Condition Overview

What is testicular cancer?

Testicular cancer occurs when cells that aren't normal grow out of control in the testicles (testes). It is highly curable, especially when it is found early.

The testes are the two male sex organs that make and store sperm. They are located in a pouch below the penis called the scrotum. The testes also make the hormone testosterone.

Testicular cancer is rare. But it is the most common cancer among young men.

Most testicular cancers start in cells that make sperm. These cells are called germ cells. The two main types of testicular germ cell cancers are seminomas and non-seminomas. Seminomas grow and spread slowly and respond to radiation therapy. Non-seminomas grow and spread more quickly than seminomas. There are several different types of non-seminomas.

This topic covers seminoma and non-seminoma cancer. It does not cover non-germ cell testicular cancers, such as Leydig cell tumours.

What causes testicular cancer?

Experts don't know what causes testicular cancer. But some problems, such as having an undescended testicle or Klinefelter syndrome, may increase a man's risk for this cancer. Most men who get testicular cancer don't have any risk factors.

What are the symptoms?

The most common symptoms of testicular cancer include:

• A lump or swelling in the scrotum that may or may not be painful.
• A heavy feeling in the scrotum.
• A dull pain or feeling of pressure in the lower belly or groin.

How is testicular cancer diagnosed?

Most men find testicular cancer themselves by chance or during a self-examination. Or a doctor may find it during a routine physical examination.

Because other problems can cause symptoms like those of testicular cancer, your doctor may order tests to find out if you have another problem. These tests may include blood tests and imaging tests of the testicles such as an ultrasound or a CT scan.

If these tests show signs of cancer, you will have surgery to remove the testicle. Surgery is the only way to know for sure if you have testicular cancer and what kind of cancer it is. This information also helps in planning any other treatment you may need.

How is it treated?

For some men, surgery to remove the testicle may be all the treatment they need. The type and stage of your cancer will help your doctor know if you need more treatment.

Treatment after surgery may include surveillance, chemotherapy, or radiation therapy. Chemotherapy is often used for cancer that has spread to other parts of the body. In some cases, surgery is used to remove that kind of cancer.

How will having testicular cancer affect you?

In most cases, removing a testicle doesn't cause long-term sexual problems or make you unable to father children. But if you had these problems before treatment, surgery may make them worse. And other treatments for cancer may cause you to become infertile. You may want to think about saving sperm in a sperm bank. Talk to your doctor if you have any questions or concerns about sexual problems or whether you can father children.

Some men choose to get an artificial, or prosthetic, testicle. A surgeon places the artificial testicle in the scrotum to keep the natural look of the genitals.

Cause

Experts don't know what causes testicular cancer. But some problems, such as having an undescended testicle or Klinefelter syndrome, may increase a man's risk for this cancer. Most men who get testicular cancer don't have any risk factors.

Symptoms

Common symptoms of testicular cancer include:

• A swelling and/or lump in one or both of the testes. You may or may not have pain in the testes or scrotum.
• A heavy feeling in the scrotum.
• A dull pain or feeling of pressure in the lower belly or groin.

Sometimes these symptoms can be caused by other problems, such as a hydrocele or epididymitis.

Symptoms of advanced testicular cancer

Testicular cancer that has spread (metastasized) beyond the testicles and regional lymph nodes to other organs may cause other symptoms depending on the area of the body affected. Symptoms of late-stage testicular cancer may include:

• Dull pain in the lower back and belly.
• Lack of energy, sweating for no clear reason, fever, or a general feeling of illness.
• Shortness of breath, coughing, or chest pain.
• Headache or confusion.

What Happens

In most cases, the first sign of testicular cancer is a change in the size or shape of one or both testicles (testes). Often this change doesn't cause pain, though pain may be present. If unnoticed or untreated, testicular cancer may spread (metastasize) to other areas of the body.

