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Testicular cancer

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Testicular cancer accounts for approximately 0.7% of all cancers. It's the most common cancer in men between the age of 20 and 35. Approximately 1,960 men are diagnosed with the condition each year in the UK. Around 70 people die every year from testicular cancer.
Brought to you by NHS Choices

Overview

Introduction

The testicles are part of the male reproductive system. They produce sperm and the male hormone testosterone. The testicles hang down behind the penis, and are located within the scrotum (a loose bag of skin).

The body is made up of millions of different types of cells. Sometimes these cells can become abnormal and start to multiply. When this happens it causes a growth, known as a tumour, to form. Tumours can be benign (not cancerous) or malignant (cancerous). They can occur in any part of the body where the cells multiply abnormally.

Testicular cancer is different from many other types of cancer. Most cancers tend to affect older people. Testicular cancer, however, is more common in young and middle-aged men. Approximately 50% of all cases of testicular cancer affect men who are under 35 years of age, and 90% of cases affect those who are under the age of 55.

Cancer of the testicles is also one of the most treatable forms of cancer. Over 95% of men make a full recovery from testicular cancer.

Types of testicular cancer

There are two main types of testicular cancer:

  • seminoma, and
  • non-seminoma

The terms seminoma and non-seminoma refer to the type of cell that makes up the cancerous tumour. Seminoma testicular cancers only contain seminoma cells. Non-seminomas may contain a variety of different cancer cells. However, both types of testicular cancer are treated in a similar way.

Testicular cancer is also a type of germ cell cancer. A germ cell cancer is one that starts in the cells that are used to make sperm or eggs (ovarian cancer is another type of germ cell cancer).

Symptoms

Symptoms of testicular cancer

The most common symptom of testicular cancer is a lump, or swelling, in one of your testicles. Testicular lumps are most commonly found on either the front, or the side, of the testicle. They often feel like a hard, pea-sized swelling.

See your GP if you have a lump or swelling in your testicle

Most testicular lumps are not a sign of cancer. Research has shown that less than 4% of testicular lumps are cancerous.

However, this does not mean that you should ignore a lump, or swelling, in your testicle. It is very important that you see your GP, who will be able to examine your testicles to help determine whether the lump is cancerous.

If you do not feel able to visit your GP, you can go to your local sexual health (GUM) clinic, where a health professional will be able to examine you. You can find your local clinic by visiting the FPA (formerly the Family Planning Association) website (see useful links).

Testicular cancer can also cause other symptoms, including:

  • a dull ache, or sharp pain, in your testicles, or scrotum, which may come and go,
  • a feeling of heaviness in your scrotum,
  • a dull ache in your lower abdomen,
  • a sudden collection of fluid in your scrotum (hydrocele),
  • fatigue, and
  • generally feeling unwell.

Rarer symptoms

In rare cases of testicular cancer, the tissue in your breast area may be enlarged, or tender. Your nipples may also feel sore and tender as a result of the hormonal changes going on in your body.

If your testicular cancer has spread to other parts of your body, you may also experience a variety of other symptoms. Although testicular cancer can spread to your lymph nodes (part of your immune system) and lungs, it rarely travels to other organs.

This means that if your cancer does spread, you are most likely to experience symptoms such as:

  • coughing,
  • difficulty breathing,
  • difficulty swallowing, and
  • a swelling in your chest.

Causes

Causes of testicular cancer

The causes of testicular cancer are not yet fully understood. However, research has identified a number of factors which may increase your chances of developing the condition. Some of these risk factors are outlined below.

Undescended testicles

The medical name for undescended testicles is cryptorchidism. When male babies grow in the womb, their testicles develop inside their abdomen. The testicles then normally move down into the scrotum when the baby is born, or during their first year of life.

However, for some children, the testicles fail to descend into the scrotum. Surgery is normally required to move the testicles down. If your testicles require surgery because they do not descend, it may increase the risk of you developing testicular cancer.

One study found that if surgery is performed before the child is 13 years of age, their risk of testicular cancer is approximately double than that of the rest of the population. However, if the operation is carried out after the boy is 13 years of age, or older, the risk of developing testicular cancer is five times greater than that of the rest of the population.

Age and race

Unlike most other cancers, testicular cancer is more common in young and middle-aged men, than in older, or elderly, men. It most commonly affects men who are between 20-44 years of age, with 90% of testicular cancer cases affecting men who are under the age of age 55.

