Your doctor will initially perform a general physical examination of your body and then focus on a thorough assessment of the scrotal area and abdomen. During this examination, your doctor would meticulously check for any lumps, swelling, or abnormalities that might indicate testicular cancer. Your doctor would also check for small rubbery masses called lymph nodes, in your groin and other areas. Enlargement of these small rubbery masses often suggest cancer spread.
At the end of your physical examination, your doctor may request that you undertake several laboratory and diagnostic tests that include:
Blood tests form an essential component of diagnosis of testicular cancer. These tests include:
These markers not only assist in diagnosis but also help monitor treatment response and detect potential recurrence during follow-up care.
Modern imaging technology plays a crucial role in testicular diagnosis.
Ultrasound scanning typically serves as the primary imaging tool, effectively distinguishing between testicular cancer and simple, non-serious conditions of the scrotum through detailed look at the testicles and surrounding tissues. When cancer is suspected or confirmed, additional imaging such as CT scans or MRI may be necessary to assess if the cancer has spread to other parts of the body, particularly the lymph nodes, lungs, or other organs.
When cancer is suspected, a definitive diagnosis typically requires a biopsy through a surgical removal of the affected testicle. This procedure serves both diagnostic and therapeutic purposes, allowing other special doctors who study organs and tissues of the body (pathologists) to make a definitive diagnosis of your condition, determine the specific type of testicular cancer that you have and provide vital information for your treatment planning [12].
Mid-section of an unclothed black man with a white towel cover. Image credit: Freepik
The best time to perform self-examination of your testicles is after a warm shower or bath when the scrotal skin is most relaxed. Stand in front of a mirror in a private, well-lit space where you can comfortably examine yourself and then do the following:
1. Begin with a visual inspection. Look for any swelling, changes in size, or differences between your testicles. Some asymmetry is normal, but notable changes should be noted.
2. Using both hands, gently cup your scrotum. Get a sense of how your testicles normally feel and their usual weight.
3. Using your thumb and first two fingers, gently roll one testicle at a time. Hold the testicle between your thumb (positioned in front) and middle and index fingers (behind the testicle).
4. Feel along the entire surface, checking for any hard lumps, smooth rounded bumps, or changes in texture. Pay particular attention to any changes in firmness or unusual masses.
5. Locate the soft, rope-like structure at the back of each testicle (epididymis). It is important to familiarize yourself with this normal anatomical feature so you do not mistake it for a lump.
6. Repeat the process with the other testicle, comparing how they feel. While it is normal for one to be slightly larger or hang lower than the other, significant changes in size or texture should be noted.
What to Look For?
During your examination, be alert for:
Perform this examination monthly, and if you notice any changes or have concerns, contact your healthcare provider promptly. Remember that most testicular lumps are not cancerous, but early detection is important for successful treatment if cancer is present.
Several myths persist about testicular cancer in African societies. Here are some of them:
Fact: Studies have shown it is most common in young adults aged 15-40.
Fact: Not true. The exact cause of testicular cancer is unknown and unethical behaviors such as infidelity is not one of the known risk factors.
Fact: Early-stage cases do not often present with pain.
Fact: When caught early, testicular cancer has one of the highest cure rates among cancers affecting men.
Fact: Self-examination is important as it allows early identification of any unsual features about the testicles and promotes early visit to a healthcare provider.
Understanding these facts is essential for promoting awareness and encouraging appropriate health-seeking behavior.
1. How often should I perform a self-exam check?
It is recommended that you perform a self-exam once a month after a warm shower. By checking regularly, you will have an easier time noticing when something has changed. Most men are intimately aware of their genitalia and any changes that occur. The most important lesson is that if you feel something abnormal, seek a professional opinion right away.
2. Does a lump always indicate cancer?
No. When you notice one though, you should see your doctor promptly for further evaluation.
3. Is testicular cancer treatable?
Yes, especially when detected early. In such situation, the survival rate exceed 95%.
Your health journey is defined by awareness, being engaged and seeking help. Understanding testicular cancer involves more than knowing about health and disease, it is about taking action. When you recognise the risks of testicular cancer, practice regular self-examination, and maintain open communication with healthcare providers, you can significantly improve your health outcomes for the condition.
1. Burger, H. et al. “Testicular Germ Cell Cancer in Africa: A Survey on Patterns of Practice.” South African Journal of Oncology, vol. 6, Sept. 2022. doi: 10.4102/sajo.v6i0.241. Available from here
2. Rosen, A. et al. “Global Trends in Testicular Cancer Incidence and Mortality.” European Urology, vol. 60, no. 2, Aug. 2011, pp. 374–79. ScienceDirect, doi: 10.1016/j.eururo.2011.05.004. Available from here
3. Cassell A, Jalloh M, Ndoye M, Yunusa B, Mbodji M, Diallo A, Gaye O, Labou I, Niang L, Gueye S. Review of Testicular Tumor: Diagnostic Approach and Management Outcome in Africa. Res Rep Urol. 2020 Feb 18;12:35-42. doi: 10.2147/RRU.S242398. Available from here.
4. Omotoso, O., Teibo, J.O., Atiba, F.A. et al. Addressing cancer care inequities in sub-Saharan Africa: current challenges and proposed solutions. Int J Equity Health 22, 189 (2023). doi: 10.1186/s12939-023-01962-y. Available from here.
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6. Skinner, M. Testicular Tumors: Epidemiology and Risk Factors. Encyclopedia of Reproduction. [2018]. Elsevier Limited.
7. American Cancer Society. What is Testicular Cancer? [Internet, n.d.]. Cited Feb. 2, 2025. Available from here.
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9. Rajpert-De Meyts E, Aksglaede L, Bandak M, et al. Testicular Cancer: Pathogenesis, Diagnosis and Management with Focus on Endocrine Aspects. [Updated 2023 Mar 29]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from here.
10. Giona S. The Epidemiology of Testicular Cancer. In: Barber N, Ali A, editors. Urologic Cancers [Internet]. Brisbane (AU): Exon Publications; 2022 Sep 12. Chapter 9. doi: 10.36255/exon-publications-urologic-cancers-epidemiology-testicular-cancer. Available from here
11.. Roudsari R, Sharifi F, Goudarzi F. Barriers to the participation of men in reproductive health care: a systematic review and meta-synthesis. BMC Public Health. 2023;23:818. doi: 10.1186/s12889-023-15692-x. Available from here.
12. Gaddam SJ, Chesnut GT. Testicular Cancer. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. [Updated 2023 May 27]. Available from here
Published: February 24, 2025
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