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Overview

Cancer of the testicle is 1 of the less common cancers, and tends to mostly affect men between 15 and 49 years of age.

Typical symptoms are a painless swelling or lump in 1 of the testicles, or any change in shape or texture of the testicles.

It's important to be aware of what feels normal for you. Get to know your body and see a GP if you notice any changes.

The testicles

The testicles are the 2 oval-shaped male sex organs that sit inside the scrotum on either side of the penis.

The testicles are an important part of the male reproductive system because they produce sperm and the hormone testosterone, which plays a major role in male sexual development.

Types of testicular cancer

The different types of testicular cancer are classified by the type of cells the cancer begins in.

The most common type of testicular cancer is germ cell testicular cancer, which accounts for around 95% of all cases. Germ cells are a type of cell that the body uses to create sperm.

There are 2 main subtypes of germ cell testicular cancer. They are:

  • seminomas – which have become more common in the past 20 years and now account for 40 to 45% of testicular cancers
  • non-seminomas – which account for most of the rest and include teratomas, embryonal carcinomas, choriocarcinomas and yolk sac tumours

Both types tend to respond well to chemotherapy.

Less common types of testicular cancer include:

  • Leydig cell tumours – which account for around 1 to 3% of cases
  • Sertoli cell tumours – which account for less than 1% of cases

This topic focuses on germ cell testicular cancer.

You can contact the cancer support specialists at Macmillan for more information about Leydig cell tumour and Sertoli cell tumours.

The Macmillan helpline number is 0808 808 00 00, open Monday to Friday, 9am to 8pm.

How common is testicular cancer?

Testicular cancer is a relatively rare type of cancer, accounting for just 1% of all cancers that occur in men.

Around 2,300 men are diagnosed with testicular cancer each year in the UK.

Testicular cancer is unusual compared with other cancers because it tends to affect younger men.

Although it's relatively uncommon overall, testicular cancer is the most common type of cancer to affect men between the ages of 15 and 49.

For reasons that are unclear, white men have a higher risk of developing testicular cancer than men from other ethnic groups.

The number of cases of testicular cancer diagnosed each year in the UK has roughly doubled since the mid-1970s. Again, the reasons for this are unclear.

Causes of testicular cancer

The exact cause or causes of testicular cancer are unknown, but a number of factors have been identified that increase a man's risk of developing it.

Undescended testicles

Undescended testicles (cryptorchidism) is the most significant risk factor for testicular cancer.

Around 3 to 5% of boys are born with their testicles inside their abdomen. They usually descend into the scrotum during the first year of life, but in some boys the testicles do not descend. 

In most cases, testicles that do not descend by the time a boy is a year old descend at a later stage.

If the testicles do not descend naturally, an operation known as an orchidopexy can be carried out to move the testicles into the correct position inside the scrotum.

It's important that undescended testicles move down into the scrotum during early childhood because boys with undescended testicles have a higher risk of developing testicular cancer than boys whose testicles descend normally.

It's also much easier to observe the testicles when they're in the scrotum.

Men with undescended testicles are about 3 times more likely to develop testicular cancer than men whose testicles descend at birth or shortly after.

Family history

Having a close relative with a history of testicular cancer or an undescended testicle increases your risk of also developing it.

For example, if your father had testicular cancer, you're around 4 times more likely to develop it than someone with no family history of the condition.

If your brother had testicular cancer, you're about 8 times more likely to develop it.

Current research suggests a number of genes may be involved in the development of testicular cancer in families where more than 1 person has had the condition.

This is an ongoing area of research in which patients and their families may be asked to take part.

Previous testicular cancer

Men who have previously been diagnosed with testicular cancer are between 12 and 18 times more likely to develop it in the other testicle.

For this reason, if you have been diagnosed with testicular cancer, it's very important that you keep a close eye on the other testicle.

Read What should my testicles look and feel like?