Testicular cancer is also more common in white men, compared with other racial groups. It is also more common in northern and western Europe than in any other part of the world.

Close family member

If a close family member has had testicular cancer, such as your father, or brother, it may increase your risk of developing the condition. It is thought that approximately 1 in 5 cases of testicular cancer are the result of an inherited faulty gene.

Mumps orchitis

Mumps orchitis is a rare complication of mumps (a viral infection of your salivary glands). In men, mumps orchitis can cause either one, or both, of the testicles to become inflamed. This can be very painful, and it can also increase your risk of developing testicular cancer later in life.

Fertility problems

Some research has suggested that men with fertility problems, such as a low sperm count, or low sperm mobility (when the sperm do not move around as well as they should), may be at an increased risk of testicular cancer. However, this risk is relatively small. For example, one study found that out of 32,000 men who had fertility problems, only 89 went on to develop testicular cancer.

No link to vasectomies

Past research had suggested that there may be a link between vasectomies and testicular cancer. However, more recent studies have shown that this is not the case. You are not at any increased risk of developing testicular cancer if you undergo vasectomy surgery.

Injuries, or strains, to the groin will also not increase your risk of developing testicular cancer.

Diagnosis

Diagnosing testicular cancer

Visiting your GP

If you notice a lump, or abnormality, in your testicles, you should first see your GP. Although most testicular lumps are not cancerous, it is essential for you to have the abnormality checked. This because the treatment for testicular cancer is much more effective the earlier the condition is diagnosed.

Physical examination

As well as asking you about your symptoms, and consulting your medical history, your GP will normally need to carry out a physical examination of your testicles.

Your GP may hold a small light, or torch, against the lump in your testicle, to see whether light passes through it. Cancerous lumps tend to be solid, and light cannot normally pass through them.

If your GP suspects that the lump in your testicle may be cancerous, you will be referred for further testing at a hospital. Some of the tests that you may have are outlined below.

Scrotal ultrasound

A scrotal ultrasound scan is a painless procedure which uses high frequency sound waves to produce an image of the inside of your testicles. This is one of the main ways in which your specialist will be able to determine whether or not your lump is cancerous.

During a scrotal ultrasound, your specialist will be able to determine the position and size of the abnormality in your testicle.

It will also give them a good indication of whether the lump is solid, or whether it is filled with fluid. A lump filled with fluid is known as a cyst, and is usually harmless. However, a more solid lump may be a sign that the swelling is cancerous.

Blood tests

To help confirm your diagnosis, you may require a series of blood tests. These tests will be used to detect certain hormones in your blood, which are known as 'markers'. Testicular cancer often produces these markers, so having them in your blood may be a strong indication that you have the condition.

The markers in your blood that will be tested for include:

  • AFP (alpha feta protein),
  • HCG (human chorionic gonadotrophin), and
  • LDH (lactate dehydrogenate).

It is important to remember that not all forms of testicular cancer produce these markers. There may still be a chance that you have testicular cancer, even if your blood test results come back normal.

Biopsy

The only way to definitively confirm a case of testicular cancer is to have a biopsy of the tumour taken. The cells from the tumour can then be examined in a laboratory to determine whether it is cancerous (malignant), or non-cancerous (benign).

Usually, a biopsy involves taking a small sample of cells from the tumour. Unfortunately, for most cases of testicular cancer, the only way to safely take a biopsy is to remove the affected testicle completely. This is because specialists often think that the risk of the cancer spreading is too high for a conventional biopsy to be taken.

Your specialist will only remove your testicle if they are relatively certain that your lump is cancerous. Losing a testicle will not affect your ability to have children, or your sex life. The main form of treatment for testicular cancer is to have the testicle removed, so it is likely that you will need to undergo this procedure at some point anyway.

The removal of a testicle is known as an orchidectomy. See the 'treatment' section for more information about the procedure.

Other tests

If your specialist feels it is necessary, you may require further tests to check whether your testicular cancer has spread to any other parts of your body. When cancer of the testicle spreads, it most commonly affects the lungs. This means that you may require a chest X-ray to check for any signs of a tumour.

You may also require a scan of your body, such as a magnetic resonance imaging (MRI) scan, or a computerised tomography (CT) scan to check for signs of the cancer spreading.

