Testicular Cancer

Topic Overview

What is testicular cancer?

Testicular cancer occurs when cells that are not 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 most common among white males. It is not common in men of African or Asian background.1 Although rare, testicular cancer is the most common form of cancer in men between the ages of 20 and 34.2

What causes testicular cancer?

Experts don't know what causes testicular cancer. But some problems may increase your chances of getting it. These include:1, 3

  • Having a testicle that has not dropped down into the scrotum from the belly. This is called an undescended testicle. Normally, a baby’s testicles drop down into his scrotum before he is born or by the time he is 3 months old.
  • Klinefelter syndrome . This is a genetic problem that affects males. Normally, males have one X and one Y chromosome. Males with Klinefelter syndrome have at least two X chromosomes and, in rare cases, as many as three or four.
  • A family history of testicular 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 change in the size or shape of one or both testes. You may or may not have pain.
  • A heavy feeling in the scrotum.
  • A dull pressure or pain in the lower back, belly, or groin, or in all three places.

How is testicular cancer diagnosed?

Most men find testicular cancer themselves during a self-examination. Or your doctor may find it during a routine physical exam.

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 or CAT scan. These tests can also help find out if cancer has spread to other parts of your body.

How is it treated?

Nearly all men with testicular cancer begin treatment with surgery to remove the testicle that has cancer. This surgery is called radical inguinal orchiectomy. Removing the testicle allows your doctor to find out the type of cancer cells you have. It also helps him or her plan any other treatment you may need.

Treatment after surgery may include:

  • Watchful waiting . You may be able to wait and watch to see what happens. During watchful waiting, you will have regular checkups with your doctor to make sure that the cancer is gone.
  • Chemotherapy . This is powerful medicine that destroys any cancer cells that remain after surgery.
  • Radiation therapy . This is a high dose of X-rays used to destroy cancer cells. It is mostly used to treat a kind of cancer called seminoma, but it is sometimes used after surgery to kill leftover cancer cells. Radiation therapy can also be used to treat cancer that has spread beyond the testes.
  • Additional surgery to remove lymph nodes. This surgery is called retroperitoneal lymph node dissection (RPLND).

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.

Testicular cancer is highly curable when it is found early. Even when it is found at an advanced stage, it is considered very curable.

How will having testicular cancer affect you?

In most cases, removing a testicle does not 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. Also, 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.

Unlike many other kinds of cancer, most testicular cancers grow slowly and respond well to treatments such as chemotherapy and radiation therapy. But these treatments can cause side effects. Most of the time, the side effects last only a little while, but there also are longer-term side effects from treatments.

Frequently Asked Questions

Learning about testicular cancer:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with testicular cancer:

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Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  Testicular cancer: Which treatment should I have for stage I nonseminoma testicular cancer after my surgery?
  Testicular cancer: Which treatment should I have for stage I seminoma testicular cancer after my surgery?

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  Cancer: Controlling cancer pain
  Cancer: Controlling nausea and vomiting from chemotherapy
  Lymphedema: Managing lymphedema

Cause

The exact causes of testicular cancer are unknown.

Several conditions may increase your risk of getting testicular cancer. (Most men who get testicular cancer don't have any risk factors.) These risk factors include:1, 3

  • An undescended testicle (cryptorchidism). This is a testicle that has not descended from the abdomen into the scrotum. Normally, the testes descend into the scrotum before the baby is born or during the first 3 months of infancy. A man is at a higher risk even if the testicle is moved down surgically.
  • Klinefelter syndrome . This is a genetic disorder that affects males. Normally, males have one X and one Y chromosome. Males with Klinefelter syndrome have at least two X chromosomes and, in rare cases, as many as three or four.
  • A family history of testicular cancer.