After you are diagnosed with testicular cancer, you and your doctor will begin planning your treatment. Nearly all men with testicular cancer have surgery. After surgery, you may have other treatments, if they are needed. This depends on your choices, the type of cells involved, and the stage of your cancer.

Testicular cancer is one of the most curable forms of cancer, especially during its early stages. If you have symptoms of testicular cancer, see a doctor as soon as possible.

What Increases Your Risk

Some things may increase your chances of getting testicular cancer. These risk factors include:

• An undescended testicle. This is a testicle that has not moved down (descended) from the abdomen into the scrotum.
• Klinefelter syndrome. This is a genetic disorder that affects males.
• A personal or family history of testicular cancer.

Most men who get testicular cancer don't have any known risk factors.

When To Call

Call your doctor as soon as possible if you have any symptoms of testicular cancer, including:

• A swelling or lump in one or both of the testes. You may or may not have pain in the testicles or scrotum.
• A heavy feeling in the scrotum.
• A dull pain or feeling of pressure in the lower belly or groin.

Surveillance

Some early-stage testicular cancers are successfully managed with a "wait-and-see" approach after surgery. This option involves frequent exams as well as blood tests and imaging tests to watch your condition. Surveillance may let you avoid the side effects from other follow-up treatments, such as chemotherapy and radiation therapy.

Who to see

Your family doctor or general practitioner can check your symptoms and your risk of testicular cancer. You may be referred to a urologist.

Health professionals who can manage your cancer treatment include:

• Urologists.
• Medical oncologists.
• Radiation oncologists.

Examinations and Tests

If testicular cancer is suspected, your doctor will do some testing. Tests may include:

• Testicular ultrasound. This test may be used to rule out other possible causes of an enlarged or painful testicle before the testicle is removed.
• Blood tests. These are often done to measure the levels of these tumour markers in your blood:
  • Alpha fetoprotein (AFP)
  • Beta human chorionic gonadotropin (beta-hCG)
  • Lactate dehydrogenase (LDH)
• Imaging tests, such as chest X-ray and CT scan of the chest, abdomen, and pelvis.

If the ultrasound and blood tests suggest testicular cancer, a doctor will surgically remove your affected testicle. It will be checked for cancer. If cancer is found, you may have other tests, such as X-rays, CT scans, or MRIs, to find out the stage of your cancer.

Ongoing examinations and tests

During your treatment for testicular cancer, your doctor will schedule a thorough follow-up program to monitor your recovery, especially if you are doing surveillance. These examinations and tests may continue for several years. In addition to physical examinations, your follow-up program may include:

• Periodic imaging tests such as chest X-rays or CT scans.
• Blood tests to check the levels of tumour markers in your blood. Tumour marker levels that are stable or that increase after you've had treatment may be a sign of more cancer.

Early detection

Testicular self-examination may help detect testicular cancer. These cancers may be first found as a painless lump or an enlarged testicle during a self-examination.

Some doctors recommend that men ages 15 to 40 perform monthly testicular self-examinations (TSE). But many doctors don't believe that monthly TSE is needed for men who are at average risk for testicular cancer. Monthly TSE may be recommended for men who are at high risk for this kind of cancer. This includes men who have a history of an undescended testicle or a family or personal history of testicular cancer.

Treatment Overview

If you are diagnosed with testicular cancer, your doctor will explain what type of cancer you have, whether it has spread beyond the testicle (metastasized), and the potential for curing it. You and your doctor will discuss your treatment options and possible outcomes of those treatments. Testicular cancer is highly curable, especially when it's diagnosed at an early stage.

If the cancer isn't treated during its early stages, it may spread (metastasize) to the lymph nodes and to the lungs, liver, brain, and bones. But often testicular cancer that has spread can still be treated successfully.

Some cancer treatments raise your risk of infertility. Unless you are sure you won't want to father a child in the future, talk to your doctor about sperm banking before any treatment for testicular cancer.