If you have been diagnosed with testicular cancer, you also need to be observed for signs of recurrence for between 5 and 10 years, so it's very important that you attend your follow-up appointments.

Cancer Research UK has more information about testicular cancer risks and causes.

Outlook

Testicular cancer is 1 of the most treatable types of cancer, and the outlook is 1 of the best for cancers.

In England and Wales, almost all men (99%) survive for a year or more after being diagnosed with testicular cancer, and 98% survive for 5 years or more after diagnosis.

Cancer Research UK has more information about survival rates for testicular cancer.

Almost all men who are treated for testicular germ cell tumours are cured, and it's rare for the condition to return more than 5 years later.

Treatment almost always includes the surgical removal of the affected testicle (orchidectomy or orchiectomy), which does not usually affect fertility or the ability to have sex.

In some cases, chemotherapy or, less commonly, radiotherapy may be used for seminomas (but not non-seminomas).

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Symptoms

Typical symptoms are a painless swelling or lump in 1 of the testicles, or any change in shape or texture of the testicles.

The swelling or lump can be about the size of a pea, but may be larger.

Most lumps or swellings in the scrotum are not in the testicle and are not a sign of cancer, but they should never be ignored.

Other symptoms

Testicular cancer can also cause other symptoms, including:

  • an increase in the firmness of a testicle
  • a difference in apperance between 1 testicle and the other
  • a dull ache or sharp pain in your testicles or scrotum, which may come and go
  • a feeling of heaviness in your scrotum

When to see a GP

See a GP if you notice a swelling, lump or any other change in 1 of your testicles.

Lumps within the scrotum can have many different causes, and testicular cancer is rare.

Your GP will examine you and if they think the lump is in your testicle, they may consider cancer as a possible cause.

Only a very small minority of scrotal lumps or swellings are cancerous. For example, swollen blood vessels (varicoceles) and cysts in the tubes around the testicle (epididymal cysts) are common causes of testicular lumps.

If you do have testicular cancer, the sooner treatment begins, the greater the likelihood that you'll be completely cured.

If you don't feel comfortable visiting your GP, you can go to your local sexual health clinic, where a healthcare professional will be able to examine you.

Metastatic cancer

If testicular cancer has spread to other parts of your body, you may also experience other symptoms.

Cancer that's spread to other parts of the body is known as metastatic cancer.

Around 5% of people with testicular cancer will experience symptoms of metastatic cancer.

The most common place for testicular cancer to spread to is nearby lymph nodes in your tummy (abdomen) or lungs. Lymph nodes are glands that make up your immune system.

Less commonly, the cancer can spread to your liver, brain or bones.

Symptoms of metastatic testicular cancer can include:

  • a persistent cough
  • coughing or spitting up blood 
  • shortness of breath 
  • swelling and enlargement of male breasts
  • a lump or swelling in your neck
  • lower back pain
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Diagnosis

See a GP as soon as possible if you notice a swelling, lump or any other change in 1 of your testicles.

Most lumps within the scrotum are not cancerous, but it's important to get checked as soon as possible.

Treatment for testicular cancer is much more effective when started early.

Physical examination

As well as asking you about your symptoms and looking at your medical history, a GP will usually need to examine your testicles.

They may hold a small light or torch against your scrotum to see whether light passes through it.

Testicular lumps tend to be solid, which means light is unable to pass through them.

A collection of fluid in the scrotum will allow light to pass through it.

Tests for testicular cancer

If you have a non-painful swelling or lump, or a change in the shape or texture of 1 of your testicles, and a GP thinks it may be cancerous, you'll be referred for further testing within 2 weeks.

Some of the tests you may have are described below.

Scrotal ultrasound

A scrotal ultrasound scan is a painless procedure that uses high-frequency sound waves to produce an image of the inside of your testicle.

It's 1 of the main ways of finding out whether or not a lump is cancerous (malignant) or non-cancerous (benign).

