More than nine out of ten cancers in the testicle develop from ‘germ cells’. These are the cells which produce sperm. There are two main types of this form of testicular cancer:
Seminomas tend to grow and spread less quickly than non-seminomas.
Very rarely, another type of cancer called a lymphoma can develop in your testicles. This is cancer of the lymphatic tissue. This is the most common cancer found in the testicles in men over 50.
By far the most common symptom of testicular cancer is a swelling or a hard lump on your testicle. This is usually painless. 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
- a collection of fluid in your scrotum (called a hydrocele)
If the cancer is at a later stage, you can get other symptoms including:
- back pain
- coughing or feeling breathless
- enlarged breasts
If you have any of these symptoms, see your GP.
It’s important to regularly check your testicles for any changes. Get to know what is normal for you so that you’ll notice any changes. The earlier testicular cancer is diagnosed, the better your chances of recovery.
Your GP will ask you about your symptoms and carefully examine your testicles. If you have a swelling or lump in your testicle your GP may refer you to a hospital specialist. This is usually a urologist (a doctor who specialises in identifying and treating conditions that affect the urinary system).
Your doctor will offer you a blood test to check the levels of certain hormones and proteins that can be high if you have testicular cancer. They will also ask you 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’s a painless test and 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. Your doctor will only recommend removing your testicle if they are fairly sure there is cancer there. If you do have testicular cancer then removal of the affected testicle would be the first part of your treatment anyway.
If you’re found to have cancer, you may need to have other tests to see 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 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 discuss your treatment with you and also describe any effects your treatment may have, such as on your sex life and fertility. See our FAQs for more information on how treatment may affect your fertility.
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 put into your scrotum to give it a normal appearance. If you’ve just had one testicle removed your ability to get an erection and father a child shouldn’t be affected.
After surgery, a team of specialists including an oncologist (a doctor who specialises in cancer care) will look at all your results. They’ll decide whether further treatment is advisable. 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 is recommended in your circumstances.
Chemotherapy uses medicines to destroy cancer cells. It’s usually used in testicular cancer when it has spread outside the testicle, or has come back after surgery to remove your testicle. You may also have chemotherapy after surgery to reduce the chance of the cancer returning in the future. This is then known as adjuvant chemotherapy.
The type of chemotherapy treatment you have will vary depending on your type and stage of testicular cancer. Usually you have a course of treatment, which you’ll 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.
Radiotherapy uses radiation to kill cancer cells. Radiotherapy is mainly used to treat testicular cancers which are seminomas, as they are very sensitive to radiation. 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’ll be asked to attend hospital appointments and have regular check-ups after your treatment to see if any of the cancer remains or returns. How often these happen will depend upon what type of cancer, and what treatment you had.
It’s really important that you go along for these check-ups. This is because, unlike many other types of cancer, if testicular cancer comes back after treatment it can often still be cured.
No one knows for sure why a man gets testicular cancer. However, there are some things that can make it more likely – these are called risk factors.
The main risk factor for testicular cancer is being born with an undescended testicle. This means that one or both of your testicles stayed in your abdomen rather than descending into your scrotum. Your testicles may have moved down later, or you may have needed a surgical operation to bring them down. If you’ve had an undescended testicle 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 six times more likely to develop testicular cancer later in life.
Other factors that may increase your risk of getting testicular cancer include:
- having had testicular cancer in the other testicle previously
- 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 vasectomy or an injury to your testicles doesn’t increase your risk of getting testicular cancer.
Being diagnosed with cancer can be distressing for you and your family. Things happen quickly and it can be overwhelming. An important part of cancer treatment is support to deal with the emotional aspects as well as the physical symptoms. Your specialist cancer doctors and nurses are experts in providing the support you need. Tell them about any problems you’re having.
One way to help yourself is by finding out about your type of cancer and how it is best treated. Being well informed may help you cope better with your diagnosis, and also help you make decisions about your care. Fortunately there’s a lot of information, support and advice available for people with cancer. See our Resources section for details of organisations that are there to help you.
