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Testicular cancer

Cancer of the testicle is quite uncommon. It tends to affect young men between about 20 and 35, although you can get it if you’re younger or older than this.

Testicular cancer is one of the most treatable of all cancers. Most men make a full recovery, particularly if the cancer is diagnosed early. That’s why it’s important for you to contact your GP as soon as possible if you feel anything unusual in your testicle. To find out how to check yourself, see our factsheet on testicular cancer awareness.

Treatment usually involves surgery to remove the affected testicle. Chemotherapy and radiotherapy may also be recommended. Most men who want to father a child can still do so after treatment for testicular cancer.

How cancer develops
Cells begin to grow in an uncontrolled way

More about testicular cancer

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

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. 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 most often affects just one testicle, but rarely it can affect both. For every 100 men treated for testicular cancer in one testicle, two will get cancer in the other at some time in the future. See our FAQ below for more information about getting cancer in both testicles.

Testicular cancer affects around 2,400 men in the UK each year. The number of men getting testicular cancer has gone up by over a quarter since the early 1990s and still seems to be rising. No one is sure why. For more information about what makes a man more likely to get testicular cancer, see our section below on causes.

An image showing the male pelvis

Types of testicular cancer

More than nine out of ten cancers in the testicle develop from what are known as ‘germ cells’. These are the cells which produce sperm. There are two main types of this form of testicular cancer:

  • seminoma
  • non-seminoma

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, and is the most common cancer found in the testicles in men over 50.

Symptoms of testicular cancer

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 hydrocoele)

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, contact your GP.

It’s important to regularly check your testicles for any changes. To find out how to do this, have a look at our information on testicular cancer awareness. Get to know what’s normal for you so that you’ll notice any changes. The earlier testicular cancer is diagnosed, the better your chances of recovery.

Diagnosis of testicular cancer

If you find a lump, or something else abnormal around your testicles, it’s important to contact your GP as soon as possible.

Your GP will ask you about your symptoms and carefully examine you, including 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).

Or your GP may first offer you an ultrasound test. 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 cancer or not.

Your hospital doctor will offer you a blood test to check for certain hormones and proteins that can be high if you have testicular cancer. If you haven’t already had one, they’ll also ask you to have an ultrasound scan.

The only way to confirm testicular cancer is with a biopsy. In other types of cancer this would usually 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. (If you do have testicular cancer then removal of the affected testicle would be the first part of your treatment anyway.) The removed testicle will be sent to the laboratory to look for cancer cells.

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 scan, MRI scan and a chest X-ray.

You can find a lot more information about tests and the stages of testicular cancer from the websites listed under ‘Other helpful websites’ below.

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 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.

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 put into your scrotum to give it a normal appearance. Or you could choose to have one placed at a later time. 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 further surgery to have the lymph nodes in your abdomen removed, for example. Your doctor will explain what treatment is recommended in your circumstances.

Non-surgical treatments

Chemotherapy

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

Radiotherapy uses radiation to kill cancer cells. Radiotherapy is mainly used to treat testicular cancers which are seminomas, as they’re 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.

After your treatment

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 the type of cancer, and what treatment you had.

Your doctor may monitor your testosterone levels and offer you testosterone replacement treatment if they go too low.

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.

Causes of testicular cancer

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 going down 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.

There are a number of other things which are linked to a higher chance of getting testicular cancer. These 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

White men get testicular cancer more often than men from other ethnic groups, but no one knows why.

Having a vasectomy or an injury to your testicles doesn’t increase your risk of getting testicular cancer. However, having an injury to your testicles may lead you to examine them. You may then find a lump that was already there, but you just hadn’t noticed it yet.

Help and support

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. Talk to your doctor or nurse if you’re finding your feelings hard to cope with.

Everyone has their own way of coping. But for further support and advice you may find it helpful to contact one of the well known cancer organisations or visit their websites. They have more information about testicular cancer. Some have a telephone helpline you can ring, or an online forum you can join for a chat with others in your position. There may also be local groups where you can meet other people with similar medical issues, or other carers. Your cancer team may know of some.

See our section ‘other helpful websites’ below for contact details of relevant organisations. You may also find our general cancer articles helpful.

FAQ: What happens if I get cancer in both testicles?

Very few men get cancer in both testicles. However, if this does happen, you may need to have both testicles removed. Your testicles make sperm, and also produce the hormone testosterone. So after having both testicles removed you’ll be infertile (unable to father children). It will also be important that you 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 chance to bank your sperm. This means your sperm will be frozen so that you have the option of trying for children using infertility treatment in the future.

Testosterone replacement therapy replaces the hormone that your body can no longer make after your testicles are removed. It’s available in a number of different forms including gels and skin patches. You’ll need to take testosterone replacement therapy for the rest of your life to keep you healthy. It will help you keep a normal sex drive and let you have an erection.

Your doctor may offer to put artificial testicles (implants or prostheses) into your scrotum after 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.

FAQ: Will having testicular cancer mean I can’t have children?

Most men who want to father a child after having testicular cancer can do so. 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.

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 with infertility treatment.

Ask your doctor to explain how your treatment may affect your fertility, and what can be done to let you father children in future.

FAQ: Will I need chemotherapy or radiotherapy as well as surgery?

Not necessarily.

A team of doctors and other cancer specialists will be involved in planning the best care for you in your particular circumstances. All testicular cancers are treated with surgery to remove the affected testicle. 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, your doctor will recommend that you have 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.

Your doctor will explain why they’re recommending chemotherapy or radiotherapy in your circumstances. They’ll also be able to tell you what these treatments involve, and talk about any possible side-effects you may have.

FAQ: What happens if my testicular cancer comes back?

The good news is that most men who are treated for testicular cancer are cured – their cancer doesn’t come back.

If your testicular cancer does come back, it will usually be within two years of finishing your treatment. If this happens, your doctor will offer you further treatment which might still cure your cancer. This treatment will usually be chemotherapy. Your doctor will explain what this will involve in your particular circumstances.

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.

Details

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  • Resources Resources

    Further information

    Sources

    • Testicular cancer. BMJ Best Practice. bestpractice.bmj.com, last updated November 2017
    • Testicular cancer. Medscape. emedicine.medscape.com, updated 5 July 2017
    • Testes and epididymis anatomy. Medscape. emedicine.medscape.com, updated 30 June 2016
    • Testicular cancer. PatientPlus. patient.info/patientplus, last checked 24 November 2014
    • Genitourinary cancers. Oxford handbook of oncology (online). Oxford Medicine Online. www.oxfordmedicine.com, published September 2015
    • Guidelines on testicular cancer. European Association of Urology, 2016. www.uroweb.org
    • Map of Medicine. Testicular cancer. International View. London: Map of Medicine; 2015 (Issue 4)
    • Testosterone. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 14 November 2017
    • Testicular cancer. Cancer Research UK. www.cancerresearchuk.org, last reviewed 9 September 2014
    • Testicular cancer statistics. Cancer Research UK. www.cancerresearchuk.org, accessed 14 November 2017
    • Testicular cancer. American Cancer Society. www.cancer.org, last revised 12 February 2016
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    Reviewed by Dr Kristina Routh, Bupa Health Content Team, November 2017
    Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon
    Next review due November 2020

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