Testicular Cancer

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
	References
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What is testicular cancer?

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-exam . 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. 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 and then go away. Long-term side effects from treatment are rare.

Frequently Asked Questions

Health tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Which treatment should I have for stage I nonseminoma testicular cancer?
	Which treatment should I have for stage I seminoma testicular cancer?
	Actionsets are designed to help people take an active role in managing a health condition.
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	Controlling nausea and vomiting caused by chemotherapy
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The exact causes of testicular cancer are unknown.

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 male fetus is born or during the first 3 months of infancy.
• 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 of developing testicular cancer. Monthly TSEs may be recommended for men at high risk of developing testicular cancer, including those who have one or more of the above risk factors. If you have increased risk, you should see your health professional regularly for testicular examinations because painless changes in the testes may go unnoticed during a self-examination.

Common symptoms of testicular cancer include:

• 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 health professional 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

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 health professional 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 determine the type of cancer cells present and whether your cancer has spread beyond the testes (stage).

After the removal of the affected testicle, your treatment plan may involve watchful waiting, radiation therapy, chemotherapy, or additional surgery. This depends on your choices, the type of cancer cells involved, and the stage of your cancer.

Testicular cancer is one of the most curable forms of cancer, especially during its early stages. If you have symptoms of testicular cancer, it is important that you see a health professional as soon as possible.

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.

The most common symptom of testicular cancer is a noticeable change in the size or shape of one or both testicles.

It is important to call your health professional 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

Following 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 health professional will recommend treatment with medications (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, consult your health professional immediately. 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:

• General practitioners.
• Family medicine doctors.
• Nurse practitioners.
• Physician assistants.
• Internists.
• Urologists.

Health professionals who can manage your cancer treatment include:

• Urologists.
• Medical oncologists.
• Radiation oncologists.

To prepare for your appointment, see the topic Making the Most of Your Appointment

Most abnormalities of the testes are found during a self-examination or routine physical exam by a health professional. If testicular cancer is suspected, your health professional 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, including X-rays, CT scans, or MRIs of the abdomen, chest, and head.

Ongoing exams and tests

During your treatment for testicular cancer, your health professional 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 health professionals recommend that men between the ages of 15 and 40 perform monthly testicular self-examination. However, this is controversial. Many health professionals do not believe monthly TSE is necessary for men who are at average risk of developing testicular cancer. Monthly TSE may be recommended for men who are at high risk of developing testicular cancer. This includes men with a history of an undescended testicle or a family or personal history of testicular cancer.

If you are diagnosed with testicular cancer, your health professional 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 health professional 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 the type of cancer cells 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 health professional 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 medications 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 medications. 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 examinations 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 health professionals consider watchful waiting to be a legitimate treatment option.

If you are diagnosed with a stage I seminoma or nonseminoma (NSGCT), you may have a choice regarding your next course of treatment. It is important to understand that each treatment option, including watchful waiting, has its own risks. In helping you choose your course of treatment, your doctor should 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:

Which treatment should I have for stage I seminoma?

Which treatment should I have for stage I nonseminoma?

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 more difficult 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, it is important to talk with your health professional. 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:

• Physical exams.
• Imaging tests, including X-rays, CT scans, and MRIs.
• 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 health professional regularly for years to come, so it's a good idea to develop a relationship based on trust and the sharing of information. Your health professional 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 examination, 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:

• Chemotherapy, including cisplatin, etoposide, and bleomycin
• Surgery, to remove any involved lymph nodes or treat other areas where the cancer has spread (metastasized)
• Radiation therapy

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

Even though testicular cancer is considered a very curable form of cancer, it is a very serious disease that kills hundreds of American men every year.⁸ 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). Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to palliative care is difficult. For more information, see the topics Care at the End of Life and Hospice Care.

There are no proven ways to prevent testicular cancer. However, 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-examination or by a health professional during a routine physical.
• Be aware of any pain or discomfort in your scrotum, pelvis, or lower back. If you have any discomfort in these areas, see your health professional as soon as possible.

For more information about testicular cancer, see the following topics:

• Testicular Cancer — Health Professional Information [NCI PDQ]
• Testicular Cancer — Patient Information [NCI PDQ]

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 health professional has given you instructions or medications 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 nausea or vomiting includes watching for and treating early signs of dehydration, such as a dry mouth, sticky saliva, and reduced urine output with dark yellow urine. For more information on how to deal with these side effects, see:

  Controlling nausea and vomiting caused by chemotherapy.

