You will usually begin by seeing your doctor, who will examine your testicles and scrotum for a lump or swelling. Some people may find this embarrassing, but doctors are used to doing these examinations. It will only take a few minutes.
If the doctor feels a lump that might be cancer, you will have an ultrasound. If the lump looks like a tumour on the ultrasound, you will have a blood test and are likely to be referred to a specialist called a urologist. The urologist may recommend removal of the testicle to confirm the diagnosis.
An ultrasound is a painless scan that uses soundwaves to create a picture of your body. This is a very accurate way to tell the difference between fluid-filled cysts and solid tumours. It can show if a tumour is present and how large it is.
The person performing the ultrasound will spread a gel over your scrotum and then move a small device called a transducer over the area. This sends out soundwaves that echo when they meet something dense, like an organ or a tumour. A computer creates a picture from these echoes. The scan takes about five to ten minutes.
Blood tests can check your general health and how well your kidneys and other organs are working. The results of these tests will also help you and your doctors make decisions about your treatment.
Some blood tests look for proteins produced by cancer cells. These proteins are called tumour markers. If your blood test results show an increase in the levels of certain tumour markers, you may have testicular cancer.
Raised levels of tumour markers are more common in mixed tumours and non-seminoma cancers. It is possible to have raised tumour markers due to other factors, such as liver disease or blood disease. Some people with testicular cancer don’t have raised tumour marker levels in their blood.
There are three common tumour markers measured in tests for testicular cancer:
- alpha-fetoprotein (AFP) – raised in some non-seminoma cancers
- beta human chorionic gonadotropin (beta-hCG) – raised in some non-seminoma and seminoma cancers
- lactate dehydrogenase (LDH) – raised in some non-seminoma and seminoma cancers.
Doctors will use your tumour marker levels to assess the risk of the cancer coming back after surgery, and this helps them plan your treatment. If the diagnosis of testicular cancer is confirmed after surgery, you will have regular blood tests to monitor tumour marker levels throughout treatment and as part of follow-up appointments.
Tumour marker levels will drop if your treatment is successful, but they will rise if the cancer is active. If this happens, you may need more treatment.
Surgery to remove the testicle
After doing a physical examination, ultrasound and blood tests (see above), your urologist may strongly suspect testicular cancer. But none of these tests can give a definite diagnosis. The only way to be sure of the diagnosis is to surgically remove the affected testicle and examine it in a laboratory. The surgery to remove a testicle is called an orchidectomy or orchiectomy.
For other types of cancer, a doctor can usually make a diagnosis by removing and examining some tissue from the tumour. This is called a biopsy. Doctors don’t usually biopsy the testicle because there is a small risk that making a cut through the scrotum can cause cancer cells to spread.
Tissue removed during the orchidectomy is sent to a laboratory. A specialist called a pathologist examines the cells under a microscope and provides information about the cancer, such as the type, and whether and how far it has spread (the stage). This helps doctors plan further treatment.
In most case, the surgeon needs to remove only one testicle. It is rare for both testicles to be affected by cancer at the same time.
Before you have any surgery, you should ask your doctor for a referral to a fertility specialist if you are wanting to have children in the future. You may be able to store sperm for later use (sperm banking).
“My doctor said to me, ‘If you're going to get a cancer, this is the one to get. The cure rate is high, side effects are minimal and life afterwards is pretty normal’.” – Mark
Having an orchidectomy
An orchidectomy is an operation to remove a testicle. This is often done to confirm a diagnosis of testicular cancer. It is also the main treatment for testicular cancer that has not spread.
- You will have a general anaesthetic before the orchidectomy.
- The urologist will make a cut (incision) in the groin above the pubic bone. This is shown in the diagram below with a blue line.
- The whole testicle is pulled up and out of the scrotum through this cut.
- The spermatic cord is also removed because it contains blood and lymph vessels that may act as a pathway for the cancer to spread to other areas of the body.
- The scrotum is not removed but it will no longer contain a testicle. (You may choose to have an artificial testicle inserted to keep the shape. This is called a prosthesis.)
- The operation takes about 30 minutes.
- After the orchidectomy, you can usually go home the same day, but may need to stay in hospital overnight.
