Testicular cancer

Published by Bupa’s Health Information Team, August 2011.

This factsheet is for men who have testicular cancer, or for anyone who would like information about it including the symptoms, causes and treatments.

Testicular cancer is an abnormal and uncontrolled growth of cells that starts in a testicle. The outlook for men diagnosed with testicular cancer is one of the best for all cancers, with most men making a full recovery.

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About the testicles

The testicles are located inside the scrotum, the loose bag of skin that hangs below the penis. The testicles produce sperm and the hormone testosterone from the start of puberty.

About testicular cancer

In testicular cancer, cells in one of your testicles start to grow abnormally and out of control. Testicular cancer most often affects just one testicle, but rarely it can affect both.

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 is the tissues and organs, including your bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. 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 2,000 men in the UK each year, and mostly affects young and middle-aged men. Testicular cancer isn’t common – out of every 1,000 men diagnosed with cancer, fewer than 10 are testicular cancer. However, the number of men who develop it is increasing.

Types of testicular cancer

There are two main types of testicular cancer – seminoma and 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 occur in the testicles. This is cancer of the lymphatic tissue. It's the most common testicular cancer in men over 50.

Symptoms of testicular cancer

The most common symptom of testicular cancer is swelling or a hard, pea-sized lump on your testicle. 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

Very rarely, if the cancer is at a later stage, symptoms can include breast tenderness, back pain, shortness of breath and coughing.

These symptoms often aren't caused by testicular cancer but if you have them, or you’re in any doubt, 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. For information on how to examine your testicles see Related topics.

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, it's most common in men born with an undescended testicle (one that remains in your abdomen rather than descending into the scrotum). Boys who don't have this corrected by the age of 11 may be up to 32 times more likely to develop testicular cancer later. 

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

• having a brother or father who has had testicular cancer
• fertility problems
• being white
• having HIV or AIDS
• having a rare complication of mumps called orchitis (painful swelling of the testicles)

There isn’t any good scientific evidence to show that a vasectomy or an injury to your testicles can cause testicular cancer.

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 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. Ultrasound is a quick, easy and painless test. You may not need any further investigations if the ultrasound does not show any problem.

The only way to confirm testicular cancer is with a biopsy. In other types of cancer this involves removing a small sample of tissue, but for most men with suspected testicular cancer, the entire affected testicle will need to be removed in an operation called an orchidectomy. This is because the risk of the cancer spreading is too high with a normal biopsy.

If your test results show you have cancer, you may need to have other tests to assess whether the cancer has spread. The process of finding out the stage of a cancer is called staging. These further tests may include a CT or MRI scan or a chest X-ray.

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. Before you see a specialist, consider writing down a few questions to ask so that you don’t forget them on the day. 

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 the cancer is more advanced, you may need to have the lymph nodes in your abdomen removed for example. Your oncologist will explain what treatment you will 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 is given 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 you have lots of cancer cells in your lymph nodes in your abdomen, or if the cancer has spread beyond these, 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. Sometimes chemotherapy is used to shrink a large tumour before surgery, which will make it easier to remove. This is neo-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 to your lymph nodes at the back of your abdomen.

After your treatment

If you're diagnosed with testicular cancer, your doctor will talk to you about the effects it may have on your sex life and body image. Some men who have treatment for testicular cancer find they have a reduced sex drive or problems with sexual function. There may be an emotional cause for these problems or you may feel tired as a side-effect of your treatment. You may find that your sex drive increases when you recover from your treatment.

Some types of treatment, such as chemotherapy, can affect your fertility. Your hospital will therefore offer you the opportunity to store your sperm before you have treatment. Ask your doctor for more information about the effects of specific treatments on fertility.

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

Prevention of testicular cancer

You may be able to reduce your risk of developing testicular cancer by making changes to your lifestyle, such as stopping smoking, exercising and eating a healthy, balanced diet.

It’s important to familiarise yourself with the signs and symptoms of testicular cancer and to check your testicles regularly so that you notice any changes early. If you notice anything you aren't sure about, it’s best to get it checked by a doctor.

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.
 

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.