If you have or have had testicular cancer, you are part of a pretty rare group of men. It is one of the least common forms of cancer, making up just 1% of all cancers that occur in men. Around 2,300 men in the UK, usually between the ages of 15 and 49, are diagnosed with testicular cancer each year.
Types of Testicular Cancer
The most common type is germ cell testicular cancer, making up for around 95% of all cases. Your germ cells are what your body uses to create sperm. The 2 main subtypes of germ cell testicular cancer are seminomas (pronounced sem-e-no-mahs) and non-seminomas. Less common types of testicular cancer include Leydig cell tumours and Sertoli cell tumours.
Signs of Testicular Cancer
Signs of testicular cancer can include:
- a lump or swelling in your testicle
- your scrotum feeling heavier or fuller than usual
- a dull ache in the abdomen or groin
- pain or discomfort in the testicle or scrotum
- a sudden collection of fluid in the scrotum
- enlargement or tenderness of the chest muscles
- pain or discomfort in your lower back
Causes of Testicular Cancer
The exact causes of testicular cancer are unknown. However, there are a number of factors that can increase your risk of developing it.
Around 3 to 5% of boys are born with their testicles inside their abdomen. They will usually descend into the scrotum during the first year of their lives. In some cases the testicles do not descend, causing undescended testicles (also known as cryptorchidism). If you have this, you are roughly 3 times more likely to develop testicular cancer.
An operation known as an orchidopexy can be carried out, which moves the testicles into the correct place inside the scrotum.
Having a close family member with a history of testicular cancer increases your risk of also developing it. If your father had testicular cancer, you’re around 4 times more likely to develop it yourself, and around 8 times more likely if your brother has had it.
There is ongoing research that suggests a number of genes may be involved in the development of testicular cancer in families where more than 1 man has developed it.
Previous Testicular Cancer
If you have previously been diagnosed with testicular cancer, you are between 12 and 18 times more likely to develop it in the other testicle.
So, it’s extremely important that you monitor the other testicle carefully throughout your lifetime. You will also need to be observed for signs of recurrence for between 5 and 10 years.
Diagnosing Testicular Cancer
Most lumps within the scrotum are not cancerous. However, you should see your GP as soon as you can if you notice a swelling, lump or any other change to your testicles. Your GP will ask about your symptoms and look at your medical history, and then usually examine your testicles. If your GP thinks it may be cancerous, you’ll be sent for tests, usually within 2 weeks.
|Scrotal ultrasound||A high-frequency sound wave is used to produce an image of the inside of your body, in this case your testicle. This painless procedure is the same thing used on pregnant women for an ultrasound scan of their baby.|
The specialist doing the scan will be able to tell the position and size of the tumour in your testicle. The scan will show if the lump is on the testicle itself or separate within the scrotum. It will also show whether or not the abnormality is solid or filled with fluid. Fluid filled lumps are usually harmless, whereas solid lumps are a clearer sign that the swelling is cancerous.
|Blood tests||Testicular cancer can produce certain chemicals and hormones in your blood, like alpha feto-protein (AFP) and human chorionic gonadotrophin (HCG). These are called markers. Blood tests will check to see if there are markers in your blood, as they may indicate you have cancer. Not all men with testicular cancer will produce markers and you may still have cancer even if your blood test results are normal.|
|Histology||The only way to confirm testicular cancer for sure is to examine part of the lump under a microscope in what is known as histology. In many other forms of cancer, a small part can be removed and examined.|
With testicular cancer, the only way to examine the lump is to remove the testicle completely in most cases. However, the ultrasound scan and blood tests are usually enough evidence to make a firm diagnosis before this stage. A specialist will not remove your testicle unless that are relatively sure the lump is indeed cancer.
|X-ray and CT scan||In almost all cases, further tests are needed to check whether the cancer has spread. If testicular cancer does spread, it most commonly affects the lymph nodes in the lungs or the back of the abdomen.|
For this reason, you will almost always need to have a chest x-ray and possibly also a CT scan. In some cases, an MRI scan may be used instead.
Read the Finding Out blog for more information and a personal account of what it is like to be diagnosed with testicular cancer.
Testicular Cancer Treatment
Your treatment plan will depend on the type and stage of your testicular cancer.
The first option for all cases of testicular cancer is to surgically remove the affected testicle. The whole of the testicle will be removed because removing only the tumour may lead to the cancer spreading. This procedure is called an orchidectomy, which will be carried out no matter what stage your cancer is at.
