• Scrotal cancer refers to cancers originating in or around the scrotum, with testicular cancer being the most common type.
• Recognizing scrotal cancer symptoms early, such as a painless lump or swelling, is vital for timely intervention.
• Risk factors for scrotal cancer include undescended testicles, family history, and certain genetic conditions.
• Scrotal cancer diagnosis involves physical examination, imaging tests like ultrasound, and blood markers.
• Scrotal cancer treatment options typically include surgery, chemotherapy, and radiation therapy, with tailored approaches based on the cancer type and stage.

Understanding Scrotal Cancer: Types & Causes

What is scrotal cancer? It refers to any cancer that develops within the scrotum, the sac of skin that holds the testicles. While the term can broadly include various cancers affecting structures within the scrotum, the most common form by far is testicular cancer. Other, rarer forms can arise from the epididymis, spermatic cord, or the scrotal skin itself. Early identification of these conditions is paramount for successful treatment outcomes, emphasizing the importance of awareness regarding potential risk factors and symptoms.

The incidence of cancers affecting the scrotum varies significantly depending on the specific type. Testicular cancer, for instance, is the most common cancer in men aged 15 to 44 years, though it remains relatively rare overall, accounting for about 1% of all male cancers. According to the American Cancer Society, the lifetime risk of testicular cancer is about 1 in 250, with approximately 9,910 new cases diagnosed in the United States in 2023. Understanding the distinct characteristics of these malignancies is essential for accurate diagnosis and effective therapeutic strategies.

Types of Scrotal Cancer

While the umbrella term scrotal cancer covers any malignancy in this region, specific types are defined by their origin. The vast majority are germ cell tumors of the testicles, which are broadly categorized into seminomas and non-seminomas. Seminomas tend to grow and spread more slowly, while non-seminomas, which include embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma, often grow more rapidly. Beyond testicular germ cell tumors, other rare forms of cancer can also occur:

• Testicular Germ Cell Tumors: These originate from the germ cells in the testicles and constitute over 90% of all testicular cancers. They are further divided into seminomas and non-seminomas based on their cellular characteristics.
• Stromal Tumors: These are rare and develop in the hormone-producing tissues of the testicles, such as Leydig cells or Sertoli cells. They are usually benign but can sometimes be malignant.
• Lymphoma: While typically a systemic cancer, lymphoma can sometimes originate in or spread to the testicles, particularly in older men.
• Sarcomas: Extremely rare, these can develop from the connective tissues within the scrotum, such as rhabdomyosarcoma or leiomyosarcoma.
• Scrotal Skin Cancer: Cancers like squamous cell carcinoma can develop on the skin of the scrotum, often linked to chronic irritation or exposure to certain chemicals, though this is also very uncommon.

Causes of Scrotal Cancer

The precise causes of scrotal cancer, particularly testicular cancer, are not fully understood, but several risk factors have been identified. It’s important to note that having one or more risk factors does not guarantee that a person will develop cancer, and many men with testicular cancer have no known risk factors. However, these factors can increase an individual’s susceptibility to the disease.

Key risk factors include:

Exposure to certain chemicals, particularly in occupational settings, has also been linked to some rare forms of scrotal skin cancer, historically observed in chimney sweeps due to soot exposure. However, for the more common testicular cancers, environmental factors are less clearly defined compared to genetic and developmental factors.

Recognizing Symptoms and Diagnosis

Early recognition of scrotal cancer symptoms is critical for improving treatment outcomes. Many men discover testicular cancer themselves through self-examination, highlighting the importance of regular checks. The most common symptom is a painless lump or swelling in one of the testicles. While most testicular lumps are not cancerous, any new lump or change in the scrotum should be promptly evaluated by a healthcare professional. Ignoring these signs can lead to delayed diagnosis and potentially more advanced disease.

