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Testicular cancer

Testicular cancer is an abnormal and uncontrolled growth of cells that starts in your testicle. It mostly affects men aged 20 to 40.

In testicular cancer, cells in one of your testicles start to grow abnormally and out of control. The testicles are located inside your scrotum, the loose bag of skin that hangs below your penis. Your testicles produce sperm and the hormone testosterone from the start of puberty.

Testicular cancer most often affects just one testicle, but rarely, it can affect both. Also after treatment for cancer in one testicle, you can develop it later in the other.

Testicular cancer can sometimes spread to your lymph nodes in your abdomen (tummy) or more rarely, to other organs, through your bloodstream or lymph system. The lymphatic system consists of the tissues and organs in your body that produce and store cells that fight infection and disease. These include your bone marrow, spleen, thymus and lymph nodes. The channels that carry lymph are also part of this system. If testicular cancer spreads to other parts of your body, it can form secondary tumours. The spread of cancer through your body is called metastasis.

Testicular cancer affects around 2,280 men in the UK each year, and mostly affects men aged 20 to 40, although you can get it if you’re younger or older than this. Testicular cancer isn’t common – one out of every 100 men diagnosed with cancer have testicular cancer. However, the number of men who develop it is increasing, particularly white men.

The outlook for men diagnosed with testicular cancer is one of the best for all cancers and most make a full recovery, particularly if it's diagnosed early.

Types of testicular cancer

There are two main types of testicular cancer:

  • seminoma
  • non-seminoma

The names refer to the type of cell that makes up the tumour.

Very rarely, another type of cancer called a lymphoma can develop in your testicles, which is cancer of the lymphatic tissue. This is the most common cancer found in the testicles in men over 50.

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How cancer develops
Cells begin to grow in an uncontrolled way
An image showing the position of the testicles and surrounding structures

Details

  • Symptoms Symptoms of testicular cancer

    The most common symptom of testicular cancer is swelling or a hard, pea-sized (or larger) lump on your testicle, which isn’t usually painful. Other symptoms can include:

    • a pulling sensation or heavy feeling in your scrotum
    • a dull ache in your groin or lower abdomen
    • pain or discomfort in your testicle or scrotum (which may come and go)
    • a collection of fluid in your scrotum (called a hydrocele)
    • feeling unwell and tired

    If the cancer is at a later stage, you can get symptoms including:

    • enlarged breasts
    • back pain
    • shortness of breath
    • coughing
    • feeling sick

    If you have any of these symptoms, see your GP.

    It’s important to regularly check your testicles for any changes. The earlier testicular cancer is diagnosed, the easier and quicker it is to treat and the better your chances of recovery.

    Bupa Health Assessment: Testicular check

    If you are concerned about testicular cancer, Bupa can help you get a diagnosis.

  • Diagnosis Diagnosis of testicular cancer

    Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history, and whether anyone else in your family has had testicular cancer. Your GP may refer you to a urologist (a doctor who specialises in identifying and treating conditions that affect the urinary system) or a testicular cancer specialist.

    You may have a blood test to check the levels of certain hormones and proteins that can be high if you have testicular cancer. You may also be asked to have an ultrasound scan. An ultrasound scan uses sound waves to produce an image of the inside of your scrotum and your testicle. It can help to show whether the lump is caused by a condition other than cancer.

    The only way to confirm testicular cancer is with a biopsy. In other types of cancer this would involve removing a small sample of tissue. However for testicular cancer, your entire affected testicle is usually removed in an operation called an orchidectomy. This is because the risk of the cancer spreading is too high with a normal biopsy. However, very occasionally if you have a very small tumour, your surgeon will remove only part of your testicle, which is called a partial orchidectomy.

    If you’re found to have cancer, you may need to have other tests to assess if the cancer has spread. This process of finding out whether the cancer has spread is called staging. These further tests may include a CT or MRI scan or a chest X-ray.

  • Treatment Treatment of testicular cancer

    Treatment for testicular cancer is usually very successful. The type of treatment you have will depend on the type of cancer you have and how far it has spread. Your doctor will describe your treatment to you and also describe any effects your treatment may have, such as on your sex life and fertility. See out FAQs for more information on how treatment may affect your fertility.

    Surgery

    The main treatment for testicular cancer is surgery to remove your affected testicle (if it hasn’t already been removed during your diagnosis). If you’re diagnosed early, surgery may be the only treatment that you need.

    Your doctor will talk to you about the operation and your options. You may be able to have an artificial testicle inserted into your scrotum to give it a normal appearance.

