Testicular cancer

Doctors still don't know exactly what causes testicular cancer. However, certain risk factors are known to raise a person's chances of developing it.

Having one or more of these risk factors doesn't mean a man will definitely get testicular cancer. Similarly, having none of them doesn't guarantee he won't.

Macmillan Cancer Support offers more detailed information on the causes and risk factors of testicular cancer.

Diagnosing testicular cancer

Usually, you’ll begin by seeing your GP, who will examine you.

If your GP thinks your symptoms may be linked to testicular cancer, they’ll refer you to a hospital to be seen within 2 weeks. Sometimes, your GP will arrange for an ultrasound scan of the testicle before you visit the hospital.

At the hospital, you’ll see a urologist. This is a doctor who specialises in treating problems with the testicles, penis, prostate, bladder and kidneys. They’ll examine you and ask about your general health and any previous health problems you may have had.

They’ll arrange an ultrasound scan of the scrotum and testicles. They’ll also arrange blood tests.

Some hospitals have testicular one-stop clinics. This means as well as seeing a urology doctor, you may have an ultrasound on the same day. You’ll also be seen by a specialist nurse.

Get Checked Early has more information on what to expect when getting checked.

Ultrasound scan

An ultrasound scan uses sound waves to produce a picture of the inside of your testicles. This is done by putting gel onto the scrotum and then passing a device like a microphone over the area.

It’s a painless test, and only takes a few minutes.

An ultrasound is the quickest and most accurate test for diagnosing testicular cancer. It can tell your doctor whether the lump is a harmless cyst (fluid-filled lump) or likely to be a cancer.

Blood tests

Some testicular cancers make certain chemicals called tumour markers that are released into the blood. You may have blood tests to see if you have raised levels of these chemicals.

Even if these chemicals aren’t raised in the blood, you may still have testicular cancer.

You’ll also have other blood tests to check your general health. This includes your iron (haemoglobin) levels and how your liver and kidneys are working.

Sometimes doctors diagnose testicular cancer during tests for symptoms in other areas of the body. For example, if a testicular cancer has spread, it may be diagnosed after having had a CT or MRI scan.

Waiting for test results can be a difficult time. Macmillan Cancer Support have more information that can help.

After the ultrasound scan

If the ultrasound shows the lump is highly likely to be testicular cancer, the whole testicle needs to be closely examined. The only way to get a definite diagnosis is to have surgery to remove the whole of the affected testicle. This operation is called an orchidectomy. This is because taking just a small piece of tissue (biopsy) may miss a cancer.

On rare occasions, the surgeon will remove only part of the testicle. For example, this may happen when someone has only one testicle. Or it may happen if the scan doesn’t show clearly how likely it is to be cancer.

A doctor called a pathologist will examine the removed tissue using a microscope. This is to see if there are any cancer cells. If there are, the sample will show which type of testicular cancer you have.

Further tests

After testicular cancer is diagnosed, you may also have a chest X-ray or a CT scan. This is to check that your lungs aren’t affected. The results help your doctors decide the best treatment for you.

Removing the testicle (orchidectomy)

As well as confirming a diagnosis, removing the testicle removes the cancer. It’s the main treatment for testicular cancer that hasn’t spread.

If the other testicle is healthy, an orchidectomy will not affect your ability to get an erection or your fertility. Fertility is being able to make someone pregnant.

If you’re gay, bisexual or transgender

There may be times when members of your healthcare team ask about your sexual orientation or gender identity. This information can help your team give the right care and support to you and the people close to you. You may find it makes things easier or less stressful for you.

If the questions they ask don’t fit who you are or how you identify, tell your team.

If you’re unsure or uncomfortable answering a question, it’s okay to check why the person is asking. You can ask them why they need this information and why they think it’s relevant to your care.

Stages of testicular cancer

The stage of a cancer describes its size and if it has spread from where it started. Testicular cancer is divided into stages 1 to 3. Staging also includes the level of tumour marker tests.

Knowing the stage helps your doctor decide on the best treatment for you.

Macmillan Cancer Support have more information about the stages of testicular cancer.

After surgery to diagnose and remove the cancer (orchidectomy), your doctors and specialists meet as a team to decide on the best treatment plan for you. This group is called a multidisciplinary team.