- You will need someone to take you home and stay with you for the first 24 hours.
What to expect after surgery
After an orchidectomy, you will need to take care while you recover. Talk to your treatment team about managing side effects.
Stitches and bruising
You will have a few stitches to close the incision. These will usually dissolve after several weeks. There may be some bruising around the wound and scrotum. The scrotum can become swollen if blood collects inside it (intrascrotal haematoma). If this occurs, the swelling may make it feel like the testicle hasn’t been removed. Both the bruising and the haematoma will disappear over time.
Having pain relief
Your doctor can prescribe medicines to control any pain you have after the operation. Let the doctor or nurses know if the pain worsens. Don’t wait until it is severe before asking for more pain relief.
You’ll probably be advised to avoid strenuous activities, such as heavy lifting and vigorous exercise, for six weeks. It is usually okay to have sex two to four weeks after surgery. Your doctor will discuss these precautions with you.
Wearing supportive underwear
For the first couple of weeks, it’s best to wear underwear that provides cupping support for the scrotum. This will offer comfort and protection as you recover, and can also reduce swelling.
You can buy scrotal support underwear at most pharmacies. It is similar to regular underwear and is not noticeable under clothing. You could also wear your usual underwear with padding placed under the scrotum.
Returning to driving and work
You should be able to drive after two to four weeks and go back to work when you feel ready.
Losing a testicle may cause some people to feel embarrassed or depressed, or could lead to low self-esteem. It may help to talk about how you are feeling with someone you trust, such as a partner, friend or counsellor. See information about finding support services.
Effects on sexuality and body image
Your ability to get an erection and experience orgasm should not be affected by the removal of one testicle. Some people find that it takes time to adjust to the changes to their body and this may affect how they feel about sex. Some proplr choose to replace the removed testicle with an artificial one (prosthesis, see below).
As long as the remaining testicle is healthy, losing one testicle is unlikely to affect your ability to have children (fertility). Some people may have fertility problems as the other testicle may be small and make less sperm. The urologist may advise you to store some sperm at a sperm banking facility before the surgery, just in case you have fertility problems in the future.
Testicular cancer usually occurs in only one testicle, so it is rare to need both testicles removed. People who have both testicles removed no longer produce testosterone and will need to take testosterone replacement therapy. They will also be infertile.
Having a prosthesis
You may decide to replace the removed testicle with an artificial one called a prosthesis. The prosthesis is a silicone implant similar in size and shape to the removed testicle. There are different brands. Some feel firmer than others.
Whether or not to have a prosthesis is a personal decision. If you choose to have one, you can have the operation at the same time as the orchidectomy or at another time. Your urologist can give you more information about your options.
If the removal of your testicle and initial tests show that you have cancer, you may have further tests to see whether the cancer has spread to other parts of the body, such as lymph nodes or other organs. These tests may also be used during or after treatment to check how well the treatment has worked.
You may have a computerised tomography (CT) scan of your chest, abdomen and pelvis. Sometimes this is done before the orchidectomy.
A CT scan uses x-rays to take pictures of the inside of your body and then compiles them into one detailed, cross-sectional picture. To make the scan pictures clearer and easier to read, you may have to fast (not eat or drink) for a period of time before your appointment.
All tests and scans have risks and benefits, and you should discuss these with your doctor. You should let your medical team know if you have diabetes or kidney disease. It is also important to tell them if you have had an allergic reaction to iodine or dye (the contrast) during a previous scan.
Before the scan, you may be given an injection of a dye into a vein in your arm to make the pictures clearer. The injection can make you feel hot all over for a few minutes. You might also feel like you need to urinate but this sensation won’t last long. You may be asked to drink a liquid instead of having an injection.
You will lie flat on a table while the CT scanner, which is large and shaped like a doughnut, takes pictures. The test is painless and takes about 15 minutes.
In some circumstances, such as if you have an allergy to the dye normally used for a CT scan, you may instead have a magnetic
resonance imaging (MRI) scan. An MRI scan uses a powerful magnet and radio waves to create detailed pictures of areas inside the body. Sometimes a dye will be injected into a vein before the scan to help make the pictures clearer.