Treatment begins with surgery (orchiectomy) to remove the affected testicle. After surgery, depending on which type of cancer cells are present and whether your cancer has spread to other areas of your body (stage), you may need only surveillance. Or you may need further treatment.

Most testicular cancers are either seminomas or non-seminomas. The main difference between the two is that seminomas grow and spread slowly and respond to radiation therapy. Non-seminomas grow and spread more quickly than seminomas. They don't respond to radiation.

Seminomas

Seminomas are the kind of testicular cancer that grow and spread slowly. After surgery, treatments may include:

• Surveillance.
• Radiation therapy.
• Chemotherapy.

For seminomas that are more advanced (stage II or stage III cancers), treatments begin with surgery (orchiectomy) and may include radiation, chemotherapy, or combination chemotherapy. After chemotherapy, tissue masses that remain may need to be removed with surgery.

Non-seminomas

Non-seminomas are the kind of testicular cancer that grow and spread more quickly than seminomas. They don't respond well to radiation therapy. After surgery, treatments may include:

• Surveillance.
• Chemotherapy.
• Surgery to remove lymph nodes.

For non-seminomas that are more advanced (stage II or stage III cancers), treatments begin with surgery (orchiectomy) and may include surgery to remove lymph nodes, chemotherapy, or combination chemotherapy. After chemotherapy, any tissue masses that remain will be removed with surgery, if possible.

Treatment choices

If your cancer was found early, you may have a choice about further treatment. Talk with your doctor about the risks and possible side effects of each treatment option.

Follow-up care

After treatment, it is important to receive follow-up care. This care may lead to early identification and management of cancer that comes back. Your regular follow-up program may include:

• Physical examinations.
• Imaging tests, including X-rays, CT scans, and MRIs.
• Blood tests to check tumour marker levels. Stable or increasing tumour marker levels after treatment may mean that your cancer is still present or has returned. You may need more treatment.

A diagnosis of testicular cancer means that you will be seeing your doctor regularly for years to come. It's a good idea to build a relationship based on trust and the sharing of information. Your doctor may give you some advice on changes to make in your life to help treatment succeed.

Cancer that has come back

Testicular cancer that has come back (recurred) may be found during a physical examination, through an imaging test, or as a result of increasing tumour marker levels. In some cases, recurrent cancer can be successfully treated. This is especially true if the cancer has spread only to the lymph nodes in the pelvis, belly, or lower back and pelvis.

Recurrent testicular cancer may be treated with chemotherapy, surgery to remove lymph nodes, or radiation. Chemotherapy may be followed by surgery to remove any remaining cancer.

Hospice palliative care

Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Hospice palliative care can improve your quality of life by helping you manage your symptoms. It can also help you with other concerns that you may have when you are living with a serious illness.

Testicular cancer can almost always be cured, even if it comes back (recurrent) or has spread (metastasized). But if you do have cancer that can't be cured, a time may come when treatment to cure cancer no longer seems like a good choice. This can be because the side effects and time of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. Hospice palliative care providers will work to help manage pain and other symptoms or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.

It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care. You and your doctor can decide when you may be ready for hospice palliative care.

You can find additional information about testicular cancer online at the:

• Canadian Cancer Society website at www.cancer.ca.
• U.S. National Cancer Institute website at www.cancer.gov.

Prevention

There are no proven ways to prevent testicular cancer.

Self-Care

Home treatment can help you manage the side effects that may occur from your treatment. Some treatments for testicular cancer, such as chemotherapy or radiation, can have serious side effects. Be sure to follow any instructions and take medicines given to you by your doctor.