Treatment

Treating testicular cancer

Testicular cancer is one of the most treatable cancers, with approximately 95% of men making a full recovery. As with most cancers, the earlier the condition is detected and diagnosed, the better your chance of recovery.

The three main forms of treatment for testicular cancer are:

  • surgery,
  • chemotherapy, and
  • radiotherapy.


Surgery is the most common and effective form of treatment for testicular cancer. It is normally the first line of treatment for all stages and types of testicular cancer. Surgery and other treatments for testicular cancer are outlined below.

Orchidectomy

An orchidectomy is the medical name for the surgical removal of a testicle. If you have testicular cancer, it is necessary to remove the whole testicle because only removing the tumour may lead to the cancer spreading. Therefore, by removing the entire testicle your chances of making a full recovery are greatly improved.

If your testicular cancer is caught in the early stages, an orchidectomy may be the only treatment that you require.

The operation is performed under general anaesthetic. A small cut is made in your groin and the whole testicle is removed through this incision. If you want to, you can have an artificial (prosthetic) testicle inserted into your scrotum, so that the appearance of your testicles is not greatly affected. This artificial testicle is normally made from silicone.

How will an orchidectomy affect me?

Following an orchidectomy, you will need to stay in hospital for a few days. If you only have one testicle removed, there should not be any lasting side effects. Your sex life, and your ability to father children, will not be affected.

If you have both testicles removed, you will be infertile. However, it is very rare for both testicles to be affected by cancer and, therefore the removal of both is uncommon. You may be able to bank your sperm before your operation, which should allow you to father children if you decide that you want to.

Testosterone replacement therapy

Having both testicles removed will also stop you from producing testosterone. This means that you will require testosterone replacement therapy.

Testosterone tends to be given either in injections or skin patches. If you have injections, you will normally need to have them every 2-3 weeks. If you have testosterone replacement therapy, you will be able to maintain an erection and your sex drive.

Lymph node surgery

If your testicular cancer is more advanced, it can sometimes spread to your lymph nodes. Your lymph nodes help form part of your body's immune system, which protects the body against illness and infection.

Lymph node surgery is carried out under general anaesthetic. The lymph nodes in your chest and abdomen are the most likely nodes which need to be removed.

In some cases, the removal of your lymph nodes may leave you infertile. As with an orchidectomy, you may wish to bank your sperm before your operation, in case you become infertile.

Nerve sparing lymph node dissection

There is a type of operation, known as a 'nerve sparing' lymph node dissection, which can greatly reduce your risk of becoming infertile.

However, as this operation is a fairly new procedure, and can only be performed by specialised surgeons, it may not be available at all hospitals or treatment centres. This type of operation can also increase the risk of your cancer returning because not all of the lymph node is removed.

Radiotherapy

Radiotherapy is a form of cancer therapy which uses high energy beams of radiation to help destroy cancer cells. Most seminoma types of testicular cancer will require radiotherapy as well as surgery. This is to help prevent the cancer from returning.

If your testicular cancer has spread to your lymph nodes, you may also require radiotherapy.

Side effects of this type of treatment can include:

  • fatigue,
  • skin rashes,
  • stiff joints and muscles,
  • loss of appetite, and
  • nausea.

These side effects are usually only temporary, and you should find that they improve once you have completed your treatment.

Chemotherapy

Chemotherapy is a type of cancer treatment that uses anti-cancer medicines to either kill the malignant (cancerous) cells in your body, or stop them multiplying.

If your testicular cancer is advanced, or has spread to other places in your body, you may require chemotherapy. It is also used to help prevent the cancer from returning. Chemotherapy is most commonly used to treat non-seminoma tumours.

Chemotherapy medicines can either be injected or given to you orally (by mouth).
Chemotherapy can also attack the normal, healthy cells in your body, which is why this form of treatment can potentially have many side effects. The most common side effects include:

  • vomiting,
  • hair loss,
  • nausea,
  • mouth sores, and
  • fatigue.

These side effects are usually only temporary and you should find that they improve once you have completed your treatment

Will the NHS fund an unlicensed drug if my doctor wants to prescribe it for me?

It is possible for your doctor to prescribe a drug outside the uses it is licensed for, if they are willing to take personal responsibility for this ‘off-licence’ use of a treatment.