A small cut will be made in your groin. Through this hole, your testicle will be removed along with the attached tubes and blood vessels. You can have it replaced with an artificial (prosthetic) testicle, so the appearance of your scrotum is not seriously affected. You will be under general anaesthetic during the operation.
By removing the whole testicle your chances of making a full recovery are greatly improved. It’s often possible to be leave the hospital within a few days and there should not be any lasting side effects. If you still have your other testicle, your sex life and ability to have children will not be affected.
More surgery may be needed later down the line to remove any affected lymph nodes or deposits in the lungs or liver. In some cases, more surgery may also be needed after chemotherapy to remove tumours from other parts of the body. This depends on whether or not the cancer has spread.
If you detect testicular cancer in the very early stages, surgery may be the only treatment you need.
Powerful medicines are used to kill cancer cells and prevent cancer returning. In most cases of stage 1 testicular cancer, the chance of it returning is low. You will be carefully monitored for a number of years following your surgery.
For stage 2 and 3 testicular cancers, up to 3 or 4 cycles of chemotherapy may be given using a combination of different medications.
High-energy beams of radiation are used to kill cancer cells. It is often used to treat those unable to tolerate chemotherapy, as it is less intense.
It may be used alongside simpler forms of chemotherapy to treat stage 1 testicular cancer, and some cases of stage 2 testicular cancer.
Stages of Testicular Cancer
Cancer stages are based on how far it has spread, as well as the levels of cancer related chemicals (markers) in your blood. It is not possible to determine the stage of your cancer until the tumour and testicle has been removed, and all of the tests have been completed to confirm your diagnosis.
|Stage 1||The cancer is contained within your testicle. In most cases, only surgery is needed to treat this.|
|Stage 2||The cancer has spread into nearby lymph nodes. These are the small glands that fight infection in your tummy or pelvis. More surgery may be needed, along with some chemotherapy and radiotherapy.|
|Stage 3A||The cancer has spread into distant lymph nodes elsewhere in your body. For example, near your collarbone or lungs. Your marker levels may be normal or only slightly raised. More than one cycle of chemotherapy may be needed.|
|Stage 3B||The cancer has spread into either nearby or distant lymph nodes and you have higher marker levels. Several cycles of chemotherapy will be needed.|
|Stage 3C||This is the same as stage 3B, but you have very high marker levels or the cancer has now spread into another body part, like your liver.|
Testicular cancer is one of the most treatable types of cancer, and the outlook is one of the best too. Almost all men (98%) live for at least 5 years following diagnosis. It’s also extremely rare for the cancer to return more than 5 years later.
The risk of cancer returning will depend on the stage it was at when you were diagnosed and the treatment you have had since. Most returning non-seminoma testicular cancers will occur within 2 years of the completion of your initial treatment. Returning seminoma testicular cancers can occur up to 3 years after.
You will need to take regular tests to check if the cancer has returned, including physical examinations, blood tests, x-rays, and CT scans.
Living with One Testicle
If you still have one healthy testicle, you should have a normal and fertile sex life following your treatment and recovery. Your remaining testicle should make enough testosterone so that you won’t notice any difference. If you choose to have a prosthetic testicle, visually there should be very little or noticeable difference to how your scrotum looked before. The prosthetic testicle will feel harder and less squidgy, but that is all.
In some cases, treatment for testicular cancer can cause infertility. Changes that occur in the testicle before the cancer develops can also cause low sperm count. Both do not happen often, but you may wish to consider sperm banking before your treatment begins as a precaution.
Sperm banking is the process of freezing a sample of your sperm, so it can be used in the future to impregnate your partner, if necessary. This is a wise decision even if your fertility and sperm count are both unaffected by the cancer and treatment. It will safeguard any desires to have children, should you have problems with your remaining testicle in the future.
Testosterone Replacement Therapy
Some men experience post-treatment symptoms that are caused by a lack of testosterone production. They can be caused for other reasons but the symptoms include fatigue, loss of sex drive, weight gain, and erectile dysfunction.
If you have both testicles removed, you will stop producing testosterone for certain and will most probably develop these symptoms. Testosterone replacement therapy is given via an injection, a skin patch or a gel for your skin. This will allow you to maintain an erection and boost your sex drive.