Infertility from sperm problems has been linked to testicular cancer. Men with sperm problems have a higher rate of testicular cancer than men who do not. Experts don't yet know if the two problems share the same cause or if one causes the other.4

Some doctors recommend that men ages 15 to 40 perform a monthly testicular self-examination (TSE). Others do not believe a monthly TSE is needed for men who are at average risk for testicular cancer. Monthly TSEs may be recommended for men at high risk for testicular cancer, including those who have one or more of the above risk factors. Sometimes changes in the testes do not cause pain. So you may not notice these changes during a self-exam. If you have increased risk, see your doctor regularly for testicular exams.

Symptoms

Common symptoms of testicular cancer include:

  • A swelling and/or lump in one or both of the testes. Pain in the testes or scrotum may or may not be present.
  • A feeling of heaviness in the scrotum.
  • A dull feeling of pain in the region of the lower abdominal area, groin, or lower back.

Call your doctor if you have any of the above symptoms. It is also important to know that these symptoms may occur as a result of conditions unrelated to testicular cancer. Conditions that have symptoms similar to testicular cancer include:5

  • Hydrocele . A hydrocele is a painless buildup of fluid around one or both testicles that causes the scrotum or groin area to swell. Even though the swelling may be unsightly or uncomfortable, it is not painful. An acquired hydrocele can occur at any age but is most common in men older than 40.
  • Varicocele . A varicocele is an enlarged, twisted vein (varicose vein) in the scrotum, most often on the left side. It feels like a “bag of worms” and may occasionally cause discomfort.
  • Spermatocele. A spermatocele (epididymal cyst) is a sperm-filled cyst in the long, tightly coiled tube that lies behind each testicle and collects sperm (epididymis). It feels like a smooth, firm lump in the scrotum.
  • Orchitis . This is an inflammation or infection of the testicle that may be caused by a virus or bacteria. Orchitis occurs most often in men who have mumps.
  • Epididymitis . This is an inflammation and infection of the long, tightly coiled tube that lies behind each testicle and collects sperm (epididymis). Epididymitis is usually caused by a bacterial infection but may also occur following a urologic procedure. Sexually transmitted diseases cause most cases of epididymitis in men younger than 35.

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 abdomen.
  • Lack of energy, sweating for no apparent reason, fever, or a general feeling of illness (malaise).
  • Shortness of breath, coughing, or chest pain.
  • Headache, confusion, or dementia.

Testicular cancer is considered one of the most curable forms of cancer. An early diagnosis followed by an appropriate treatment program can greatly increase your chance for a positive outcome.3

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 does not 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 begin treatment with the surgical removal of the affected testicle(s), a procedure called a radical inguinal orchiectomy. Removing the affected testicle helps your doctor find out which type of cancer cells are present and whether your cancer has spread beyond the testes (stage).

After the removal of the affected testicle, your treatment plan may involve watchful waiting, radiation therapy, chemotherapy, or additional surgery. This depends on your choices, the type of cancer 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

Several conditions may increase your chances of getting testicular cancer. These risk factors include:1, 3

  • An undescended testicle (cryptorchidism). This is a testicle that has not moved down (descended) from the abdomen into the scrotum. Normally the testicles descend before or soon after birth. Surgery is usually done to move an undescended testicle into the scrotum. This makes it possible to check the testicle over time. Some experts say that it may lower testicular cancer risk when done early.6, 7 But there has not been enough research to prove that this is true.
  • Klinefelter syndrome . This is a genetic disorder that affects males. Normally, males have one X and one Y chromosome. Males with Klinefelter syndrome have at least two X chromosomes and, in rare cases, as many as three or four.
  • A family history of testicular cancer.

Men with infertility from sperm problems have a higher rate of testicular cancer than average. Experts don't yet know if the cancer and sperm problems share the same cause or if one causes the other.4

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

When To Call a Doctor

The most common symptom of testicular cancer is a noticeable change in the size or shape of one or both testicles.

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. Pain in the testicles or scrotum may or may not be present.
  • A feeling of heaviness in the scrotum.
  • A dull feeling of pain in the abdomen, groin, or lower back.