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

It'll also give a clear indication of whether the lump is in the testicle or separate within the scrotum, and whether it's solid or filled with fluid.

A fluid-filled lump or collection around the testis is usually harmless. A more solid lump may be a sign the swelling is cancerous.

Blood tests

To help confirm a diagnosis, you may need a series of blood tests to detect certain hormones in your blood, known as markers.

Testicular cancer often produces these markers, so it may indicate you have the condition if they're in your blood.

Markers in your blood that'll be tested for include:

  • alpha feto-protein (AFP)
  • human chorionic gonadotrophin (HCG)

A third blood test is also often carried out as it may indicate how active a cancer is.

It's called lactate dehydrogenase (LDH), but it's not a specific marker for testicular cancer.

Not all people with testicular cancer produce markers. There may still be a chance you have testicular cancer even if your blood test results come back normal.

Histology

The only way to definitively confirm testicular cancer is to examine part of the lump under a microscope. These tests and reports are called histology.

Unlike many cancers where a small piece of the cancer can be removed (a biopsy), in most cases the only way to examine a testicular lump is by removing the affected testicle completely.

This is because the combination of the ultrasound and blood marker tests is usually sufficient to make a firm diagnosis.

Also, a biopsy may injure the testicle and spread cancer into the scrotum, which is not usually affected.

Your specialist will only recommend removing your testicle if they're relatively certain the lump is cancerous.

Losing a testicle will not affect your sex life or ability to have children.

The removal of a testicle is called an orchidectomy. It's the main type of treatment for testicular cancer, so if you have testicular cancer, it's likely you'll need to have an orchidectomy.

Other tests

In almost all cases, you'll need further tests to check whether testicular cancer has spread.

When cancer of the testicle spreads, it most commonly affects the lymph nodes in the back of the abdomen or the lungs.

You may need to have a chest X-ray to check for signs of a tumour.

You'll also need a scan of your entire body. This is usually a CT scan to check for signs of the cancer spreading.

In some cases, a different type of scan known as an MRI scan may be used.

Stages of testicular cancer

After all tests have been completed, it's usually possible to determine the stage of your cancer.

There are 2 ways that testicular cancer can be staged.

The first is based on a 3-stage system. The stages are based on how far the cancer has spread, as well as the levels of chemicals associated with cancer (markers) that are in your bloods.

Stage 1 testicular cancer is when the cancer is contained within your testicle.

Stage 2 testicular cancer is when the cancer has spread into nearby lymph nodes (small glands that fight infection) in your pelvis or tummy.

Stage 3 cancer is split into 3 sub-stages.

Stage 3A testicular cancer is when the cancer has spread into distant lymph nodes, such as the nodes near your collarbone or to your lungs. Your marker levels are normal or only slightly raised.

Stage 3B testicular cancer can take 2 forms:

  • the cancer has spread to nearby lymph nodes and you have higher marker levels, or
  • the cancer has spread to distant lymph nodes or your lungs and you have higher marker levels

With stage 3C testicular cancer, the cancer spread is the same as stage 3B, but you have very high marker levels or the cancer has now spread into another 1 of your body organs, such as the liver or the brain.

The second system is known as the TNM staging system, which is not used widely in the UK:

  • T indicates the size of the tumour
  • N indicates whether the cancer has spread to nearby lymph nodes
  • M indicates whether the cancer has spread to other parts of the body (metastasis)

Cancer Research UK has more information about testicular cancer stages.

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Treatment

Chemotherapy, radiotherapy and surgery are the 3 main treatments for testicular cancer.

Your recommended treatment plan will depend on:

  • the type of testicular cancer you have – whether it's a seminoma or a non-seminoma
  • the stage of your testicular cancer

The first treatment option for all cases of testicular cancer, whatever the stage, is to surgically remove the affected testicle (an orchidectomy).

For stage 1 seminomas, after the testicle has been removed a single dose of chemotherapy may be given to help prevent the cancer returning.

