Testicular cancer

It can be embarrassing to talk about your testicles and any changes to them. But understanding more about them might help:

• Testicles are small and oval-shaped. They hang below your penis in a sac called the scrotum.
• The testicles start to produce more of a hormone called testosterone when you reach puberty. Puberty is when your body begins to change from a child into an adult. For boys, this happens around the age of 12. The extra testosterone gives you a lower voice, hair on your face and body, and makes your muscles get bigger. You also need it for your sex drive and for getting an erection.
• The testicles also make sperm from puberty onwards. When sperm fertilises a woman’s egg during sex, this can start a pregnancy.
• The testicles make millions of sperm every day. If sperm are not ejaculated, they are absorbed back into your body.
• The epididymis stores sperm until ejaculation. When you ejaculate, the sperm travel through the spermatic cord and mix with fluid from the prostate to make semen. They go out of the body through the urethra (this is the same tube you wee through).

Lymph nodes (glands)

We have lymph nodes throughout our bodies. They are part of the lymphatic system, which protects us from infections. Lymph nodes are small and round, and are connected by tiny tubes that carry fluid called lymph.

Sometimes cancer cells from the testicle can spread to lymph nodes at the back of the abdomen (tummy). You will have a scan to check your lymph nodes.

The main symptoms of testicular cancer are:  

• a painless lump or a swelling in a testicle – sometimes the swelling can suddenly get bigger and become painful  
• pain or a feeling of heaviness in the scrotum (the sac that holds the testicles) 
• a change in the shape or feeling of the testicle. 

There might also be other symptoms if the cancer has spread, such as:  

• pain in your back, groin or lower abdomen (tummy) 
• shortness of breath 
• tender or swollen nipples – this is not common, but can be caused by hormones produced by the cancer.  

Most lumps and swellings, especially in the epididymis (the tube behind the testicle), are not cancer. But it is important to get any lump, swelling or other symptoms checked by your GP straight away. Doctors are used to talking about private parts of the body, so try not to feel embarrassed. 

You may find it difficult to tell the people close to you (like your family, friends or a partner) about a problem with your testicles. But try to talk to them as they will want to help and support you as much as they can. When you are going to see your GP, you might want to take someone with you.   

If you do not want to see your GP, you can go to your local sexual health clinic. You don’t have to give your name at these clinics. You can find the number online or in your local phone book.

The important thing is to get any symptoms checked by a doctor straight away.  

Remember, testicular cancer can nearly always be cured, and it is easier to treat when it is found early.  

Testicular cancer is rare. We don’t know exactly what causes testicular cancer, but research is looking into this.  

But we do know that some things can increase the chances of testicular cancer. These are called risk factors. You might have a higher risk of testicular cancer if:  

• one or both of your testicles did not come down into the scrotum when you were a baby and you needed an operation 
• your dad or a brother has had testicular cancer.  

An injury or sporting strain to the testicles does not cause testicular cancer. But if you get an injury and have any swelling or a lump, get it checked by your doctor.  

Remember, nothing you have done has caused the cancer.  

If you think you might have any symptoms of testicular cancer, you should go straight to your GP. They will be able to talk to you about your symptoms. If they think your symptoms could be because of cancer, they can do tests to find out more. 

You may have tests done by your GP or at the hospital. The tests will help your doctors see whether you have testicular cancer.  

Going to your GP  

If you think you might have symptoms of testicular cancer, you should go to your GP. They will be able to talk to you about your symptoms. If they think the symptoms could be because of cancer, they can examine your testicles and do some tests to find out more.  

They might arrange for you to have an ultrasound scan. This uses sound waves to take a picture of the testicles.  

At the hospital  

If you need more tests, you will be referred to a hospital. This could be a general hospital or a specialist cancer hospital.  

You will see a specialist doctor (urologist), who will examine you and do the following tests: 

• blood tests to check for chemicals in the blood called tumour markers – some types of testicular cancer produce high levels of these.  
• an ultrasound scan of the scrotum and testicles, if you haven’t already had one – this can usually tell the difference between a cancer and a cyst (a harmless lump filled with fluid).  

Removing a testicle 

If the ultrasound scan shows that the lump is very likely to be cancer, your doctor will talk to you about an operation to confirm the diagnosis. The only way to get a definite diagnosis of testicular cancer is to do an operation to remove the whole of the affected testicle (orchidectomy).  

You will only have this operation if it is necessary. Your specialist will explain this to you. After the operation, a doctor will use a microscope to look for cancer cells in the testicle. 

This may be the only operation you need to treat the cancer. It will not stop you having sex or being able to make someone pregnant in the future.  

You can read more about this operation in our section on treatment for testicular cancer.  

Further tests  

If you are diagnosed with testicular cancer, you will also need some other tests:  

• more blood tests to check the tumour markers again 
• if you are going to have chemotherapy, you will need blood tests to check how well your liver and kidneys are working 
• chest x-rays or CT scans to check your lungs are healthy 
• CT, MRI or PET scans to find out if the cancer has spread to the lymph nodes at the back of your tummy (abdomen), or to anywhere else in your body.  