Beyond a palpable lump, other symptoms may include a feeling of heaviness in the scrotum, a dull ache in the lower abdomen or groin, sudden collection of fluid in the scrotum (hydrocele), or pain or discomfort in a testicle or the scrotum. In rare cases, if the cancer has spread, symptoms might include back pain, shortness of breath, chest pain, or abdominal pain. It is important to remember that these symptoms can also be caused by non-cancerous conditions, but only a medical professional can make an accurate diagnosis.

The process of scrotal cancer diagnosis typically begins with a thorough physical examination by a doctor, who will check the scrotum for lumps, swelling, or tenderness. If a suspicious mass is found, several diagnostic tests will be ordered:

• Scrotal Ultrasound: This is the primary imaging test used. It uses sound waves to create detailed images of the testicles and scrotum, helping to determine if a lump is solid (more likely to be cancerous) or fluid-filled (usually benign).
• Blood Tests (Tumor Markers): Certain substances, known as tumor markers, can be elevated in the blood of men with testicular cancer. These include alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH). These markers are useful for diagnosis, staging, and monitoring treatment effectiveness.
• Biopsy (Rarely Performed Directly): Unlike many other cancers, a biopsy of the testicle is rarely performed before surgery due to the risk of spreading cancer cells. If cancer is strongly suspected based on ultrasound and blood tests, the entire testicle is usually removed surgically (radical inguinal orchiectomy) for definitive diagnosis and treatment.
• CT Scans or X-rays: If cancer is confirmed, CT scans of the abdomen, pelvis, and chest, or chest X-rays, may be performed to check if the cancer has spread to other parts of the body (metastasis).

A comprehensive diagnostic approach ensures that the type and stage of cancer are accurately determined, which is crucial for planning the most effective treatment strategy. The combination of physical examination, imaging, and blood tests provides a robust pathway to confirm or rule out scrotal malignancies.

Scrotal Cancer Treatment and Prognosis

The scrotal cancer treatment options depend heavily on the type of cancer, its stage, and the patient’s overall health. For most testicular cancers, the initial and primary treatment is surgery. This is often followed by surveillance, chemotherapy, or radiation therapy, depending on the specific characteristics of the tumor and whether it has spread. The goal of treatment is to eradicate the cancer while preserving quality of life as much as possible.

The main treatment modalities include:

• Surgery (Radical Inguinal Orchiectomy): This is the standard first step for nearly all testicular cancers. The entire affected testicle is removed through an incision in the groin. This procedure is usually curative for early-stage disease. For some advanced cases, surgery to remove lymph nodes in the abdomen (retroperitoneal lymph node dissection, RPLND) may also be performed.
• Chemotherapy: This involves using powerful drugs to kill cancer cells throughout the body. It is often used for cancers that have spread beyond the testicle or for more aggressive types. Combinations of drugs, such as BEP (bleomycin, etoposide, and cisplatin), are commonly used.
• Radiation Therapy: This uses high-energy rays to kill cancer cells. It is more commonly used for seminoma, particularly if it has spread to lymph nodes, as seminomas are often very sensitive to radiation.
• Surveillance: For some early-stage cancers, particularly certain types of seminoma, active surveillance (regular check-ups, blood tests, and imaging) may be chosen instead of immediate chemotherapy or radiation, to monitor for recurrence and avoid unnecessary treatment side effects.

The scrotal cancer prognosis is generally very good, especially when detected and treated early. Testicular cancer is one of the most curable solid tumors. According to the National Cancer Institute’s SEER program, the 5-year relative survival rate for testicular cancer is approximately 95% overall. This high survival rate is attributed to effective treatment options and the fact that many cases are diagnosed at an early stage.

Prognosis can vary based on the stage of cancer at diagnosis:

Even for advanced cases, significant progress in chemotherapy has led to high cure rates. Regular follow-up care is crucial after treatment to monitor for recurrence and manage any long-term side effects. Patients are encouraged to discuss all treatment options and potential side effects with their healthcare team to make informed decisions.