• Home treatment for diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your health professional before using any nonprescription medications 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 health professional 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 medications cause hair loss, and some people have only mild thinning that is noticeable only to them. Talk to your health professional about whether hair loss is an expected side effect with the medications you will receive.
• Poor appetite. Healthy habits such as eating a balanced diet and getting enough sleep and exercise can help control your symptoms. It is important to eat well during treatment for testicular cancer to prevent weight loss and to conserve your strength.
• Sleep problems. If you find you have trouble sleeping, be sure to have a regular bedtime, get some exercise during the day, avoid naps, 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 your 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 health professional. Your health professional may also be able to refer you to organizations that can offer additional 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 health professional has given you instructions or medications 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 any home treatment you use for pain with your health professional. For more information, see the topic Cancer Pain.

Chemotherapy treatment for testicular cancer uses powerful medications to kill the cancer cells in your body. However, because of the risk of serious side effects associated with chemotherapy, it is important to discuss the risks and benefits of these medications with your doctor before beginning treatment.

Chemotherapy can cause nausea and vomiting. Your doctor may prescribe medications to be taken with your treatments and when you get home, to help relieve any nausea that you may have.

Medication Choices

Some common medications 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 medications:
  • Cisplatin
  • Bleomycin
  • Etoposide
• Ifosfamide and paclitaxel.

Medications to control and prevent nausea and vomiting may include:

• Serotonin antagonists, such as ondansetron (Zofran), granisetron (Kytril), or dolasetron (Anzemet). These medications more effectively prevent nausea and vomiting caused by chemotherapy when they are combined with corticosteroids, such as dexamethasone (Hexadrol or Decadron).
• Phenothiazines, such as Compazine and Phenergan.
• Metoclopramide (Reglan).
• Dimenhydrinate (Gravol).

What To Think About

You may be given a choice between receiving chemotherapy or another treatment. When making your decision, it is important to talk to your health professional 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 health professional can use other medications to help relieve some of these side effects.

Although uncommon, chemotherapy for the treatment of testicular cancer has also been associated with 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.^{9, 1, 5} Generally, these long-term side effects have been associated with 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 regarding the long-term side effects of chemotherapy.

Fertility and chemotherapy. Chemotherapy for testicular cancer has been connected with 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. Most chemotherapy does not permanently affect healthy sperm counts, but some chemotherapy does. 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.

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.¹⁰)

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 health professional 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. In addition, 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:

  How to manage lymphedema.

• Excessive bleeding (hemorrhage).
• Pulmonary embolism, which is the sudden blockage of blood flow within the lung.

Surgery Choices

Radical inguinal orchiectomy

Retroperitoneal lymph node dissection (RPLND)

What To Think About

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 undergo hormone replacement therapy to replace testosterone, the male hormone produced by the testes. However, 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 health professionals 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.

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. However, when planning your treatment with your health professional, it is important to 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 developing cancer later in life.

Other Treatment Choices

Radiation therapy

What To Think About

The treatment options available to you 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 connected with 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 receive. Even though most radiation treatment programs do not permanently affect healthy sperm counts, many health professionals recommend sperm banking before radiation therapy, for those men who may wish to have children in the future.
• 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 undergo 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. However, these complementary therapies should not replace standard therapy.

• Acupuncture
• Herbs
• Biofeedback
• Meditation
• Yoga
• Guided imagery
• Vitamins and nutritional supplements

Before you try any of these therapies, discuss their possible benefits and side effects with your health professional. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

Organizations

• Fertility Problems

Citations

1. Raghavan D (2003). Bladder, renal, and testicular cancer. In DC Dale, DD Federman, eds., Scientific American Medicine, vol. 3, part 12, chap. 14. New York: WebMD.

2. Huyghe E, et al. (2003). Increasing incidence of testicular cancer worldwide: A review. Journal of Urology, 170(1): 5–11.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. American Cancer Society (2006). Cancer Facts and Figures 2006, pp. 1–54. Atlanta: American Cancer Society. Available online: http://www.cancer.org/docroot/STT/content/STT_1x_Cancer_Facts__Figures_2006.asp.

9. Small EJ, Torti FM (2002). Testis. In M Dollinger et al., eds., Everyone's Guide to Cancer Therapy, 4th ed., pp. 770–780. Kansas City: Andrews McMeel.

10. 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 (2006). Can testicular cancer be found early? Cancer Reference Information. Available online: http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_Testicular_Cancer_Be_Found_Early_41.asp?sitearea=.

• Stoller ML, et al. (2007). Urology. In SJ McPhee et al., eds., Current Medical Diagnosis and Treatment, 46th ed., pp. 954–997. New York: McGraw-Hill.

• U.S. Preventive Services Task Force (2004). Screening for testicular cancer: Recommendation statement. Available online: http://www.ahrq.gov/clinic/uspstf/uspstest.htm.