A short course of radiotherapy is also sometimes recommended.

But in many cases, the chance of recurrence is low and your doctors may recommend that you're very carefully monitored over the next few years.

Further treatment is usually only needed for the small number of people who have a recurrence.

For stage 1 non-seminomas, close follow-up (surveillance) may also be recommended, or a short course of chemotherapy using a combination of different medications.

For stage 2 and 3 testicular cancers, 3 to 4 cycles of chemotherapy are given using a combination of different medications.

Further surgery is sometimes needed after chemotherapy to remove any affected lymph nodes or deposits in the lungs or, rarely, in the liver.

Some people with stage 2 seminomas may be suitable for less intense treatment with radiotherapy, sometimes with the addition of a simpler form of chemotherapy.

In non-seminoma germ cell tumours, additional surgery may also be required after chemotherapy to remove tumours from other parts of the body, depending on the extent of the spread of the tumour.

Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours.

Before discussing your treatment options with your specialist, you may find it useful to write a list of questions to ask them.

For example, you may want to find out the advantages and disadvantages of particular treatments.

Orchidectomy

An orchidectomy is a surgical procedure to remove a testicle.

If you have testicular cancer, the whole of the affected testicle will need to be removed because only removing the tumour may lead to the cancer spreading.

By removing the entire testicle, your chances of making a full recovery are greatly improved. Your sex life and ability to father children will not be affected.

About 1 in 50 people will get a second new testicular cancer in their remaining testicle.

In such circumstances, it's sometimes possible to only remove the part of the testicle containing the tumour. You should ask your surgeon about this if you're in this position.

If testicular cancer is detected in its very early stages, an orchidectomy may be the only treatment you require.

An orchidectomy is not carried out through the scrotum. It's done by making a cut in your groin that the testicle is removed through, along with all the tubes and blood vessels attached to the testicle that pass through the groin into the tummy. The operation is carried out under general anaesthetic. 

You can have an artificial (prosthetic) testicle inserted into your scrotum so the appearance of your testicles is not greatly affected.

The artificial testicle is usually made of silicone, a soft type of plastic. It probably will not be exactly like your old testicle or the one you still have. It may be slightly different in size or texture.

After an orchidectomy, it's often possible to be discharged quickly, although you may need to stay in hospital for a few days. If only 1 testicle is removed, there should not be any lasting side effects.

If both testicles are removed (a bi-lateral orchidectomy), you'll be infertile.

But removing both testicles at the same time is very rarely required and only 1 in every 50 cases require the other testicle to be removed at a later date.

You may be able to bank your sperm before having a bilateral orchidectomy to allow you to father children if you decide to.

Sperm banking

Most people are still fertile after having 1 testicle removed. But some treatments for testicular cancer can cause infertility.

Some people with testicular cancer may have low sperm counts because of changes that occur in the testicles before the cancer develops.

For some treatments, such as chemotherapy, infertility may occur, but standard chemotherapies have a less than 50% chance of causing infertility if the remaining testicle is normal.

In people who need to have post-chemotherapy removal of lumps at the back of the abdomen, known as retroperitoneal lymph node dissection (RPLND), the ability to ejaculate may be affected, even though the remaining testicle can still produce sperm.

Before your treatment begins, you may want to consider sperm banking.

This is where a sample of your sperm is frozen so it can be used at a later date to impregnate your partner during artificial insemination.

Before sperm banking, you may be asked to have tests for HIV, hepatitis B and hepatitis C.

If you're having complex chemotherapy for stage 2 and 3 testicular cancer, you should always be offered sperm banking. Ask if you're concerned about your fertility.

Not all men are suitable for sperm banking. For the technique to work, the sperm has to be of a reasonably high quality.

There may also be situations where it's considered too dangerous to delay treatment for sperm banking to take place.

Most NHS cancer treatment centres offer a free sperm banking service. But it's up to each area of the country to decide whether they store sperm for free or whether you have to pay.

