What is Testicular Cancer?
Testicular cancer begins in the testicles (testes). The testes produce male sex hormones and sperm. They sit inside the scrotum, which is a sack of skin under the penis.
There are two main types of testicular cancer: seminomas and nonseminomas. Other types are rare. The type found depends on the cell that the cancer starts from.
- Seminoma is mainly from germ cells in the testes. It is a very treatable cancer. There are three kinds: classic (the most common), anaplastic, or spermatocytic.
- Nonseminomas are made from more than one kind of cell. They may be: choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumors. This type of cancer is common, and it tends to grow more quickly, but is also often very treatable.
Testicular tumors can include one or more types of cancer cells.
Risk Factors, Signs & Symptoms
Risk Factors for Testicular Cancer
Research helps us learn more about what causes testicular cancer. The most common risk factors are:
- Birth defects - in the testicles, penis, or kidneys (also known as congenital abnormalities)
- Family History - for men whose brother or father has had the disease
- Previous Testicular Cancer - for men who’ve had this cancer in the past in the other testicle
- Undescended Testicle (Cryptorchidism) - for men with a testicle that does not move down into the scrotum at birth (Note: even after surgery to place the testicle in the scrotum)
Signs & Symptoms
Most men find their own testicular cancers first. Between regular checkups, men should look out for symptoms like:
- A dull ache in the lower abdomen, back, or groin
- If a testicle gets larger or feels different
- A heavy feeling in the scrotum
- Pain or aches in a testicle or the scrotum
- A lump or swelling in a testicle, with no pain
- Fluid in the scrotum
Diagnosis and Staging
Most men find their own testicular cancers. If a man experiences pain, heaviness, aches, growth or other changes in the testicles or scrotum, he should see a doctor.
To learn the cause of these symptoms, a physical exam is the first step. The doctor will evaluate a man’s general health, and may order tests:
- Blood Tests: measure tumor markers or substances found in abnormal amounts. AFP (alpha-fetoprotein), BHCG (beta-human chorionic gonadotropin) and LDH (lactate dehydrogenase) are markers that suggest a testicular tumor. Blood tests can find tumor markers before a tumor can be seen in other ways. A man may have normal tumor markers, but still have testicular cancer.
- Ultrasound: to create a picture of the scrotum with sound waves and a computer screen. It can show if a mass is present. This test can rule out other issues, not related to cancer.
- Biopsy: to study a sample of tissue from the testicle under a microscope and check for cancer cells. A pathologist is the doctor who does this. This test is done to find and define cancer by cell type and stage. Often, the urologist will remove the entire affected testicle through a cut in the groin first. The tissue will be tested after it is removed. In very rare cases, only a sample of tissue is removed.
If testicular cancer is found, more scans will be done to learn if cancer has spread to other parts of the body. Those scans may include a chest x-ray, CT scan, PET scan or MRI.
Treatment and Side Effects
Treatment for testicular cancer depends on: the stage, the patient’s age, and the patient’s overall health. Before choosing treatments, men have time to get a second opinion and talk through all options. It helps to learn as much as possible before picking a treatment plan.
Seminomas and nonseminomas are treated differently. If a tumor contains both types of cells, it is treated as a nonseminoma.
There are three types of standard treatments:
Orchiectomy is surgery to remove the affected testicle through a cut in the groin. A man with one healthy testicle can still have sex. This operation rarely affects a man’s ability to have children.
Some men choose to have a “fake testicle” placed in the scrotum during or after surgery. It offers the look of a normal scrotum.
A large machine directs high-energy rays to kill cancer cells in the body. Radiation aimed at lymph nodes in the abdomen may be used to treat seminomas after surgery. It can be helpful. Men with nonseminomas do not use radiation therapy. Those tumors are less likely to respond.
This treatment uses drugs to kill cancer cells. In patients with testicular cancer, chemotherapy may be given after orchiectomy. These drugs are given through IV (veins).