Manage side effects

• Home treatment for nausea or vomiting includes watching for and treating early signs of dehydration, such as having a dry mouth or feeling light-headed when you stand up. Eating smaller meals may help. So can a little bit of ginger candy or ginger tea.
• Home treatment for diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your doctor before using any non-prescription medicines for your diarrhea.
• Home treatment for constipation includes gentle exercise along with adequate intake of fluids and a diet that is high in fruits, vegetables, and fibre. Check with your doctor before using a laxative for your constipation.
• Home treatment for fatigue includes making sure you get extra rest while you are receiving chemotherapy or radiation therapy. Let your symptoms be your guide. You may be able to follow your usual routine and just get some extra sleep. Fatigue is often worse at the end of treatment or just after treatment is completed.
• Home treatment for pain includes using non-steroidal anti-inflammatory medicines (NSAIDs) or an alternative therapy, such as biofeedback. Be sure to talk to your doctor before using any over-the-counter pain relievers.
  • Cancer: Controlling Cancer Pain

Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counsellor can really help. Ask your doctor about support groups. Or visit the Canadian Cancer Society website at www.cancer.ca.

Practice healthy habits

Healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms.

• Eat well. Try to eat a balanced diet to prevent weight loss and to conserve your strength during treatment for testicular cancer.
• Get enough sleep. If you find you have trouble sleeping, be sure to have a regular bedtime, get some exercise during the day, avoid caffeine late in the day, and follow other tips to help you sleep more easily.

Manage your feelings

• Manage stress. This may include expressing your feelings to others. Relaxation techniques, such as meditation, and support groups may help too.
• Understand hair loss. Hair loss can be emotionally distressing. Talk to your doctor about whether hair loss is an expected side effect with the medicines you will receive.
• Accept your emotional reactions. Your reactions may make it harder to make decisions about your health. Talk with your doctor or others about your feelings.
• Understand your feelings about your body and your sexuality. Your attitudes may change following treatment for cancer. Your doctor may be able to refer you to organizations that can offer additional support and information.

Medicines

Chemotherapy treatment uses medicines to kill the cancer cells in your body.

Chemotherapy can cause nausea and vomiting. Your doctor may prescribe medicines to control nausea and vomiting to take before, during, or after your treatments.

You may be given a choice between receiving chemotherapy or another treatment. When making your decision, talk to your doctor about the risks and possible side effects of chemotherapy.

Medicine choices

Some common medicines used to treat testicular cancer include:

• Carboplatin. Seminoma cancer may be treated with a single dose of this chemotherapy medicine.
• Cisplatin-combination chemotherapy. Non-seminoma cancer may be treated with combinations of chemotherapy medicines, such as bleomycin, etoposide, and cisplatin.

Surgery

Testicular cancer may be treated with:

• Surgery to remove a testicle (radical inguinal orchiectomy). Nearly all men with testicular cancer have this surgery.
• Surgery to remove lymph nodes in the pelvis and lower back (retroperitoneal lymph node dissection, or RPLND). This may be used for non-seminoma cancer.
• Surgery to remove other areas of cancer if it has spread in the body. This is done for non-seminoma cancer, either before or after having chemotherapy.

Other Treatment

Radiation therapy

Radiation therapy for testicular cancer uses high-dose X-rays or other types of radiation to kill cancer cells. The type of radiation used to treat testicular cancer is external beam radiation. This means the radiation comes from a machine outside the body and is aimed at a specific part of your body.

Radiation therapy may be used to treat the seminoma type of testicular cancer. Because the lymph nodes in the pelvis and lower back are the most common areas for testicular cancer to spread, radiation is often focused on that area.

You may have a choice between radiation therapy or another treatment. When making your decision, talk to your doctor about the risks and possible side effects of radiation therapy.

Complementary therapies

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:

• Acupuncture to relieve pain.
• Meditation or yoga to relieve stress.
• Massage and biofeedback to reduce pain and ease tension.
• Breathing exercises for relaxation.

Mind-body treatments like the ones listed above may help you feel better. They can make it easier to cope with cancer treatments. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.

Before you try a complementary therapy, talk to your doctor about its potential value and side effects. Let your doctor know if you are already using any such therapies. These therapies aren't meant to take the place of standard medical treatment. But they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.