You will lie on a table that slides into a metal cylinder that is open at both ends. The machine makes a series of bangs and clicks and can be quite noisy. The scan is painless, but some people feel anxious lying in the narrow cylinder. Tell your doctor or nurse beforehand if you are prone to anxiety or claustrophobia. They can suggest breathing exercises or give you medicine to help you relax. The scan takes about 30 minutes, and most people are able to go home as soon as it is over.
In some circumstances, you may also be given a positron emission tomography (PET) scan combined with a CT scan. You will be injected with a small amount of a glucose (sugar) solution containing some radioactive material, then asked to rest for 30 to 60 minutes while the solution spreads throughout your body before you have the scan. Cancer cells show up more brightly on the scan because they absorb
more of the glucose solution than normal cells do.
It may take a few hours to prepare for a PET–CT scan, but the scan itself usually takes about 15 minutes. The radioactive material in the glucose solution is not harmful and will leave your body within a few hours.
The tests described in this section will help to show whether the cancer has spread (the stage). There are several staging systems for testicular cancer, but the most commonly used on is the tumou–nodes–metastasis or TNM system (see below). The TNM scores and the levels of tumour markers in the blood are used to work out an overall stage for the cancer. Stage 1 means that the cancer is found only in the testicle (early stage cancer). Stage 2 and above mean that the cancer has spread outside the testicle to the lymph nodes in the abdomen or pelvis, or to other areas of the body.
TNM staging system
- T (tumour): describes whether the cancer is only in the testicle (T1) or has spread into nearby blood vessels or tissue (T2, T3, T4)
- N (nodes): describes whether the cancer is not in any lymph nodes (N0) or has spread to nearby lymph nodes (N1, N2)
- M (metastasis): describes whether cancer has not spread to distant parts of the body (M0) or whether cancer has spread to distant lymph nodes, organs or bones (M1)
Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease.
To assess your prognosis, your doctor will consider these points:
- your test results
- the type of testicular cancer you have
- the stage of the cancer
- other factors such as your age, fitness and medical history.
Testicular cancer has the highest survival rates of any cancer other than common skin cancers (according to statistics from Cancer in Australia 2019 published by the Australian Institute of Health and Welfare). Regular monitoring and review (surveillance) is a major factor in ensuring good outcomes, so it’s vital that you attend all your follow-up appointments.
Key points about diagnosing testicular cancer
- Your doctor will examine your testicles and scrotum for a lump and swelling.
- An ultrasound will create a picture of your scrotum and testicles. This is a quick and painless scan.
- Blood tests will look for chemicals (tumour markers) in your blood that may indicate cancer. Some people with testicular cancer do not have raised tumour marker levels.
- In most cases, the only way to diagnose testicular cancer with certainty is to remove the testicle. This operation is called an orchidectomy. This is also the main treatment for testicular cancer that has not spread.
- After an orchidectomy, you will have side effects such as pain and bruising. These will ease over time. Wearing scrotal support underwear will help.
Further tests and staging
- If the removal of the testicle shows that you have cancer, you will probably have more tests to see whether the cancer has spread. You may have a CT scan and other scans.
- The doctor will tell you the stage of the cancer, which describes whether and how far it has spread.
- Testicular cancer usually has high survival rates but it is very important to attend regular follow-up appointments.
Expert content reviewers:
Professor Declan Murphy, Urologist and Director of Genitourinary Oncology, Peter MacCallum Cancer Centre, Vic.; Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer and Palliative Care Network, North Metropolitan Health Service, WA; Associate Professor Nicholas Brook, Senior Consultant Urological Surgeon, Royal Adelaide Hospital and the University of Adelaide, SA; Clinical Associate Professor Peter Grimison, Medical Oncologist, Chris O’Brien Lifehouse and the University of Sydney, NSW; Dr Tanya Holt, Senior Radiation Oncologist, Radiation Oncology Princess Alexandra Hospital Raymond Terrace (ROPART), Qld; Brodie Kitson, vonsumer; Elizabeth Medhurst, Genitourinary and Stereotactic Ablative Body Radiotherapy (SABR) Nurse Consultant, Peter MacCallum Cancer Centre, Vic; Rosemary Watson, 13 11 20 Consultant, Cancer Council Victoria