Testicular cancer

Testicular cancer starts in one of the testicles. The testicles are the main part of the male reproductive system.

Anyone who has testicles can get this cancer, including men, transgender (trans) women and people assigned male at birth. It's most likely to happen between the ages of 25 and 40.

Each year in the UK, around 2,300 men are diagnosed with testicular cancer.

Testicular cancer is usually curable. Like other cancers, it's not infectious, so you can't pass it on to other people.

In the UK, the charity Macmillan Cancer Support has more information about the testicles and the male reproductive system.

From puberty onwards, you should check your testicles regularly. Testicular cancer can usually be cured, but it's easier to treat when it's found early.

An ultrasound scan uses sound waves to make a picture of the inside of your testicles. The person doing the scan puts some gel on the scrotum and then moves a small device, a bit like a microphone, over the area.

It doesn't hurt, and it only takes a few minutes.

For testicular cancer, an ultrasound is the quickest and most accurate test your doctor can use. It can show whether a lump is a harmless cyst (a lump filled with fluid) or is likely to be a cancer.

If the ultrasound shows the lump is very likely to be testicular cancer, the whole testicle needs to be looked at closely. 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. Taking just a small piece of tissue (a biopsy) could miss a cancer, which is why the whole testicle is removed.

On rare occasions, the surgeon will remove only part of the testicle. This may happen when someone has only one testicle, for example. It may also happen if the scan doesn't show clearly how likely the lump is to be cancer.

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

Once testicular cancer has been diagnosed, you may also need a chest X-ray or a CT scan. These check that your lungs aren't affected, and the results help your doctors decide the best treatment for you.

Removing the testicle (an operation called orchidectomy) does two things. It confirms the diagnosis, and it takes the cancer out. For testicular cancer that hasn't spread, it's the main treatment.

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

Most people with testicular cancer have surgery first, called an orchidectomy. It removes the cancer, and it also helps the doctors confirm the diagnosis.

After the operation, your doctors and a team of specialists meet to talk about the best treatment for you. This group is called a multidisciplinary team. They'll go through the options for further treatment with you and explain what might suit your situation best. They can also talk with you about the things you may want to think over when making your decision.

Your treatment options depend on:

• the stage of testicular cancer you have
• whether it's non-seminoma or seminoma
• the risk of the testicular cancer coming back

After surgery, the treatment options for testicular cancer include the following.

If the risk of testicular cancer coming back after surgery is low, your doctor may suggest surveillance, which means monitoring. They'll check you regularly for any signs that the cancer has returned. It's very important that you go to all your appointments.

Chemotherapy for testicular cancer works by using anti-cancer (cytotoxic) drugs to destroy cancer cells. Doctors may give it to lower the risk of the cancer coming back. It can also be used when testicular cancer has already spread, or when it has come back after treatment.

Now and then, higher doses of chemotherapy might be used to treat testicular cancer. This treatment is known as high-dose chemotherapy with stem cell support.

Radiotherapy uses high-energy rays to destroy cancer cells. Doctors may use it to treat seminoma, a type of testicular cancer. It can also be given to lower the risk of the cancer coming back in the lymph nodes at the back of the tummy (abdomen), or to treat a seminoma that has come back. These nodes are called the retroperitoneal lymph nodes.

More rarely, radiotherapy is used to treat non-seminomas.

After chemotherapy, some people need to have the lymph nodes at the back of the tummy taken out. The operation is called a retroperitoneal lymph node dissection (RPLND).

Sometimes testicular cancer spreads to other parts of the body, such as the lungs, brain or liver. If more surgery is needed, it's done in a specialist unit. Your doctor will explain what the operation involves if you need it.

Sometimes the side effects of treatment take a long time to improve. Others may not go away completely and can become permanent. These are called long-term effects.

Some side effects only show up years after treatment finishes. These are called late effects. You may not have any of them, or they may range from mild to severe.

Possible late effects include:

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

There are different ways to manage these.

Macmillan Cancer Support, a UK charity, has more information on the late effects of testicular cancer treatment.

Treatments used for testicular cancer don't usually affect your ability to have sex or make someone pregnant (your fertility). But it's common to worry about this.

Cancer support information on how treatment may affect your sex life and fertility includes:

• contraception during treatment
• having children in the future
• testosterone replacement
• storing sperm (sperm banking)

You'll have regular check-ups at the hospital after your treatment finishes. Your doctor will examine you and check your remaining testicle. These visits may be every month to begin with, but how often you go will depend on the type and stage of your testicular cancer.

You may have regular tumour marker tests. Other tests may include:

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

Please go to these appointments. If you can't make one, book another straight away.

Having to attend follow-up appointments can feel stressful. Your healthcare team can help you cope with any problems you have after treatment and help you find support. This can make you feel more confident and give you back a feeling of control.

If you have new symptoms between appointments, contact your hospital doctor, nurse or doctor.

Check your remaining testicle every month. It's rare to develop a new cancer in the other testicle, but having already had testicular cancer increases the risk of this happening.

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

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.

Some people choose to make positive changes to how they live after treatment, even if their lifestyle is already healthy. These changes can improve your health and wellbeing and help your body recover. They may also help to reduce the risk of late effects. They 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.