Cancer Research UK has more information about sperm banking, including the cost of sperm storage.

Testosterone replacement therapy

If you still have a remaining healthy testicle, it should make enough testosterone so you will not notice any difference.

If there are any problems with your remaining testicle, you may experience symptoms caused by a lack of testosterone.

These symptoms can be caused for other reasons, but can include:

  • tiredness
  • weight gain
  • loss of libido (sex drive)
  • reduced beard growth
  • reduced ability to achieve or maintain an erection (erectile dysfunction)

Having both testicles removed will definitely stop you producing testosterone and you'll develop the above symptoms.

Testosterone replacement therapy is where you're given testosterone in the form of an injection, skin patch or gel to rub into your skin.

If you have injections, you'll usually need to have them every 2 to 3 months.

After having testosterone replacement therapy, you'll be able to maintain an erection and your sex drive will improve.

Side effects associated with this type of treatment are uncommon, and any side effects that you do experience will usually be mild.

They may include:

  • oily skin, which can sometimes trigger the onset of acne
  • breast enlargement and swelling
  • a change in normal peeing patterns, such as needing to pee more frequently or having problems peeing caused by an enlarged prostate gland that puts pressure on your bladder

Lymph node and lung surgery

More advanced cases of testicular cancer may spread to your lymph nodes. Lymph nodes are part of your body's immune system, which helps protect against illness and infection.

Lymph node surgery is carried out under general anaesthetic. The lymph nodes in your tummy are the nodes most likely to need removing.

In some cases, the nerves near the lymph nodes can become damaged, which means that rather than ejaculating semen out of your penis during sex or masturbation, the semen instead travels back into your bladder. This is known as retrograde ejaculation.

If you have retrograde ejaculation, you'll still experience the sensation of having an orgasm during ejaculation, but you will not be able to father a child.

There are a number of ways of treating retrograde ejaculation, including the use of medicines that strengthen the muscles around the neck of the bladder to prevent the flow of semen into the bladder.

Men who want to have children can have sperm taken from their urine for use in artificial insemination or IVF.

Some people with testicular cancer have deposits of cancer in their lungs, and these may also need to be removed after chemotherapy if they have not disappeared or reduced sufficiently in size.

This type of surgery is also carried out under general anaesthetic and does not usually significantly affect breathing in the long-term.

Nerve-sparing retroperitoneal lymph node dissection

A newer type of lymph node surgery called nerve-sparing retroperitoneal lymph node dissection (RPLND) is increasingly being used because it carries a lower risk of causing retrograde ejaculation and infertility.

In nerve-sparing RPLND, the site of the operation is limited to a much smaller area. This means there's less chance of nerve damage occurring.

The disadvantage is that the surgery is more technically demanding.

Nerve-sparing RPLND is currently only available at specialist centres that employ surgeons with the required training.

Laparoscopic retroperitoneal lymph node dissection

Laparoscopic retroperitoneal lymph node dissection (LRPLND) is a type of keyhole surgery that can be used to remove the lymph nodes.

During LRPLND, the surgeon will make a number of small cuts in your tummy.

An instrument called an endoscope is inserted into 1 of the cuts. An endoscope is a thin, long, flexible tube with a light and a camera at 1 end, enabling images of the inside of your body to be relayed to an external television monitor.

Small surgical instruments are passed down the endoscope and can be used to remove the affected lymph nodes.

The advantage of LRPLND is that there's less postoperative pain and a quicker recovery time.

Also, as with nerve-sparing RPLND, in LRPLND there's a smaller chance that nerve damage will lead to retrograde ejaculation.

But as LRPLND is a new technique, there's little available evidence regarding the procedure's long-term safety and effectiveness.

If you're considering LRPLND, you should understand there are still uncertainties about the safety and effectiveness of the procedure.