More information about tests and scans

A cancer doctor, and usually a specialist nurse, will give you the test results at a cancer treatment centre. The results will help your specialist to plan the best treatment for you.  

Having tests and waiting for the results can be an anxious time. It can help to talk about how you feel. You can get support from family, friends, your specialist nurse or your doctor.  

If you need more treatment, you will have it at the cancer treatment centre. 

Treatment for testicular cancer can be very successful. Most young men with testicular cancer are cured, even if the cancer has spread. Treatment includes: 

• surgery  
• surveillance  
• chemotherapy.  

To make sure you have the right treatment, your specialist needs to know what stage the cancer is. The stage of a cancer describes its size and whether it has spread outside the testicle. You may need more tests to confirm the stage of the cancer. Waiting to hear about the stage can be worrying. But this information is important because it helps your doctors plan the best treatment.  

If you have any questions about your treatment, ask your doctor or nurse.  

You may be offered the chance to take part in a clinical trial. If your doctor thinks there is a trial that is suitable for you, they will discuss this with you. You will be able to talk things over with your specialist and family before you decide what to do. It will be your decision whether or not to take part in a trial. 

Surgery to remove the testicle is one of the main treatments for testicular cancer. The operation is called an orchidectomy. It can be done as a day patient or during a short stay in hospital.  

You may feel shocked and scared about having surgery. Your doctor and nurse will tell you more about it so that you know what to expect.  

The surgeon makes a small cut (incision) through your lower abdomen (tummy) in the groin on the side of the affected testicle. The testicle is pushed up from the scrotum and removed through the cut.  

During the operation, the surgeon can put a false testicle into your scrotum so that you will look the same as before. You can talk to your surgeon about this before the operation. You don’t have to make your mind up about this straight away. You can have a small operation to put a false testicle in at another time.  

After the operation  

You will have a small dressing where the cut was made. You can usually remove this a day or two after the operation. The stitches in the wound will dissolve by themselves over a few weeks.  

You will probably feel a bit sore, but your doctor or nurse will give you painkillers to take regularly. Let your nurse or doctor know if you are still in pain. Wearing fitted briefs or shorts that support you and loose trousers like jogging bottoms can feel more comfortable after your operation.  

You will probably also feel tired and need to take things easy for about a week. Most people make a quick recovery after the operation.  

If you want to know more about what happens before and after an operation, there is lots more information in our surgery section.

If one of your testicles is removed, you will still be able to get an erection and make someone pregnant. Your other testicle will still produce the hormone testosterone and make sperm.  

It is not common to have both testicles removed. If you have had both your testicles removed, your doctor can prescribe testosterone so you will still be able to have sex. But you will no longer be making sperm, so you won’t be able to make someone pregnant through sex.  

Storing your sperm before the operation can help you to become a parent in the future. Your doctor will talk to you about sperm banking before your surgery. You can find more information about preserving your fertility in our section on fertility.

This means having regular checks to look for signs of the cancer coming back. Your doctor might suggest this if the chance of the cancer coming back is low.  

If it does come back and it is found very early, then it can still be cured. If the cancer does not come back, you have avoided having unnecessary treatment. At each clinic appointment, your doctor will examine you and you may have blood tests, chest x-rays and ultrasound scans.  

Going to all your surveillance appointments is really important – so don’t forget. You could put a reminder in your phone.  

Chemotherapy uses anti-cancer drugs to destroy the cancer cells.  

You might be given chemotherapy:

• after an operation to remove your testicle – this is to reduce the chance of the cancer coming back 
• to destroy cancer cells that have already spread outside the testicle  
• if the cancer comes back 
• sometimes before surgery, if the cancer has spread. 

Chemotherapy can affect your fertility. Before your treatment starts, your doctor will talk to you about storing some of your sperm. This is called sperm banking. We have more information about cancer treatment and fertility. 

Your nurse will give the chemotherapy as an injection or drip into a vein. You have it through one of the following: 

• a fine tube (called a cannula) 
• a line into a vein in the chest (called a central line) 
• a line into the arm (called a PICC line) that leads into a vein in the chest.  

Find out more about how chemotherapy is given.  

The amount of chemotherapy you have may depend on the stage of the cancer. Chemotherapy is given in cycles of treatment. A cycle usually takes three weeks. If the stage is low, then you will usually have one or two cycles (sessions) of chemotherapy. If the stage is higher, or if the cancer comes back during surveillance, you will usually have three or four cycles.  

The drugs most often used to treat testicular cancer are cisplatin, etoposide and bleomycin. Giving these drugs together is called BEP. Carboplatin is sometimes used if the cancer is a seminoma. 

If you have BEP, you will usually spend 3 to 5 days of the first week having your chemotherapy as a day patient. Or you might need to stay in hospital overnight. After this, you will come back to the clinic for another injection of chemotherapy a week later, and again the following week.  

If the cancer has spread to other parts of the body, or if it hasn’t gone away completely with BEP, your doctor can give you different chemotherapy drugs.  