    After surgery, you will be referred to a team of specialists including an oncologist (a doctor who specialises in cancer care) to decide on further treatment. If your cancer is more advanced, you may need to have the lymph nodes in your abdomen removed for example. Your doctor will explain what treatment you need.

    Non-surgical treatments

    Chemotherapy

    Chemotherapy uses medicines to destroy cancer cells. The type of chemotherapy treatment you have will vary depending on your type of testicular cancer. Usually you have a course of treatment, which you will have as several doses over a period of weeks. Your doctor will give you information on the type and course that’s best for you.

    If the cancer has spread beyond your testicle or come back after surgery to remove your testicle, you will need to have chemotherapy. You may also have chemotherapy after surgery to reduce the chance of the cancer returning in the future. This is known as adjuvant chemotherapy.

    Radiotherapy

    Radiotherapy uses radiation to kill cancer cells. You may have radiotherapy after surgery to prevent the cancer coming back or to treat any cancer cells that have spread out of your testicle. You can have radiotherapy as an alternative to or in addition to chemotherapy.

  • Worried about testicular cancer?

    Get a picture of your current health and potential future health risks with a Bupa health assessment. Find out more today.

  • Recovery After your treatment

    You will need to attend hospital appointments and have regular check-ups after your treatment to see if any of the cancer remains. If further cancer is found, you may be able to have more treatment to remove it.

  • Causes Causes of testicular cancer

    The exact reasons why you may develop testicular cancer aren't fully understood at present. However, there are some things that can make it more likely. For example, if you were born with an undescended testicle (one that remains in your abdomen rather than descending into your scrotum) you’re three times more likely to develop testicular cancer than men who didn’t have this problem. And if you don't have this corrected by the age of 13, you may be up to five times more likely to develop testicular cancer later in life.

    Other factors that may increase your risk of getting testicular cancer include:

    • having a brother or father who has had testicular cancer
    • having fertility problems and low quality sperm
    • being white
    • having other medical conditions, such as hypospadias, an inguinal hernia, or HIV/AIDS
    • having a rare complication of mumps called orchitis (painful swelling of the testicles)

    Having a vasectomy or an injury to your testicles doesn’t increase your risk of getting testicular cancer.

  • Help and support Help and support

    Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need.

  • FAQs FAQs

    What happens if I get cancer in both testicles?

    Answer

    Very few men get cancer in both testicles. However, if this does happen, you may need to have both testicles removed.

    Explanation

    Getting cancer in both testicles is unusual, but cancer can sometimes develop in your remaining testicle after having one removed. If this happens, you will need to have the other testicle removed as well. This means that you will be infertile, but your doctor will discuss this with you before treatment and offer you the opportunity to bank your sperm. In sperm banking, your sperm will be frozen so that you have the option of trying for children using fertility treatment in the future.

    Your body will stop making the hormone testosterone after the operation so you will need to have testosterone replacement therapy. This will give you a normal sex drive and allow you to have an erection.

    Testosterone replacement therapy is available in a number of different forms including injections and skin patches. If you have injections, you will need to have them every few weeks. If you don’t keep the levels of testosterone in your body stable, you may get a low mood, tiredness and a low sex drive. Side-effects of testosterone replacement therapy include a headache and feeling sick. Skin patches have very few side-effects and keep testosterone levels very stable in your blood; however, they might irritate your skin.

    Having both testicles removed can be distressing. Your doctor can refer you to a counsellor or a sex therapist so you can talk through your feelings.

    Will having testicular cancer affect my chances of having children?

    Answer

    No, it isn't likely to unless you have cancer in both testicles.

    Explanation

    Your fertility won't usually be permanently affected if only one of your testicles is removed. Your remaining testicle will make more sperm and more of the hormone testosterone to compensate for the missing one.

    If you have both testicles removed, you will be infertile. You will be offered the opportunity to bank some of your sperm before treatment. Your sperm will be frozen so you have the option of trying for children using fertility treatment.

    If you have chemotherapy or radiotherapy, it may affect your fertility. Chemotherapy is a treatment that uses medicines to destroy cancer cells. Radiotherapy uses radiation to destroy cancer cells. A beam of radiation is targeted on the cancerous cells, which shrinks the tumour. Chemotherapy in particular can cause temporary infertility in men with testicular cancer, but your fertility should return. However, there is a chance your fertility may not recover, particularly if you have had very high doses of chemotherapy. Your doctor will discuss this and you will be offered the opportunity to bank your sperm before treatment.

    Does everybody with testicular cancer receive chemotherapy or radiotherapy?