Radiotherapy

Radiotherapy uses high-energy beams of radiation to help destroy cancer cells.

Sometimes seminomas may require radiotherapy after surgery to help prevent the cancer returning.

It may also be needed in advanced cases where someone is unable to tolerate the complex chemotherapies usually used to treat stage 2 and 3 testicular cancer.

If testicular cancer has spread to your lymph nodes, you may require radiotherapy after a course of chemotherapy.

Side effects of radiotherapy can include:

  • reddening and soreness of the skin, which is similar to sunburn
  • feeling sick
  • diarrhoea 
  • fatigue

These side effects are usually only temporary and should improve when your treatment is completed.

Chemotherapy

Chemotherapy uses powerful medicines to kill the malignant (cancerous) cells in your body or stop them multiplying.

You may require chemotherapy if you have advanced testicular cancer or it's spread within your body. It's also used to help prevent the cancer returning.

Chemotherapy is commonly used to treat seminomas and non-seminoma tumours.

Chemotherapy medicines for testicular cancer are usually injected into a vein.

In some cases, a special tube called a central line is used, which stays in a vein throughout your treatment so you do not have to keep having blood tests or needles placed in a new vein.

Sometimes chemotherapy medicines can attack your body's normal, healthy cells. This is why it can have many different side effects.

The most common include:

  • being sick
  • feeling sick
  • hair loss 
  • sore mouth and mouth ulcers 
  • loss of appetite
  • fatigue
  • breathlessness and lung damage 
  • infertility
  • ringing in your ears (tinnitus)
  • skin that bleeds or bruises easily
  • low blood count
  • increased vulnerability to infection 
  • numbness and tingling (pins and needles) in your hands and feet
  • kidney damage

These side effects are usually only temporary and should improve after you have completed your treatment.

Side effects, such as infections that occur when you have a low blood count, can be life threatening, and it's essential that you always call your cancer care team if you're worried between chemotherapy treatments.

Bleomycin

One of the medicines commonly used, called bleomycin, can cause long-term lung damage.

You should discuss this with your doctors if damage to your lungs would have specific issues for your career or lifestyle.

But the advice may still be that you should receive it for the best chance of a cure.

Having children

You should not father children while having chemotherapy and for a year after your treatment has finished.

This is because chemotherapy medications can temporarily damage your sperm, increasing your risk of fathering a baby with serious birth defects.

You'll need to use a reliable method of contraception, such as a condom, during this time.

Condoms should also be used during the first 48 hours after having a course of chemotherapy.

This is to protect your partner from any potentially harmful effects of the chemotherapy medication in your sperm.

Follow-up

Even if your cancer has been completely cured, there's a risk it'll return. 

The risk of your cancer returning will depend on what stage it was at when you were diagnosed and what treatment you have had since.

Most recurrences of non-seminoma testicular cancer occur within 2 years of surgery or completion of chemotherapy.

In seminomas, recurrences still occur until 3 years. Recurrences after 3 years are rare, occurring in less than 5% of people.

Because of the risk of recurrence, you'll need regular tests to check if the cancer has returned.

These include:

  • a physical examination
  • blood tests to check for tumour markers
  • a chest X-ray
  • a CT scan

Follow-up and testing is usually recommended depending on the extent of the cancer and the treatment offered.

This is usually more frequent in the first year or 2, but follow-up appointments may last for up to 5 years.

In certain cases, it may be necessary to continue follow-up appointments for 10 years or longer.

If the cancer returns following treatment for stage 1 testicular cancer and it's diagnosed at an early stage, it's usually possible to cure it using chemotherapy and possibly also radiotherapy.

Some types of recurring testicular cancer have a cure rate of over 95%.

Recurrences that happen after previous combination chemotherapy can also be cured, but the chances of this will vary between individuals and you'll need to ask your doctors to discuss this with you.

Cancer Research UK has more information about follow-up for testicular cancer.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 06/05/2020 09:12:07