Both varicocele and testicular cancer occur as lumps in the testis though, there is a difference between these two conditions. The key difference between varicocele and testicular cancer is that testicular cancer is a cancerous growth of the testis while varicocele is non-cancerous and occurs due to the dilatation of testicular veins (pampiniform plexus). Common types of testicular cancer are seminoma and teratoma.
What is Varicocele?
Varicocele is a swelling of the scrotum caused by dilatation of the pampiniform venous plexus of the testis. Dilatation can occur spontaneously or due to a proximal obstruction of testicular veins. It has a ‘bag of worms’ feeling during palpation. Varicoceles are common on the left side. Sometimes bilateral varicocele can occur. Varicocele is a common condition among younger people compared to older people. Even though varicoceles are known to be potentially harmless, long-standing varicoceles can lead to infertility in males.
Varicocele can be the first presentation of a proximal venous obstruction such as renal cell carcinoma causing obstructions to renal veins and subsequently to testicular veins. Therefore, varicoceles need to be properly assessed by a doctor. It does not cause pain, but tingling sensation and heaviness of the scrotum can occur. Treatment is by surgical ligations of the testicular vein which is a minor surgical procedure.
Micrograph of a seminoma
What is Testicular Cancer?
Testicular cancers have several histological types. Out of them, teratoma and seminoma are the most common varieties. Testicular cancer is seen among relatively young age group but not necessarily. Testicular cancer can present with many non-specific symptoms such as heaviness of the scrotum, hard lump in the testis or sharp pain or a dull ache. If detected at the time where the cancer is confined to the scrotum, it has a good prognosis. However, if it is already spread outside the scrotum recurrence rate is high. Pain is not a differentiating feature for testicular cancer, and many other benign conditions can give rise to a similar clinical picture. Therefore, any testicular lump should be carefully investigated to exclude testicular cancer.
Lumps with malignant potential can be detected by an ultrasonic scan of the scrotum. However, biopsy and histology will give the definitive diagnosis. Many types of hormones are secreted by testicular cancers. These hormones can be useful as biomarkers to detect the type of cancer. Some examples are alpha-fetoprotein, human chorionic gonadotropin (the “pregnancy hormone”), and LDH-1. Once the cancer is diagnosed it needs staging to decide the extent of distant and local spread. This is done by CT/MRI scanning. Treatment is decided depending on the staging. Orchiectomy is the surgical removal of the testis which is even curative at early stages of the disease. Additionally, the patient is offered hormone ablation therapy, radiotherapy or chemotherapy. Once the treatment is completed regular follow-up is required to detect any recurrences.
What is the difference between Varicocele and Testicular Cancer?
Definitions of Varicocele and Testicular Cancer
Varicocele: Varicocele is the dilatation of pampiniform plexus in the testis.
Testicular: Testicular cancer is primary cancerous growth in the testis.
Features of Varicocele and Testicular Cancer
Presentation
Varicocele: Varicoceles create a bag of worms feeling, and it is soft to palpation.
Testicular: Testicular cancer is hard to form on palpation and loss of sensation of the testis is typical.
Age group
Varicocele: Varicoceles can occur at any age.
Testicular: Testicular cancers are common at a younger age.
Complications
Varicocele: Varicoceles can cause infertility.
Testicular: Testicular cancer can spread to distant organs.
Treatment
Varicocele: Varicoceles are treated with ligation of the testicular veins surgically.
Testicular: Testicular cancer is treated with orchiectomy and hormonal ablation therapies.
Prognosis
Varicocele: Varicoceles have a better prognosis.
Testicular: Testicular cancers have relatively a bad prognosis compared to varicoceles. Prognosis is better if it is detected early.
Image Courtesy:
“Gray1147” by Henry Vandyke Carter – Henry Gray (1918) Anatomy of the Human Body. (Public Domain) via Commons
“Seminoma” by Nephron – Own work. (CC BY-SA 3.0) via Commons