Side effects of chemotherapy 

Different chemotherapy drugs cause different side effects. These can usually be well controlled with medicines. They usually go away once treatment has finished. You can talk to your doctor or nurse about what to expect.  

The most common side effects are:  

• hair loss 
• tiredness 
• feeling sick or being sick (which can be controlled with medicines)  
• being more at risk of getting an infection.  

Sometimes side effects can be long-term. There is lots more information about side effects in the chemotherapy section.  

If the lymph nodes at the back of your tummy are still swollen after chemotherapy, you usually have an operation to remove them. Lymph nodes are part of the body's immune system and help fight infection. The lymph nodes in the tummy are called the retroperitoneal lymph nodes, so the operation is called a retroperitoneal lymph node dissection. The operation will be done by experienced surgeons in specialist centres.  

The lymph nodes might contain cells that could become cancerous in the future. Having them removed is the only certain way to find this out.  

You might be in hospital for up to seven days. The surgeon usually makes a cut from the top of your tummy (near your breastbone) to below your belly button. This leaves you with a scar, but it will slowly fade to look like a fine line.  

Sometimes you have surgery to remove any abnormal cells in the lungs or the lymph nodes in the chest.  

After the operation  

You will have a drip in your arm to give you fluids until you are able to eat and drink normally. You will also have drainage tubes from the wound to stop any extra fluid collecting. The nurses will check the dressing over your wound and change it when needed. You will be given painkillers to take regularly. Your staples (like metal stitches) are removed 7 to 10 days after the operation.  

It might take a few months to get back to the level of fitness you had before.  

This operation can damage the nerves that control the release of sperm (ejaculation). This may affect your fertility. Surgeons use nerve-sparing techniques to try to stop this happening. The operation doesn’t usually stop you getting an erection or having an orgasm.  

After you have finished treatment you will have regular follow-up appointments at the hospital. You'll have blood tests for tumour markers. Sometimes you may have other scans or x-rays. If the tumour markers go up, this can be a sign that the cancer has come back and means you need more treatment.

If there is anything worrying you between appointments, contact your doctor or specialist nurse for advice.

You might find it embarrassing to talk about your private parts and how the cancer or cancer treatment has affected you. It can feel awkward talking to doctors or your family about this.  

Try not to let this stop you talking about things. It can help to let someone know how you are feeling.  

You could talk to:  

• your specialist nurse or keyworker 
• family or friends  
• a counsellor – this can be arranged by your nurses  
• other young people in a similar situation, for example through an online community or support group.

You may be worried about how the cancer will affect your relationships now or in the future. You may also worry about whether it will affect your sex life. We have more information about the physical and emotional effects that cancer can have on your sex life and relationships. 

How treatment can affect sex 

Some treatments for testicular cancer may affect your sex drive and your ability to get an erection or ejaculate. This may affect your sex life now or in the future. It can also change your feelings about your body. But there are treatments and things that can help with these changes. If you have any questions, ask your doctor or nurse for advice. We have more information about body image. 
 
If you’ve had an operation for testicular cancer, this may affect your ability to have sex. This may happen if you had an operation to remove both testicles, or the lymph nodes at the back of your tummy (abdomen). 

Coping with changes to your sex life can be tough with everything else you’re going through. Or it may become more important to you in the future. Your specialist nurse can support you and help you find more advice and support if you need it. 

If you identify as gay, bisexual or trans you may worry about talking to your health care team about this. Try to let your doctor or nurse know if there are any issues you want to talk about. So they can give you the right information and support.  

If you can’t talk to your healthcare team, the LGBT Foundation has a helpline (0345 3 30 30 30). They can give you confidential advice and support. 

Contraception 

If you have sex during or after some treatments, you will need to use contraception. You should use condoms to protect your partner from cancer drugs or treatments that can affect your semen. Your doctor will give you advice about this.  

It is also very important to use contraception with female partners to avoid pregnancy during and after cancer treatment. This is because the treatment can affect your sperm and harm a baby during pregnancy. 

Fertility means your ability to have children. Some cancers and cancer treatments can affect your fertility. But your doctors will always think about this when they plan your treatment. Your doctor will talk to you about sperm banking before treatment if this might happen. 

If only one of your testicles has been removed, the other one should still make sperm. So your fertility is not affected.  

If you have both testicles removed, then your body will not make sperm any more. You won’t be able to make someone pregnant through sex after this treatment. Your healthcare team will talk to you about sperm banking before you have this surgery. 

During treatment, you may have the lymph nodes at the back of your tummy (abdomen) removed. This can affect how your body releases sperm, which can also affect your fertility.  

If you have chemotherapy, it might affect your ability to make sperm. After chemotherapy, you can have a sperm sample checked to see if this has happened. If you are having a course of chemotherapy, you can still have sex. But you should always wear a condom while the treatment is going on and for a few months afterwards. This is to protect your partner from the chemotherapy drugs in your body. With female partners, this is also to avoid pregnancy, as the drugs could harm a developing baby. 

More information about fertility and cancer treatment