Very few men get cancer in both testicles. However, if this does happen, you may need to have both testicles removed.
Getting cancer in both testicles is unusual, but cancer can sometimes develop in your remaining testicle after having had one removed. If this happens, you’ll need to have the other testicle removed as well. Your testicles make sperm, and also produce the hormone testosterone. So after having both testicles removed you’ll be infertile (unable to father children) and you’ll need to take testosterone replacement therapy.
Your doctor will discuss infertility with you before your treatment. If you wish to father children in future your doctor will usually 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.
Testosterone replacement therapy replaces the hormone that your body can no longer make after your testicles are removed. Testosterone replacement therapy is available in a number of different forms including injections and skin patches. Discuss with your doctor which would be the best option for you. You’ll need to take it for the rest of your life to keep you healthy. Testosterone replacement therapy will help you keep a normal sex drive and allow you to have an erection.
Your doctor may offer to insert artificial testicles (implants or prostheses) into your scrotum when your testicles are removed. These are designed to keep the normal appearance of your scrotum. Ask your doctor for details, and whether this might be an option for you.
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 it affect my chances of having children? Will having testicular cancer affect my chances of having children?
Most men who want to father a child after having testicular cancer can do so. However, chemotherapy and radiotherapy can lower your fertility, and if you have both testicles removed you’ll be infertile. In these cases banking your sperm before treatment may allow you to have children afterwards.
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 make up for the missing one.
If you have both testicles removed, you’ll be infertile. Your doctor will usually offer you the opportunity to bank some of your sperm before treatment. Your sperm will be frozen so you’ll have the option of trying for children later using fertility treatment.
If you have chemotherapy or radiotherapy, it may lower your fertility. Chemotherapy in particular can cause temporary infertility in men with testicular cancer, but your fertility should return. However, there’s a chance your fertility may not recover, particularly if you’ve had very high doses of chemotherapy. Your doctor will discuss this with you and you’ll be offered the opportunity to bank your sperm before treatment.
Does everybody with testicular cancer receive chemotherapy or radiotherapy? Does everybody with testicular cancer receive chemotherapy or radiotherapy?
No. All testicular cancers are treated with surgery. Your doctor may recommend chemotherapy or radiotherapy as well, depending upon the type of cancer you have and whether it has spread.
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. This is 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.
Most men who are treated for testicular cancer are cured – their cancer doesn’t come back. However, for some others the cancer does come back. If your cancer returns your doctor will offer you further treatment which might still cure your cancer.
Unlike many other cancers, if you have testicular cancer it may still be cured even when it comes back after treatment. If your testicular cancer is going to come back, it will usually do so within two years of finishing your treatment.
Your doctor will offer you further treatment. What type of treatment you have will depend on the type of testicular cancer you have, what treatment you’ve already had and where the cancer is. Your doctor will probably offer you chemotherapy. If you had chemotherapy to treat the cancer before, they may recommend a different type of chemotherapy medicine, or treatment with high-dose chemotherapy. If the cancer comes back in the lymph nodes in your abdomen, your doctor may offer surgery to remove it.
Remember – it’s important to attend all your hospital appointments after your testicular cancer treatment. That way your doctor can check whether your cancer has come back and offer you the best treatment.
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- Referral guidelines for suspected cancer. National Institute for Health and Care Excellence (NICE), 2005, modified 2011. www.nice.org.uk
- Testosterone and esters. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 10 June 2015 (online version)
- Genitourinary cancers. Oxford handbook of oncology (online). Oxford Medicine Online. www.oxfordmedicine.com, published June 2011 (online)
- Map of Medicine. Testicular cancer. International View. London: Map of Medicine; 2013 (Issue 1)
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- Testicular cancer. American Cancer Society. www.cancer.org, reviewed 20 January 2015
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Reviewed by Dylan Merkett, Bupa Health Content Team, July 2015.
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