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Testicular Cancer

Topic 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 isn't very common. It affects mostly young, white males between the ages of 15 and 35.1

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 nonseminomas. Seminomas grow and spread slowly and respond to radiation therapy. Nonseminomas grow and spread more quickly than seminomas. There are several different types of nonseminomas.

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

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 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-exam. 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 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. 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, 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.

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 counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org.

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?

Actionsets help people take an active role in managing a health condition. Actionsets are designed to help people take an active role in managing a health condition.
  Cancer: Controlling Cancer Pain

Cause

The exact causes of testicular cancer are unknown.

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.2

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 feeling of pain in the lower belly, groin, or lower back.

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, confusion, or dementia.

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:

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

When To Call a Doctor

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 feeling of pain in the belly, groin, or lower back.

Watchful waiting

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. Watchful waiting may let you avoid the side effects from other follow-up treatments, such as chemotherapy and radiation therapy.

If you are concerned about your symptoms, talk to your doctor right away. Watchful waiting isn't 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-exam or routine physical exam by a doctor. If testicular cancer is suspected, your doctor may want to do other tests. Tests 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 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 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 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 are doing watchful waiting. These exams and tests may continue for several years. In addition to physical exams, your 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 that increase 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 may also detect testicular cancer at an early stage. Many of these cancers are first found as a painless lump or an enlarged testicle during a self-exam.

Some doctors recommend that men ages 15 to 40 perform monthly testicular self-exams (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 with a history of an undescended testicle or a family or personal history of testicular cancer.

Treatment Overview

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

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.

Surgery

Treatment begins with a radical inguinal orchiectomy (say "IN-gwuh-nul or-kee-EK-tuh-mee"), which is surgery to remove the affected testicle(s).

Treatment after surgery

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 watchful waiting. Or you may need further treatment with chemotherapy, radiation therapy, or surgery to remove lymph nodes.

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.

Click here to view a Decision Point. Testicular Cancer: Which Treatment Should I Have for Stage I Seminoma Testicular Cancer After My Surgery?
Click here to view a Decision Point. Testicular Cancer: Which Treatment Should I Have for Stage I Nonseminoma Testicular Cancer After My Surgery?

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 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 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 exam, through an imaging test, or as a result of increasing tumor 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. Sometimes high doses of chemotherapy are needed. If these treatments don't work, then high-dose chemotherapy with stem cell transplant may be tried.

In many cases of recurrent testicular cancer, chemotherapy is followed by surgery. The surgery can remove any remaining cancer as well as tissue damaged by chemotherapy.

Supportive care

Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. 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 has a very good cure rate. But for some people, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice care.

It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care.

For more information about types of care, see:

Additional information about testicular cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/testicular.

Prevention

There are no proven ways to prevent testicular cancer.

Home Treatment

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 lightheaded 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 nonprescription 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 fiber. 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 nonsteroidal anti-inflammatory medication (NSAID) or an alternative therapy, such as biofeedback.
    Click here to view an Actionset. Cancer: Controlling Cancer Pain

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. Learning relaxation techniques may also be helpful. 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.

To learn more, see the topic Getting Support When You Have Cancer.

Medications

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.

Medication choices

Some common medicines used to treat testicular cancer include:

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 nonseminoma cancer.
  • Surgery to remove other areas of cancer if it has spread in the body.

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.

Other Treatment

Radiation therapy

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

Radiation therapy may be used to treat seminoma 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.

Stem cell transplant

Stem cell transplant may be used along with high-dose chemotherapy to treat testicular cancer that has spread into other parts of the body. This is done with stem cells from the person's own body.

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:

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.

Other Places To Get Help

Organizations

American Cancer Society (ACS)
Phone: 1-800-ACS-2345 (1-800-227-2345)
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 number have information about services and activities in local areas and can provide referrals to local ACS divisions.


AUA Foundation: The Official Foundation of the American Urological Association
1000 Corporate Boulevard
Linthicum, MD  21090
Phone: 1-800-828-7866
Phone: (410) 689-3700
Fax: (410) 689-3998
Email: auafoundation@auafoundation.org
Web Address: www.urologyhealth.org
 

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

The website 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 A–Z page to find materials about urologic problems.


National Cancer Institute (NCI)
6116 Executive Boulevard
Suite 300
Bethesda, MD  20892-8322
Phone: 1-800-4-CANCER (1-800-422-6237)
Web Address: www.cancer.gov (or https://livehelp.cancer.gov/app/chat/chat_launch 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 who have 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.


References

Citations

  1. Bosl GJ, et al. (2008). Cancer of the testis. In VT DeVita et al., eds., DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology, 8th ed., vol. 1, pp. 1463–1485. Philadelphia: Lippincott Williams and Wilkins.
  2. 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.

Other Works Consulted

  • American Joint Committee on Cancer (2010). Testis. In AJCC Cancer Staging Manual, 7th ed., pp. 469–478. New York: Springer.
  • Cornett PA, Dea TO (2010). Primary tumors of the testis section of Cancer. In SJ McPhee, MA Papadakis, eds., Current Medical Diagnosis and Treatment, 49th ed., pp. 1492–1494. New York: McGraw-Hill.
  • Kollmannsberger C, et al. (2010). Evolution in management of testicular seminoma: Population-based outcomes with selective utilization of active therapies. Annals of Oncology. Published online October 6, 2010 (doi:10.1093/annonc/mdq466).
  • National Cancer Institute (2010). Testicular Cancer PDQ: Screening—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/screening/testicular/patient.
  • Neal R, et al. (2008). Testicular cancer: seminoma, search date April 2006. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  • 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

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Christopher G. Wood, MD, FACS - Urology, Oncology
Last Revised October 22, 2012

Last Revised: October 22, 2012

Author: Healthwise Staff

Medical Review: E. Gregory Thompson, MD - Internal Medicine & Christopher G. Wood, MD, FACS - Urology, Oncology

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