Testicular cancer

About testicular cancer

Your testicles lie inside your scrotum, the loose bag of skin that hangs below your penis. Your testicles produce sperm and the hormone testosterone. In testicular cancer, cells in one of your testicles start to grow abnormally and out of control.

Testicular cancer usually affects one testicle. It can sometimes affect both, but this is rare. For more information on this, see our FAQ: What happens if I get cancer in both testicles? below.

Testicular cancer prevalence seems to be rising and no one is sure why.

Testicular cancer can sometimes spread to lymph nodes in your tummy (abdomen) or, more rarely, to other parts of your body. 

Types of testicular cancer

More than nine out of 10 cancers in the testicle develop from germ cells – these are the cells that produce sperm. There are two main types of this form of testicular cancer:

• seminoma
• non-seminoma

Seminomas tend to grow and spread more slowly than non-seminomas.

Very rarely, another type of cancer called a lymphoma can develop in your testicles. This is cancer of the lymphatic tissue, and is the most common cancer found in the testicles in people over 50. Lymphatic tissue is part of the lymphatic system, which consists of organs, lymphatic vessels and lymph nodes. It plays an important role in fluid balance, and in supporting your immune system and nutrition in your body.  

Causes of testicular cancer

No one knows for sure why you can get testicular cancer. But there are some things that can make it more likely. The main one is being born with an undescended testicle. This means that one or both of your testicles stayed in your tummy rather than going down into your scrotum. Your testicles may have moved down later or you may have had an operation to bring them down. If you don’t have this corrected by the age of 13, you may be even more likely to develop testicular cancer. 

Other things that can increase your chances of getting testicular cancer include:

• having had testicular cancer in your other testicle
• having a brother or father who has had testicular cancer
• having fertility problems and low-quality sperm

White people get testicular cancer more often than those from other ethnic groups, but no one knows why.

Having a vasectomy or an injury to your testicles doesn’t increase your risk of getting testicular cancer. But it may lead you to examine them more. You may then find a testicular cancer lump that was already there but you hadn’t noticed it yet.

Symptoms of testicular cancer

Often, the first sign of testicular cancer is a swollen testicle or a hard lump on your testicle. Usually, you won’t have a painful testicle but you might feel pain or discomfort in your scrotum. 

Other testicular cancer symptoms include:

• a pulling sensation or heavy feeling in your scrotum
• a testicle that looks bigger than usual
• a dull ache in your lower tummy
• a collection of fluid in your scrotum (called a hydrocoele) 

If the cancer is at a later stage, you can get other symptoms including:

• back pain
• coughing or feeling breathless
• weight loss
• enlarged breast tissue

If you have any of these symptoms, contact your doctor.

It’s important to regularly check your testicles for any changes and have good testicular cancer awareness. Get to know what’s normal for you so that you’ll notice any changes. The earlier testicular cancer is diagnosed, the better your chances of recovery.

Diagnosis of testicular cancer

If you find a lump or notice something different around your testicles, contact your doctor as soon as possible.

Your doctor will ask you about your symptoms and examine your testicles. If you have a swelling or lump in your testicle, your doctor may refer you to a hospital specialist. This is usually a urologist. A urologist is a doctor who specialises in treating diseases that affect your urinary system and the male reproductive organs.

Your doctor may first offer you an ultrasound test.  An ultrasound scan uses sound waves to produce an image of the inside of your scrotum and your testicle. It can help to show whether the lump is cancer or not.

Your hospital doctor will offer you the following tests.

• A blood test to check for certain hormones and proteins that can be high if you have testicular cancer. If you haven’t already had one, they’ll also ask you to have an ultrasound scan.
• A biopsy, which is the only way to confirm testicular cancer. In other types of cancer, this would involve removing a small sample of tissue. But for testicular cancer, your entire testicle will usually be removed because the risk of the cancer spreading is too high with a normal biopsy. If you do have testicular cancer, then removing the affected testicle would be the first part of your treatment. The removed testicle will go to a laboratory to be examined for cancer cells. 

If you’re found to have cancer, you may need to have other tests to see if the cancer has spread. This is called . These further tests may include:

•  a CT scan
• MRI scan
• chest X-ray

Treatment of testicular cancer

Treatment for testicular cancer is usually very successful. A team of doctors and other cancer specialists will plan the best care for you. It depends on the type of testicular cancer you have and if it has spread. 

Surgery

The main treatment for testicular cancer is surgery to remove your affected testicle (if it hasn’t already been removed during your diagnosis). This operation is called an orchidectomy. If you’re diagnosed early, surgery may be the only treatment that you need. If you just have one testicle removed, you should still be able to get an erection and have children. Your doctor will talk to you about the operation and your options. For more information about your fertility after surgery, see our FAQ: Can I still have children after testicular cancer? 

You may be able to have an artificial testicle put into your scrotum to give it a normal appearance. Or you could choose to do this at a later time.

After surgery, a team of specialists including an oncologist (a doctor who specialises in cancer care) will look at all your results. They’ll decide if you need further treatment. For example, if your cancer is more advanced, you may need another operation to remove lymph nodes from your tummy. Your doctor will explain everything to you.

Chemotherapy

Chemotherapy uses medicines to destroy cancer cells. It’s usually used to treat testicular cancer if the cancer has spread outside your testicle or has come back after surgery. Even if the cancer hasn’t spread, your doctor may offer you a short course or single treatment of chemotherapy. This is to reduce the chances of testicular cancer coming back in the future.

The type of chemotherapy treatment you have will vary depending on the type and stage of your testicular cancer. Your doctor will give you information on the type and course of chemotherapy that’s best for you.

Radiotherapy

Radiotheerapy uses radiation to kill cancer cells. Radiotherapy is mainly used to treat seminoma types of testicular cancer because seminomas are very sensitive to radiation. You may have radiotherapy after surgery to prevent the cancer coming back or to treat any cancer cells that have spread out of your testicle.

Radiotherapy can affect your fertility, so your doctor will talk to you about this before you have radiotherapy. For more information, see our FAQ below: Can I still have children after testicular cancer?

After your treatment

You will need to attend hospital appointments and have regular check-ups after your treatment to see if any of the cancer remains or returns. How often these check-ups happen will depend on the type of cancer you had and how it was treated.

Your doctor may monitor your testosterone level and offer you testosterone replacement therapy if your level is too low.

It’s important that you go along for these check-ups because if testicular cancer comes back after treatment, it can often still be cured. 

Help and support

Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is support to deal with the emotional aspects as well as the physical symptoms. Your specialist cancer doctors and nurses are experts in providing the support you need. Talk to them if you’re finding your feelings hard to cope with.

You may find it helpful to contact a cancer organisation for further information, support and advice. There may also be local groups where you can meet other people with similar medical issues. Your cancer team may know of some. For contact details of relevant organisations, see our section: Other helpful websites below. You may also find our general cancer articles helpful.