Watchful Waiting

After surgery to remove a cancerous testicle, men whose tests show that their testicular cancer is early-stage and likely hasn't spread beyond the testes may choose watchful waiting (or surveillance) rather than chemotherapy or radiation therapy. Watchful waiting involves close observation through frequent exams and tests to monitor your recovery.

It may seem odd to think about having cancer and not receiving immediate and aggressive treatment to remove or destroy it. By waiting, you may be able to avoid the potential side effects of more aggressive therapy without an increased risk to your long-term survival. During watchful waiting, you will have regular imaging exams and blood tests to watch your condition. If there is no change in your condition, you may continue watchful waiting. If your cancer returns, your doctor will recommend treatment with medicines (chemotherapy), radiation therapy, or surgery.

It is important to know that each treatment option, including watchful waiting, has its own risks. In choosing your course of treatment, your doctor should fully explain the potential risks and various outcomes so that you can be an informed, active participant at every stage of your treatment.

If you are concerned about your symptoms, talk to your doctor right away. Watchful waiting is not appropriate unless it is prescribed by a doctor.

Who To See

Health professionals who can evaluate your symptoms and your risk for testicular cancer include:

Health professionals who can manage your cancer treatment include:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Most abnormalities of the testes are found during a self-examination or routine physical exam by a doctor. If testicular cancer is suspected, your doctor may want to perform other tests, including:

  • Testicular ultrasound. This test may be used to rule out other possible causes of an enlarged or painful testicle before the testicle is removed. Ultrasound is a test that uses reflected sound waves to produce an image of organs and other structures in the body. Unlike many other imaging tests, an ultrasound does not use X-rays or other types of possibly harmful radiation.
  • Blood tests, which are often performed in order to measure the levels of tumor markers in your blood. Tumor markers are substances that appear in your bloodstream when cancer is present. Tumor marker levels are monitored at all stages of treatment for testicular cancer.
  • Imaging tests, such as chest X-ray and CT scan of the chest, abdomen, and pelvis.

If the testicular ultrasound and blood tests suggest testicular cancer, a doctor will surgically remove your affected testicle. This procedure, called a radical inguinal orchiectomy, is done to confirm a diagnosis of testicular cancer. Following orchiectomy, a pathologist will examine tissue from the testicle under a microscope (biopsy). If cancer is found, you may have other imaging tests to see whether your cancer has spread beyond the testes. The tests may be X-rays, CT scans, or MRIs of the abdomen, chest, and head.

Ongoing exams and tests

During your treatment for testicular cancer, your doctor will schedule a thorough follow-up program to monitor your recovery, especially if you participate in a watchful waiting (or surveillance) program after your initial treatment. These exams and tests may continue for several years following your treatment. In addition to physical exams, your specific follow-up program may include:

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

Early detection

A genital exam is an important part of a routine physical exam for every adolescent boy and man.

Testicular self-examination (TSE) may also detect testicular cancer at an early stage. Many testicular cancers are first discovered as a painless lump or an enlarged testicle during self-examination.

Some doctors recommend that men ages 15 to 40 perform monthly testicular self-examination. But this is controversial. Many doctors do not believe monthly TSE is necessary for men who are at average risk for testicular cancer. Monthly TSE may be recommended for men who are at high risk for testicular cancer. This includes men with 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 considered a highly curable disease, especially when diagnosed at an early stage.3

Initial treatment

Treatment for testicular cancer begins with a radical inguinal orchiectomy, which is surgery to remove the affected testicle(s). Depending on which type of cancer cells are present and whether your cancer has spread to other areas of your body (stage), this procedure may be followed by one or more of the following treatments:

