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.
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.
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.
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:
- 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.
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 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:
These side effects are usually only temporary and should improve when your treatment is completed.
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
- breathlessness and lung damage
- 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.
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.
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.
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.
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.
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.