They will explain the further treatment options available and what may suit your situation best, along with the things worth thinking about when making your decision.

The right treatment depends on:

• the stage of the testicular cancer
• whether it is a seminoma or non-seminoma
• the risk of the cancer returning

After surgery, treatment options include the following.

Surveillance (monitoring)

If the risk of the cancer returning after surgery is low, your doctor may suggest surveillance instead of immediate further treatment. This means regular check-ups to watch for any sign of the cancer coming back. Attending every appointment is very important.

Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It may be given to lower the chance of the cancer returning, or to treat cancer that has already spread or come back after earlier treatment.

High-dose chemotherapy with stem cell support

In some cases, higher doses of chemotherapy are needed. Macmillan Cancer Support has more information on high-dose chemotherapy with stem cell support for testicular cancer.

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells. It is mainly used for seminoma, to lower the risk of the cancer returning in the lymph nodes at the back of the abdomen (known as the retroperitoneal lymph nodes), or if a seminoma comes back. It is used only rarely for non-seminomas.

Removing the retroperitoneal lymph nodes

Sometimes the lymph nodes at the back of the abdomen need to be removed after chemotherapy. This procedure is called a retroperitoneal lymph node dissection, or RPLND.

Surgery to other parts of the body

On rare occasions, testicular cancer spreads to other organs such as the lungs, brain, or liver. If further surgery is needed, it will be carried out at a specialist unit, and your doctor will explain the procedure to you in detail.

Treating testicular cancer that comes back

If testicular cancer returns, it can usually still be cured, even when it has spread to other parts of the body. The treatment given depends on the type of cancer, the areas affected, and what treatment you have already had. Macmillan Cancer Support has more information about treatment for recurring testicular cancer. You may also be offered treatment as part of a clinical trial.

Late effects of testicular cancer treatment

Some side effects take time to improve, and a few may not go away completely, becoming long-term effects. Others may only appear years after treatment ends, known as late effects. You may not experience any of these, or they may range from mild to severe.

Possible late effects include:

• hearing problems
• changes in sensation in the hands and feet
• heart or lung problems

There are ways to manage each of these. Macmillan Cancer Support has more information on the late effects of testicular cancer treatment.

Effects on sex and fertility

Testicular cancer treatment usually does not affect your ability to have sex or father a child, though it is natural to worry about this. Macmillan Cancer Support has more information on how treatment can affect your sex life and fertility, including contraception during treatment, having children later on, testosterone replacement, and storing sperm through sperm banking.

After testicular cancer treatment

You will have regular check-ups at the hospital once treatment ends. Your doctor will examine you and check your remaining testicle, often monthly at first, though how frequently you need to attend depends on the type and stage of your cancer.

You may have regular tumour marker tests, along with others such as:

• regular chest X-rays
• occasional CT or ultrasound scans

Going to these appointments matters. If you are unable to make one, arrange a new date right away.

Follow-up visits can feel stressful, but your healthcare team is there to help you manage any difficulties after treatment and connect you with support, which can help you feel more confident and in control.

If new symptoms appear between appointments, contact your hospital doctor, nurse, or GP. It is also important to check your remaining testicle every month. Developing a new cancer in the other testicle is rare, but having already had testicular cancer does raise the risk.

Wellbeing and recovery

Recovering from cancer and its treatment can take time. You may still have side effects, like tiredness, and be coping with the emotional effects for a while after treatment.

In time, you may find you slowly start to focus more on the day-to-day things you did before your diagnosis. Going back to work and getting back to your usual interests can be positive steps.

You may choose to make some positive lifestyle changes after treatment, even if you already have a healthy lifestyle. Changes to the way you live can improve your health and wellbeing and help your body recover. They may also help to reduce the risk of late effects. These include:

• not smoking
• keeping physically active
• having a well-balanced diet

Complementary therapies can help you feel better, reduce stress and anxiety, and improve some treatment side effects.

Your feelings

Everyone has their own way of dealing with illness and the different emotions they experience. There are lots of different ways to communicate and these can help you feel less alone. They include support groups and online support.

You may find it helpful to talk things over with family and friends or your doctor or nurse.

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan testicular cancer forum – you can talk to others affected by testicular cancer, ask questions and share your experience

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