What are the symptoms of testicular cancer?

Lump on a testis
In most cases, the first symptom noticed is a lump that develops on one testis. The lump is usually painless. (Note: most swellings and lumps in the scrotum are not due to cancer. There are various other causes. But, you should always tell a doctor if you discover a swelling or lump in one of your testes. It needs checking out as soon as possible.)

Other symptoms
Sometimes there is general swelling or discomfort in one of the testes. If the cancer is not treated and spreads to other parts of the body then various other symptoms can develop.

How is testicular cancer diagnosed and assessed?

To confirm the diagnosis
Your doctor will examine your testes and refer you to a specialist if he or she suspects that the lump is a tumour. A specialist will examine you again and may advise:

• An ultrasound scan. This is a simple painless test which uses sound waves to scan the testes. (These is a separate leaflet which describes ultrasound scans in more detail.) This test can tell if the lump is a solid mass (likely to be a tumour) or a benign cyst (a fluid filled lump which is common in the testes).
• Blood tests. Testicular cancers often make chemicals which can be detected in a blood sample. The presence of one or more of these chemicals can help to confirm a testicular cancer. They are a 'marker' of testicular cancer. However, you can still have a testicular cancer without being able to detect 'marker' chemicals in the blood. So, a negative result does not rule out cancer.

On the basis of of the examination, and the above tests, a specialist can be confident whether you have cancer or some other cause for the swelling. If cancer is diagnosed then the usual advice is to have an operation to remove the affected testis. The testis which is removed is examined under the microscope to confirm cancer.

Note: if you have one testis removed, it should not affect your sex life. You should still have normal erections, make sperm and hormones from the other testis, and so can still father children. However, if you have chemotherapy or radiotherapy (see below) it may affect fertility.

Assessing the extent and spread
If you are confirmed to have testicular cancer then further tests are usually advised to assess if the cancer has spread. This assessment is called 'staging' of the cancer which aims to find out:

• Whether the cancer has spread to nearby lymph nodes and lymph nodes in the abdomen.
• Whether the cancer has spread to other areas of the body (metastasised).

By finding out the stage of the cancer it helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis). See separate leaflet called 'Cancer Staging and Grading' for details.

Tests which may be advised to 'stage' the cancer include a CT scan, an MRI scan, chest x-ray, or other tests. (There are separate leaflets which describe each of these tests in more detail.)

Another useful test is the 'marker' blood test described above. If you had a positive test before an operation to remove the cancerous testis then the test may be repeated after the operation. If the test becomes negative it means that the cancer was probably confined to the testis. If it remains positive then it means that some cancer cells have spread to somewhere else in your body.

What is the treatment for testicular cancer?

Treatment options which may be considered include surgery, chemotherapy and radiotherapy. The treatment advised for each case depends on various factors such as the stage of the cancer, the type of cancer (seminoma or non-seminoma), and your general health.

Surgery
Surgery to remove the affected testis is normally advised in all cases. This alone may be curative if the cancer is in an early stage and has not spread. (Radiotherapy may also be advised for seminomas even at an early stage.)

Surgery may also have a role in some cases of advanced cancers to remove affected lymph nodes which may have become cancerous.

Chemotherapy and radiotherapy
One or other of these treatments are usually advised in addition to removing the testis if the cancer has spread to lymph nodes or other parts of the body outside of the testis.

• Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells, or stop them from multiplying. See separate leaflet called chemotherapy for more details.
• Radiotherapy is a treatment which uses high energy beams of radiation which are focussed on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. See separate leaflet called radiotherapy for more details.

When chemotherapy or radiotherapy are used in addition to surgery it is known as 'adjuvent chemotherapy' or 'adjuvent radiotherapy'.

Follow up after treatment
You will normally be followed up for several years following successful treatment to check that the cancer has not come back. This may include regular blood tests which check for marker chemicals (see above). You may also have regular chest x-rays or other scans or tests to check that you are free of any recurrence.

What is the prognosis (outlook)?

The outlook is usually good.

• If your testicular cancer is diagnosed and treated at an early stage, you can expect to be cured. Most testicular cancers are diagnosed at an early stage.
• Even if the cancer has spread to other parts of the body, there is still a good chance of a cure. For testicular cancer that has spread to other parts of the body the chance of being cured is much higher than for many other types of cancers which have spread. This is because the cancerous cells of testicular cancer often respond well to chemotherapy.

The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. You should ask the specialist who knows your case about your particular outlook.

Detecting testicular cancer early

Young men and teenage boys should get to know how their testes normally feel. Report any changes or lumps to your doctor. See separate leaflet called 'Get to Know Your Testes' for details.

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