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.
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.
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 between the
ages of 15 and 40 perform a monthly
testicular self-examination (TSE). Others do not
believe a monthly TSE is necessary 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.
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 understand 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).
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 monitor 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
understand 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:
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
Testicular self-examination (TSE)
may detect testicular cancer at an early stage. Many testicular cancers are
first discovered by self-examination as a painless lump or an enlarged
testicle.
Some doctors recommend that men between the ages of 15
and 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:
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:
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-examinations (TSE). 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:
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.
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 stick to
your usual routine and just get some extra sleep. Fatigue is often worse at the
end of treatment or just after treatment is completed.
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:
Cisplatin-combination chemotherapy. This is the most commonly
used treatment for testicular cancer. It is a combination of the following
three medicines:
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.
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:
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
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 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
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.
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.
Huyghe E, et al. (2003). Increasing incidence of
testicular cancer worldwide: A review. Journal of Urology, 170(1): 5-11.
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.
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.
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.
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.
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.
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.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
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.
Huyghe E, et al. (2003). Increasing incidence of
testicular cancer worldwide: A review. Journal of Urology, 170(1): 5-11.
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.
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.
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.
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.
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.
Oliver RTD, et al. (2005). Radiotherapy versus
single-dose carboplatin in adjuvant treatment of stage I seminoma: A randomized
trial. Lancet, 366: 293-300.