  • Watchful waiting . This is a period of time during which you are being monitored by your doctor but are not receiving treatment. It is also called observation or surveillance.
  • Radiation therapy . Radiation therapy is the use of high-dose X-rays to destroy cancer cells and shrink tumors. This type of treatment is commonly used to treat seminomas, as these cells are highly sensitive to radiation. Radiation therapy is not effective in treating nonseminoma cancers.
  • Chemotherapy . Chemotherapy is the use of very powerful medicines to destroy cancer cells. The most common chemotherapy used to treat testicular cancer is called cisplatin combination therapy and involves the use of several different medicines. This treatment varies in intensity and is often used for men whose cancer has spread beyond the testes to lymph nodes or other organs.
  • Additional surgery, which may be required to remove cancer cells that have spread to lymph nodes or other areas of your body. One type of surgery, called a retroperitoneal lymph node dissection (RPLND), is a common treatment for nonseminomas involving the removal of lymph nodes in the abdomen and lower back.

Some stage I testicular cancers are successfully treated with watchful waiting programs rather than chemotherapy or radiation therapy. This option involves frequent exams as well as blood and imaging tests to monitor your condition. Because of the side effects associated with follow-up treatments such as chemotherapy and radiation therapy (adjuvant therapies), most doctors think watchful waiting is a legitimate treatment option.

If you are diagnosed with a stage I seminoma or nonseminoma (NSGCT), you may have a choice for your next course of treatment. It is important to understand that each treatment option, including watchful waiting, has its own risks. Ask your doctor to fully explain these potential risks and various outcomes so that you can be an informed, active participant at every stage of your treatment. For more information, see:

Click here to view a Decision Point. Which treatment should I have for stage I seminoma?
Click here to view a Decision Point. Which treatment should I have for stage I nonseminoma?

If it is not treated during its early stages, testicular cancer may spread (metastasize) beyond the testes and regional lymph nodes to more distant lymph nodes and organs. Areas that may be affected include the lungs, liver, brain, and bones. Testicular cancer that has metastasized is harder to cure than early-stage cancer, though cure is still possible and in many cases likely. Treatment for advanced-stage testicular cancer may include more invasive surgery and more intensive chemotherapy or radiation therapy.

You may experience a wide variety of emotions after being diagnosed with testicular cancer, including denial, anger, and grief. There is no "normal" or "right" way to react to a diagnosis of cancer. There are many ways you can manage your emotional reaction to testicular cancer. You may find that talking with family and friends helps. Some men may find that spending time alone is helpful.

If your emotions are interfering with your ability to make decisions about your health, talk with your doctor. You may also contact your local hospital or American Cancer Society chapter to help you find a support group. Talking with other people who have had similar feelings can be very helpful.

Ongoing treatment

Regardless of the therapy you choose to treat your testicular cancer, it is important to receive follow-up care, which may lead to early identification and management of recurrent cancer (cancer that comes back). Your regular follow-up program may include:

  • Physical exams.
  • Imaging tests, including X-rays, CT scans, and MRIs.
  • Blood tests, to check tumor marker levels. Stable or increasing tumor marker levels after treatment may mean your cancer is still present or has returned and that further treatment is needed.

A diagnosis of testicular cancer means that you will be seeing your doctor regularly for years to come, so it's a good idea to develop 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 be successful.

Treatment if the condition gets worse

Testicular cancer that has come back (recurred) may be discovered during a physical exam, through an imaging test, or as a result of increasing tumor marker levels. Unlike other types of recurrent cancer, recurrent testicular cancer is often cured, especially if it has spread only to the lymph nodes in the pelvis, abdomen, or lower back and pelvis (retroperitoneum). Recurrent testicular cancer may be treated with one or a combination of the following treatments:

In many cases of recurrent testicular cancer, chemotherapy treatment is followed by surgery to remove any remaining cancer as well as tissue damaged as a result of the chemotherapy.

What to think about

Infertility. 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.