    Answer

    No, but increasingly more and more men are offered chemotherapy after having a testicle removed. If you have the seminoma type of testicular cancer, you may be offered radiotherapy.

    Explanation

    After having a testicle removed, you may have blood tests, a chest X-ray, ultrasound or a CT scan to see if the cancer has spread. If it has, you will be offered chemotherapy. Even if the cancer hasn't spread, your doctor may offer you a short course or single treatment of chemotherapy to reduce the chances of the cancer coming back in the future.

    Radiotherapy is sometimes used to treat seminoma, to stop cancer returning after surgery or to treat any cancer that has spread to the lymph nodes.

    Is it possible for cancer to come back even after surgery to remove both testicles?

    Answer

    Yes, it’s possible for the cancer to return even if you have had both testicles removed.

    Explanation

    It’s still possible for the cancer to come back even if you have had an operation to remove both your testicles. Testicular cancer may have spread beyond your testicles by the time it’s diagnosed so even if you had them both removed, some cancer cells may already have spread into other parts of your body. If the cancer does come back, it’s most likely to happen within two years of your treatment.

    Your options will depend on the type of testicular cancer you have, what treatment you had and where the cancer has come back in your body.

    Most men are offered chemotherapy after cancer returns. Chemotherapy is often able to kill off the majority of cancer cells and the cancer is then in ‘remission’. If all the detectable cancer disappears, it’s called ‘complete remission’. If most of the cancer disappears but a small amount remains, it’s known as ‘partial remission’. If you had chemotherapy to treat the cancer before, you may be offered a different type of chemotherapy medicine, or treatment with high-dose chemotherapy.

    If the cancer comes back in the lymph nodes in your abdomen, you will be offered surgery to remove it.

    It’s important to attend hospital appointments after your operation and have regular tests to see if any of the cancer remains.

    If you have any questions about your surgery and what results you can expect from it, or about treatments if the cancer comes back, ask your surgeon or doctor.

  • Resources Resources

    Further information

    Sources

    • Testicular cancer. American Cancer Society. www.cancer.org, published 17 January 2013
    • Testicular cancer risks and causes. Cancer Research UK. www.cancerresearchuk.org, published 19 February 2013
    • Testicular cancer – suspected. Map of Medicine. www.mapofmedicine.com, published 25 January 2013
    • Testicular cancer. Macmillan. www.macmillan.org.uk, accessed 18 April 2013
    • Guidelines on testicular cancer. European Association of Urology. www.uroweb.org, published 2013
    • Types of testicular cancer. Cancer Research UK. www.cancerresearchuk.org, published 18 February 2013
    • Testicular cancer clinical presentation. eMedicine. www.emedicine.medscape.com, published 2 April 2012
    • Testicular cancer symptoms. Cancer Research UK. www.cancerresearchuk.org, published 18 February 2013
    • Ilic D, Misso ML. Screening for testicular cancer. Cochrane Database of Systematic Reviews 2011, Issue 2. doi: 10.1002/14651858.CD007853.pub2.
    • Nonseminomatous testicular tumors. eMedicine. www.emedicine.medscape.com, published 16 April 2012
    • Testicular cancer tests. Cancer Research UK. www.cancerresearchuk.org, published 20 February 2013
    • Testicular cancer – investigation and management. Map of Medicine. www.mapofmedicine.com, published 25 January 2013
    • Which surgery for testicular cancer? Cancer Research UK. www.cancerresearchuk.org, published 22 February 2013
    • Treatment for testicular cancer. Macmillan Cancer Support. www.macmillan.org.uk, published 1 August 2012
    • Testicular cancer – further management. Map of Medicine. www.mapofmedicine.com, published 25 January 2013
    • Chemotherapy for testicular cancer. Macmillan Cancer Support. www.macmillan.org.uk, published 1 August 2012
    • Radiotherapy for testicular cancer. Macmillan Cancer Support. www.macmillan.org.uk, published 1 August 2012
    • How treatment for testicular cancer might affect your fertility and sex life. Macmillan Cancer Support. www.macmillan.org.uk, published 1 August 2012
    • Fertility – having children after testicular cancer. Cancer Research UK. www.cancerresearchuk.org, published 26 February 2013
    • Joint Formulary Committee. British National Formulary (online) London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed April 2013
    • Your sex life and testicular cancer. Cancer Research UK. www.cancerresearchuk.org, published 26 February 2013
    • Testicular cancer treatment and management. eMedicine. www.emedicine.medscape.com, published 2 April 2012
    • If your testicular cancer comes back. Cancer Research UK. www.cancerresearchuk.org, published 26 February 2013
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    Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, June 2013.

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