Testicular cancer

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

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

What happens if I get cancer in both testicles?

Answer

It’s extremely rare to 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 very rare, but cancer can occasionally 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 you can try 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 two to three weeks. If you don’t keep the levels of testosterone in your body stable, you may get mood swings, tiredness and a low sex drive, which can be caused by a lack of testosterone. Side-effects of testosterone replacement therapy include a headache and feeling sick. Skin patches have very few side-effects and keep the 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 can try 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 and radiotherapy causes temporary infertility in most men with testicular cancer, but usually their fertility returns. 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 the 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. 

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