  • Radiation therapy for testicular cancer has been connected with infertility in some men. Although most radiation treatment programs do not permanently affect healthy sperm counts, there is some risk.
  • Surgery to remove one cancerous testicle seldom causes infertility, but there is a small risk.
  • Nerve-sparing retroperitoneal lymph node dissection (RPLND) seldom causes infertility, but there is a small risk.5

If you have advanced (metastatic) testicular cancer, at some point you may choose to stop curative treatment and focus on care that ensures your comfort (palliative care). It's hard to decide when to stop medical treatment aimed at prolonging life and shift the focus to palliative care. For more information, see the topics Care at the End of Life and Hospice Care.

Prevention

There are no proven ways to prevent testicular cancer. But the following steps may increase the possibility of finding early-stage testicular cancer when it is most likely to be curable.

  • Perform regular testicular self-exams. Most cases of testicular cancer are discovered during a self-exam or during a routine physical done by a doctor.
  • Be aware of any pain or discomfort in your scrotum, pelvis, or lower back. If you have any discomfort in these areas, see your doctor as soon as possible.

For more information about testicular cancer, see the following topics:

Home Treatment

During treatment for any stage of testicular cancer, you can use home treatment to help manage the side effects that may happen with testicular cancer or cancer treatment. Home treatment may be all that is needed to manage the following common problems. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms.

Other issues may include:

  • Hair loss. This can be emotionally distressing. Not all chemotherapy medicines cause hair loss, and some people have only mild thinning that is noticeable only to them. Talk to your doctor about whether hair loss is an expected side effect with the medicines you will receive.
  • Poor appetite. Healthy habits such as eating a balanced diet and getting enough sleep and exercise can help control your symptoms. To prevent weight loss and to conserve your strength, eat well during treatment for testicular cancer.
  • Sleep problems. 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.

Many men with testicular cancer face emotional issues as a result of their disease or its treatment.

  • The diagnosis of testicular cancer and the need for treatment can be very stressful. You may be able to reduce your stress by expressing your feelings to others. Learning relaxation techniques, such as meditation or yoga, may also help you reduce stress.
  • Your feelings about your body may change following a diagnosis of testicular cancer and the need for treatment. Adapting to your body image changes may involve talking openly about your concerns with your partner and discussing your feelings with your doctor. Your doctor may also be able to refer you to groups that can offer support and information.

Testicular cancer and its treatments do not always cause pain. If you have pain, there are many options to relieve it. If your doctor gives you instructions or medicines to treat pain, be sure to follow them. Home treatment for pain, such as a nonsteroidal anti-inflammatory medication (NSAID) or an alternative therapy, such as biofeedback, may improve your physical and mental well-being. Be sure to discuss with your doctor any home treatment you use for pain. For more information, see the topic Cancer Pain.

Medications

Chemotherapy treatment for testicular cancer uses powerful medicines to kill the cancer cells in your body. But because of the risk of serious side effects linked to chemotherapy, it is important to discuss the risks and benefits of these medicines with your doctor before starting treatment.

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

Medication Choices

Some common medicines used to treat testicular cancer include:

Medicines to control and prevent nausea and vomiting may include:

  • Serotonin antagonists, such as ondansetron (Zofran), granisetron (Kytril or Sancuso), or dolasetron (Anzemet). These medicines more effectively prevent nausea and vomiting caused by chemotherapy when they are combined with corticosteroids, such as dexamethasone.
  • Phenothiazines.
  • Metoclopramide (Reglan).
  • Dimenhydrinate (Gravol).

What To Think About

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

Chemotherapy affects rapidly growing cells in your body, which, besides cancer cells, includes blood cells, hair cells, and the cells that line your digestive tract. Common short-term side effects include nausea and vomiting, hair thinning or hair loss, mouth sores, diarrhea, and an increased chance of bleeding and infection. Many men do not have problems with these side effects. Other men have a great deal of difficulty. If you have problems, your doctor can use other medicines to help relieve some of these side effects.