Your local primary care trust (PCT) may need to be involved, as it would have to decide whether to support your doctor’s decision and pay for the drug from NHS budgets.

Find out about access to new treatment

Prevention

Preventing testicular cancer

Although testicular cancer can rarely be prevented, it is important for you to check your testicles on a regular basis. Cancer is easier to treat when it is diagnosed early on. If you regularly examine your testicles, you will soon notice if any swelling or abnormality develops.

When to check your testicles

The best time to check them is after you have had a warm shower or bath as this is when your scrotal skin will be most relaxed.

Feel the size and weight of your testicles

Hold your scrotum in the palms of your hands, and use your fingers and thumbs to examine your testicles. You should first feel the size and weight of your testicles. A lot of men have one testicle which is larger than the other. You may also have a testicle which hangs slightly lower than the other.

However, if you notice any significant increase in the size or weight of your testicles, it could be a sign that something is wrong, so make sure that you visit your GP for advice.

Feel each testicle individually

As well as feeling the size and weight of your testicles, you should also gently feel each testicle individually.

When you examine your testicles, they should feel smooth, with no lumps or swellings. You should be able to feel a soft, tube-like section at the top and back of each testicle. This is your epididymis which is used to store sperm. It may feel slightly tender, but this is perfectly normal.

It is very rare to get cancer in both testicles, so if you are unsure about what your testicle should feel like, try comparing it to your other one.

If you do find a lump, or swelling, make sure that you see your GP as soon as possible.

Expert view

Professor David Neal on the questions to ask

Professor David Neal, from Addenbrooke’s Hospital in Cambridge, answers common questions about this condition.

Has the right diagnosis been made?
A major problem is getting testicular cancer diagnosed quickly enough. This is important as the earlier testicular cancer is diagnosed, then the better the chances of recovery. Sometimes, testicular cancer can be hard to diagnose. It is important to ask your GP this question: Are you sure this is not a solid lump in the testes? If they are not sure they should refer you to a specialist for further examinations and an ultra-sound test.

What supporting information can you give me?
When first diagnosed, many patients are naturally in shock and upset. It can be hard to remember to ask specific questions and to remember everything you're being told. It's a good idea to ask what supporting information your consultant can give you. Do they have an information booklet or factsheet? Can they give you some websites where you can find further information or help? This is important to help you understand your condition and to feel supported in between appointments with your consultant.

Do you have facilities for storing sperm in a sperm bank?
Cancer treatments such as chemotherapy and radiotherapy can interfere with fertility. Even if you have no plans to start a family, ask if your hospital has sperm banking facilities. Many men with testicular cancer choose to bank sperm just in case.

Is the cancer likely to spread?
Although testicular cancer can spread, survival rates for testicular cancer are good. At the early stages, survival rates are 95%. Testicular cancer is unlike most other cancers because it has high survival rates even when the cancer has spread.

Lifestyle

Support

Support for carers

Being a carer isn’t an easy role. When you’re busy responding to the needs of others, it can deplete your reserves of emotional and physical energy and make it easy for you to forget your own health and mental wellbeing. Research on carers’ health shows that high numbers of carers suffer health effects through caring. And if you're trying to combine caring with a paid job or looking after a family, this can cause even more stress.

But putting yourself last on the list doesn’t work in the long-term. If you are caring for someone else, it’s important to look after yourself and get as much help as possible. It's in your best interests and those of the person you're caring for.

Look after your health
Eat regularly and healthily. If you don’t have time to sit down for every meal, try to make time to sit down for at least one of your day's meals. Instead of relying on fast food snacks, go for healthier options, e.g. fruit.

Look after your emotional health
It’s understandable if there are times when you feel resentful and then guilty for feeling like this. Combine that with exhaustion, isolation and worries about the person you’re caring for and it’s easy to forget about you. Don’t be hard on yourself – you’re human and those feelings are natural.

Look for support
Friends and family may not always understand what you’re going through and it can be helpful to talk to people in the same situation. Carers UK has a lot of useful information on its website and runs a helpline. Visit the website at www.carersuk.org (links to external site) or call CarersLine on 0808 808 7777.

Download the Carers UK booklet New To Caring (links to external site).