Recovery after treatment depends on many things. Patients will be followed after treatment to make sure the treatment works, and recovery is going well. Even when the cancer seems to be gone, it can return.
After treatment, regular doctor visits are important. Men who have had testicular cancer have an increased chance of developing the disease in the other testicle. Follow-up blood tests, x-rays, and CT scans help catch problems early. Additional treatment may be needed.
Side Effects from Testicular Cancer Treatment
It helps to learn about possible side effects from treatment(s) before you begin. When you know what to expect, you can work with your health care team to manage your quality of life.
There are many helpful medicines and coping strategies to limit common problems. Side effects may include nausea, diarrhea, constipation and mouth sores. Everyone reacts differently. You may not have common side effects, but you can be prepared just in case.
The most common issues from each treatment are:
You should be able to go home a few hours after a radical inguinal orchiectomy. At first you’ll wear a scrotal support and use ice to help with swelling. The area will be covered with gauze for a few days to keep it dry and clean. It helps to drink lots of water and eat high-fiber foods to make bowel movements more comfortable.
Some men also need lymph nodes removed from the abdomen. This surgery is called a retroperitoneal lymph node dissection (RPLND). If it affects ejaculation, it can cause problems with fertility.
Generally, it takes two weeks to two months to fully recover. Avoid lifting heavy things, and don’t have sex until the incision has fully healed. Limit exercise, sports, and running until about 1 month after surgery. You’ll have follow-up visits with your doctor to make sure you recover well.
Side effects depend on the dose of radiation. Issues can include fatigue, loss of appetite, nausea, diarrhea and skin changes at the radiation site. This treatment can affect sperm production, but most patients regain fertility 1 to 2 years later.
Side effects depend on the specific drugs and the dose. Common side effects include nausea, hair loss, fatigue, diarrhea, vomiting, chills, fever, coughing, tight breathing, mouth sores or rash. Some people feel dizzy, numb, have slower reflexes and trouble hearing. Men who have a high dose of chemotherapy may need a bone marrow transplant.
Some cancer drugs reduce sperm count. Most patients recover their fertility, but not everyone.
Patients should talk with their health care team about sexual function concerns. It is possible to save sperm in a sperm bank before starting treatment.
Coping with Testicular Cancer
After being diagnosed with cancer, most men feel a range of dramatic emotions that change very quickly. These changes can be hard to cope with and affect the way you feel about yourself. Still, you can learn how to manage changes and find ways to improve your quality of life.
To reduce your stress and improve your quality of life, consider counseling or other emotional supports.
Cancer affects the whole person and their loved ones. When you create a support network, it can be an important part of your care and recovery. There are organizations and people who are poised to help. Individual counseling offers tools to help you cope with the challenges raised by your diagnosis. Support groups can connect you with other patients in a safe, supportive environment.
Contact the Cancer Support Helpline for more information.
Considering Sex and Fatherhood
It may be hard to talk with a doctor or nurse about sexual difficulties from treatment. Remember that they know how to deal with these issues. They’re used to talking about sexual health, so try not to feel embarrassed. Or, you can ask them for the name of a specialist or a sex therapist.
It may also feel hard to talk with your partner. More often than not, your partner will be relieved that you want to talk about our hopes and fears. Together you can find strength.
If you’re wondering about your sex life after treatment, there are a few things to consider:
- If you’ve had one testicle removed, you should be able to get erect and have sex after you recover.
- If you’ve had both testicles removed, you might have a lower sex drive. You may lose muscle mass and have hot flashes and get tired easily. It will no longer possible to have children. Still, there are ways to work through these problems. Ask your doctor.
- If you’ve had chemotherapy or radiation, you should use a condom. It’s important to protect your partner.
If you’d like to have children after testicular cancer, you can do a few things.
- First: if you haven’t had treatment yet, talk with your doctor about saving sperm (sperm banking).
- If you need chemotherapy or radiation after surgery, use a condom with sex. You’ll want to wait until after treatment before trying to have children. It’s important to prevent birth defects. Ask how long you should wait.