Although uncommon, chemotherapy for the treatment of testicular cancer has also been linked to serious long-term side effects including high blood pressure (hypertension), increased cholesterol levels, and kidney and lung damage, as well as increased risk of secondary cancers including leukemia and melanoma.1 Generally, these long-term side effects have been linked to higher doses of chemotherapy than are usually given for the treatment of stage I testicular cancers. Before beginning treatment, talk to your doctor about any concerns you may have about the long-term side effects of chemotherapy.

Fertility and chemotherapy. Chemotherapy for testicular cancer has been linked to permanent infertility in some men. Because most men diagnosed with testicular cancer are younger than 35, fertility issues are often an important part of the decision about which treatment to receive. 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.

Surgery

Nearly all men with testicular cancer begin treatment with surgery to remove the cancerous testicle. This procedure is called a radical inguinal orchiectomy.

Seminoma. For early stage seminoma testicular cancer, no more surgery is done after orchiectomy. Instead, radiation or watchful waiting are likely to be your treatment options. (For this type of cancer, chemotherapy is a newer treatment choice, though it is mostly used in Europe.8)

Nonseminoma. For some cases of nonseminoma testicular cancer, orchiectomy is followed by a retroperitoneal lymph node dissection (RPLND). This is the surgical removal of lymph nodes in the pelvis and lower back. Sometimes, chemotherapy is used before or after RPLND.

If you have nonseminoma that was diagnosed at an early stage, and tests suggest that it hasn't spread beyond the testes, you may choose to follow orchiectomy with a watchful waiting program rather than RPLND. Watchful waiting, or surveillance, is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment.

In more advanced cases of testicular cancer, chemotherapy with additional surgery and sometimes radiation may be necessary to treat cancer that has spread beyond the lymph nodes in the lower abdomen. Other areas of the body that may be affected include the lungs, brain, liver, and bones.

More about RPLND

RPLND removes lymph nodes in the pelvis and lower back that are common sites of spread (metastasis) for testicular cancers. Although this lowers the chance that your cancer will reappear, some men with stage I cancers are cured without this procedure. Also, RPLND is related to several complications, including:1

  • Retrograde ejaculation, a condition in which the semen flows from the prostate gland into the bladder rather than through the penis and outside the body, resulting in infertility. Men who suffer from retrograde ejaculation typically do not have erection problems or difficulty enjoying sex.
  • Postoperative pain.
  • Chylous ascites, a condition in which digestive fluids collect inside the abdominal cavity. This may lead to abdominal pain and difficulty breathing.
  • Lymphedema , which is a collection of fluid that causes swelling (edema) in the arms and legs. This type of edema occurs when the amount of lymph fluid in a person's arm or leg exceeds the body's ability to remove it, and the fluid then collects in the tissues of the limb. For more information, see:
    Click here to view an Actionset.Lymphedema: Managing lymphedema.
  • Excessive bleeding (hemorrhage).
  • Pulmonary embolism , which is the sudden blockage of blood flow within the lung.

Surgery Choices

Radical inguinal orchiectomy
Retroperitoneal lymph node dissection (RPLND)

What To Think About

Try to find an experienced surgeon and a medical center where many surgeries are done for your kind of cancer. Experience can make a big difference. You will likely have fewer side effects, and you'll recover more quickly.

Fertility and testicle surgery. In most cases, surgery to remove a cancerous testicle does not cause infertility unless both testicles are removed. But there is a small chance that surgery could harm your ability to conceive a child. 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.

If you have both testicles removed, it will be necessary for you to have hormone replacement therapy to replace testosterone, the male hormone produced by the testes. But in most cases when just one testicle is removed, fertility and hormone levels remain normal.

Modern laparoscopic and other "nerve-sparing" surgical techniques have reduced the number of men who suffer from retrograde ejaculation after RPLND. Even though about 95% of men remain fertile after nerve-sparing RPLND, most doctors recommend sperm banking before surgery.5 Nerve-sparing RPLND surgery may not be possible for men who previously have had chemotherapy treatment for cancer.