The Princess Royal Trust for Carers has a chatroom on its website and also runs 129 carers centres nationwide which provide information and advice and emotional support. For more information visit www.carers.org (links to external site).

Find out what benefits you're entitled to
You can find out the services available in your area by contacting your social services or local carers’ organisation or by visiting Carers UK's Finding Help page at www.carersuk.org.

Other people to contact:

  • Your GP and primary care team.
  • Social services.
  • For details of government services and information for carers, go to www.direct.gov.uk/carers (links to external site).

For more on support for patients and carers:

Social care

Social care for people with cancer

If you've been diagnosed with cancer, your treatment and medical care will probably be the first thing on your mind. But there are other aspects of your life to think about and it’s important to know exactly what kind of assistance is available and where you can get it.

If you're finding it hard to cope with day-to-day life, talk about your needs with your doctor or nurse, who will refer you to a social worker. Your social worker will be responsible for assessing exactly the kind of help you need. There are so many sources of help that it’s essential to have a social worker to guide you towards the correct course.

Social services can provide assistance with meals, laundry and/or a sitting service, where someone can come to your home. For more advanced care, an occupational therapist will be able to provide a more detailed assessment of your needs at home, making life easier by arranging equipment and making adaptations to your home.

A care attendant may also be organised to come and help with housework, dressing and washing, or even just to keep you company and give your carer a break. Look into this as soon as you can, as many care attendants have waiting lists.

Social care options include:

Care attendants
Crossroads is an organisation in England and Wales that helps carers for patients by visiting homes and taking over the responsibilities of care for a while. Visit the Crossroads website at www.crossroads.org.uk (links to external site), or phone 0845 450 0350.

Meals on wheels
Contact your local council about its meals on wheels service. It will usually be able to offer financial assistance to help pay for this. Go to www.local.direct.gov.uk (links to external site) for details of your eligibility.

Benefits
You may be eligible for income support, disability living allowance or attendance allowance. Get in touch with the Benefit Enquiry Line for more details on 0800 882200 (textphone 0800 243355) or online at www.dwp.gov.uk (links to external site).

Home adaptations
Your occupational therapist will assess your home and make changes to create a comfortable and practical place to live during your treatment. This could mean anything from putting a shower downstairs to adding handrails around the house.

For more on support for patients and carers:

Real stories

Mark's story

'I felt like I'd been hit by a freight train'

Surviving testicular cancer gave Mark Adams a new lease of life. Trekking through Peru and visiting the Great Wall of China, he admits, just wouldn’t have been on his to-do list before…

“It was the middle of 2003 when I noticed a lump in my testicle, while in the shower. It was a complete chance finding. I’d heard about cysts so I didn’t think much of it until about mid-September, when I thought it wasn’t right and I should do something about it.

“So I saw my doctor and was referred to a specialist for an ultrasound, which showed it was cancer. I felt like I’d been hit by a freight train. I thought, ‘What if this is the beginning of the end?’

“It was quite hard concentrating and taking in what the doctor was saying, because I felt so gutted. I had to try hard to put these feelings aside and to understand what they were telling me.

“That evening I had to decide who I should tell. I told my parents over the phone and they reacted very well. I then went to the Cancer Research UK website to do some research about testicular cancer.

“After surgery to remove the testicle, I went to see a consultant at the Royal Marsden Hospital. I had two weeks of radiotherapy, which was pretty straightforward, although it does affect you. I had the radiotherapy on my pelvis and stomach, so mealtimes became hard - I didn’t eat much during those two weeks. A couple of nights I felt nauseous and stayed in bed for the whole day.

“One thing I felt was guilt. When you’re waiting for your radiotherapy you’re surrounded by a lot of people in a much worse situation than yourself – they might be going through chemotherapy, losing their hair and looking really ill, whereas you feel pretty ok.

“Three years later, I could breathe a sigh of relief. Since the cancer was treated, I’ve been physically healthy and have upped my game. I’ve done some charity events in China and been to Peru on a BBC documentary, through Cancer Research UK. I've also run the London Marathon.

“No-one can ever underestimate the psychological impact of being diagnosed with cancer. But on a positive note, taking myself to the Andes and the Great Wall of China aren’t necessarily things I’d have done before. I want to give something back to the charity and do something worthwhile."

Case study provided by Cancer Research UK

Useful links

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External links


This article was originally published by NHS Choices

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