An increasing number of RPLNDs are done using laparoscopic surgery. For laparoscopy, a lighted viewing instrument (laparoscope) and other surgical instruments are inserted into the lower abdomen through small incisions, usually made below the navel. Though not yet commonly available, laparoscopic RPLND is much less invasive and carries less risk than standard RPLND surgery.

Other Treatment

Radiation therapy is a common treatment for seminoma germ-cell tumors. Because the lymph nodes in the pelvis and lower back (retroperitoneum) are the most common areas of metastasis for testicular cancer, radiation is commonly focused on that area.

In some cases, radiation therapy may be the best treatment option for completely curing testicular cancer. But when you plan your treatment with your doctor, discuss the benefits, risks, and possible side effects of each treatment.

Radiation therapy can cause long-term health conditions—although it is uncommon—including infertility and an increased chance of having cancer later in life.

Other Treatment Choices

Radiation therapy

Radiation therapy for testicular cancer uses high-dose X-rays or other types of radiation to kill testicular cancer cells. Radiation therapy may be used after surgery to keep testicular cancer from coming back. Sometimes radiation therapy is used to treat testicular cancer that has come back.

What To Think About

Your treatment options will depend on a number of factors, including the type of cancer cells present, the stage of your cancer, your overall health, and your willingness to strictly follow your doctor's follow-up schedule. If you have an early-stage cancer, you may be given the option of having radiation therapy to destroy any remaining cancer cells, or another treatment such as surgery or chemotherapy. Your decision about which treatment to receive will be based on balancing the benefits with the risks and possible side effects of each treatment option, including the effects on your quality of life and the possibility that your cancer will return.

Most side effects of radiation therapy are short-term and do not pose any serious health threat. But in rare cases, radiation can lead to infertility or cancer later in life.

  • Infertility. Radiation therapy for testicular cancer has also been linked to permanent infertility in some men. Because the majority of men diagnosed with testicular cancer are younger than 35, fertility issues are often an important part of the decision about which treatment to get. Even though most radiation treatment programs do not permanently affect healthy sperm counts, many doctors recommend sperm banking before radiation therapy for those men who may wish to have children.
  • Another cancer. Radiation therapy, although focused on cancer cells, also exposes many of the body's healthy cells to harmful radiation. Because many men who have successful treatment for testicular cancer go on to live for decades, damage to the body's healthy cells caused by radiation may not become apparent until many years after treatment is completed. Although rare, secondary cancers resulting from radiation therapy may include leukemia, as well as cancers of the colon, bladder, kidneys, and prostate.

Complementary therapies

In addition to conventional medical treatment, complementary therapies may improve the quality of your life by helping you manage the stress and side effects of cancer treatment. But these complementary therapies should not replace standard therapy.

Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

Other Places To Get Help

Organizations

American Cancer Society (ACS)
Phone: 1-800-ACS-2345 (1-800-227-2345)
TDD: 1-866-228-4327 toll-free
Web Address: www.cancer.org
 

The American Cancer Society (ACS) conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free numbers have information about services and activities in local areas and can provide referrals to local ACS divisions.


National Cancer Institute (NCI)
NCI Publications Office
6116 Executive Boulevard
Suite 3036A
Bethesda, MD  20892-8322
Phone: 1-800-4-CANCER (1-800-422-6237) 9:00 a.m. to 4:30 p.m. EST, Monday through Friday
TDD: 1-800-332-8615
E-mail: cancergovstaff@mail.nih.gov
Web Address: www.cancer.gov (or https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help online)
 

The National Cancer Institute (NCI) is a U.S. government agency that provides up-to-date information about the prevention, detection, and treatment of cancer. NCI also offers supportive care to people with cancer and to their families. NCI information is also available to doctors, nurses, and other health professionals. NCI provides the latest information about clinical trials. The Cancer Information Service, a service of NCI, has trained staff members available to answer questions and send free publications. Spanish-speaking staff members are also available.


UrologyHealth.org, American Urological Association
1000 Corporate Boulevard
Linthicum, MD  21090
Phone: 1-800-828-7866
1-866-RING AUA (1-866-746-4282) toll-free
(410) 689-3700
Fax: (410) 689-3800
E-mail: auafoundation@auafoundation.org
Web Address: www.urologyhealth.org
 

UrologyHealth.org is a Web site written by urologists for patients. Visitors can find specific topics by using the "search" option.

The Web site provides information about adult and pediatric urologic topics, including kidney, bladder, and prostate conditions. You can find a urologist, sign up for a free quarterly newsletter, or click on the Urology Resource Center to find materials about urologic problems.


References

Citations

  1. Raghavan D, et al. (2007). Bladder, renal, and testicular cancer. In DC Dale, DD Federman, eds., ACP Medicine, section 12, chap. 14. New York: WebMD.
  2. Huyghe E, et al. (2003). Increasing incidence of testicular cancer worldwide: A review. Journal of Urology, 170(1): 5–11.
  3. American Joint Committee on Cancer (2002). Bladder, renal, and testicular cancer. In AJCC Cancer Staging Manual, 6th ed., pp. 317–320. New York: Springer-Verlag.
  4. Raman JD, et al. (2005). Increased incidence of testicular cancer in men presenting with infertility and abnormal semen analysis. Journal of Urology, 174: 1819–1822.
  5. Vuky J, Motzer RJ (2003). Testicular germ cell cancer. In B Furie et al., eds., Clinical Hematology and Oncology, pp. 813–824. Philadelphia: Churchill Livingstone.
  6. Bosl GJ, et al. (2005). Cancer of the testis. In J Pine, ed., Cancer: Principles and Practice of Oncology, 7th ed., pp. 1269–1293. Philadelphia: Lippincott Williams and Wilkins.
  7. Pettersson A, et al. (2007). Age at surgery for undescended testis and risk of testicular cancer. New England Journal of Medicine, 356(18): 1835–1841.
  8. Oliver RTD, et al. (2005). Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: A randomized trial. Lancet, 366: 293–300.

Other Works Consulted

  • American Cancer Society (2007). How is testicular cancer found? Overview. Testicular Cancer. Available online: http://www.cancer.org/docroot/CRI/content/CRI_2_2_3x_How_Is_Testicular_Cancer_Found_41.asp?sitearea=.
  • American Cancer Society (2008). Cancer Facts and Figures 2008. Atlanta: American Cancer Society. Available online: http://www.cancer.org/docroot/STT/content/STT_1x_Cancer_Facts_and_Figures_2008.asp.
  • National Comprehensive Cancer Network (2008). Testicular Cancer, version 2. Available online: http://www.nccn.org/professionals/physician_gls/PDF/testicular.pdf.
  • Neal R, et al. (2006). Testicular cancer: seminoma, search date April 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
  • Presti JC Jr (2008). Genital tumors. In EA Tanagho, JW McAninch, eds., Smith's General Urology, 17th ed., pp. 375–387. New York: McGraw-Hill.
  • Richie JP, Steele GS (2007). Neoplasms of the testis. In AJ Wein et al., eds., Campbell-Walsh Urology, 9th ed., vol. 1, pp. 893–935. Philadelphia: Saunders Elsevier.
  • Rugo HS (2008). Urology. In SJ McPhee et al., eds., Current Medical Diagnosis and Treatment, 47th ed., pp. 1431–1433. New York: McGraw-Hill.
  • van As NJ, et al. (2008). Evidence-based pragmatic guidelines for the follow-up of testicular cancer: Optimising the detection of relapse. British Journal of Cancer, 98(12):1894–1902.

Credits

Author Bets Davis, MFA
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Christopher G. Wood, MD, FACS - Urology/Oncology
Last Updated January 26, 2009

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