Your medical team will advise you on the best treatment for you, based on your general health, the type of testicular cancer you have, the size of the tumour, the number and size of any lymph nodes involved and whether the cancer has spread to other parts of your body.
If you had an orchidectomy and the cancer was completely removed along with your testicle, you may not need further treatment. Instead, you will have surveillance, with regular blood tests (checking tumour markers), chest x-rays and CT (computerised tomography) scans for five to ten years.
Surveillance can help find if there is any cancer remaining (residual cancer). It can also help work out if the cancer has come back (recurrence). How often you will need the check-ups and scans will depend on whether you had seminoma or non-seminoma testicular cancer. Your doctor will set up a surveillance schedule according to your circumstances, which is important to follow.
Chemotherapy is the treatment of cancer with drugs that aim to kill cancer cells or slow their growth while causing the least possible damage to healthy cells.
When chemotherapy is given after surgery, it is known as adjuvant treatment. If the cancer is only in the testicle, it can usually be treated with surgery alone and chemotherapy may not be needed. Sometimes, your treatment team assesses that there is a moderate risk of the cancer spreading or returning. In this case, a single dose (or two cycles) of chemotherapy will be recommended.
In rare cases, when the cancer has spread to other parts of the body, chemotherapy may be given before surgery as the main treatment.
Everyone reacts differently to chemotherapy. Side effects of chemotherapy can include fatigue, low white blood cell count, nausea and vomiting, constipation, hair loss, erection difficulties, lower sperm production, numbness or tingling fingers or toes, ringing in the ears, breathlessness, coughing, and an increased risk of heart disease and other cancers.
Radiation therapy uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow, multiply or spread. The radiation is usually in the form of focused, high-energy x-ray beams.
Radiation therapy is sometimes given to people with seminoma cancer after surgery to prevent the cancer from coming back or to destroy any cancer cells that may have already spread from the cancer to the lymph nodes.
Side effects of radiation therapy can include skin reactions, fatigue, stomach and bowel problems, hair loss, bladder irritation, infertility, and an increased risk of heart disease and other cancers. Most side effects disappear within a few weeks of finishing treatment.
Using contraception during treatment
Even if treatment lowers sperm production, there is still a chance your partner could become pregnant. Because chemotherapy and radiation therapy can damage sperm, you will need to use contraception during treatment and sometimes for some months afterwards to prevent pregnancy. Your doctor will discuss this with you in more detail.
Surgery to remove lymph nodes
In some cases, an operation called a retroperitoneal lymph node dissection (RPLND or lymphadenectomy) is done to remove lymph nodes at the back of the abdomen that may contain cancer cells.
- Non-seminoma cancer – Your doctors may recommend an RPLND if scans after chemotherapy show that the lymph nodes have not returned to normal size, as this may mean that they still contain cancer cells.
- Seminoma cancer – Chemotherapy or radiation therapy can usually destroy seminoma cancer cells in the lymph nodes, so an RPLND is rarely used. The operation may be offered for advanced seminoma cancer if there are no other treatment options.
An RPLND is a long, complex operation. The standard approach involves open surgery, with a large cut made from the breastbone to below the bellybutton. The surgeon moves the organs out of the way, then removes the affected lymph nodes from the back of the abdomen (the retroperitoneum).
It can take many weeks to recover from an RPLND. At first, you will probably be very tired and may not be able to do as much as you are used to. The main side effects are pain and tenderness in the belly.
An RPLND may also damage the nerves that control ejaculation. This can cause retrograde ejaculation, which is when semen travels backwards into the bladder, rather than forwards out of the penis. Although retrograde ejaculation is not harmful to the body, it causes infertility.
In the rare situation that testicular cancer is so advanced that treatment cannot make it go away, your doctor may talk to you about palliative treatment, which helps to improve people’s quality of life by managing symptoms of cancer without trying to cure the disease.
Many people think that palliative treatment is only for people at the end of their life, but it can help people at any stage of advanced cancer. It is about living for as long as possible in the most satisfying way you can.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, practical, emotional, spiritual and social needs. The team also supports families and carers.
Other effects of treatment
Managing changes to sexuality and intimacy
The removal of one testicle won’t affect erections or orgasms but it can affect testosterone levels. RPLND may damage nerves, causing semen to travel backwards into the bladder instead of forwards out of the penis. This still feels like an orgasm, but no semen will come out.
Chemotherapy drugs may remain in your system and be present in your semen for a few days. For a few weeks after chemotherapy, you may have some trouble getting and keeping an erection. Radiation therapy to the pelvis may temporarily stop semen production. You will still feel the sensations of an orgasm but will ejaculate little or no semen (dry orgasm). In most cases, semen production will return to normal after a few months.
Some tips for managing changes to your sexuality include:
- Protect your partner from any drugs in your semen by using barrier contraception, such as condoms, during chemotherapy and for a number of days afterwards, as advised by your doctor.
- Accept that tiredness and worry may lower your interest in sex and remember that sex drive usually returns when treatment ends.
- Be gentle the first few times you are sexually active after treatment.
- Start with touching, and tell your partner what feels good.
- Talk openly with your doctor or sexual health counsellor about any challenges. They may be able to help and reassure you.
Managing fertility changes
Most people who have had one testicle removed can go on to have children naturally. If you have had both testicles removed (rarely required), you will no longer produce sperm and will be infertile. People who experience retrograde ejaculation after retroperitoneal lymph node dissection will also be infertile.
Both chemotherapy and radiation therapy can temporarily decrease sperm production and cause unhealthy sperm. It may take one or more years before there are enough healthy sperm to conceive a child. In some cases, infertility may be permanent.
Some tips for managing changes to your fertility include:
- Use sperm banking to store sperm before cancer treatment for use at a later date. Samples can be stored for many years.
- Avoid pregnancy until sperm are healthy again by using contraception for 6 to 12 months after chemotherapy or radiation therapy, as advised by your doctor. You may need a sperm analysis test to determine this.
- If infertility appears to be permanent, talk to a counsellor or family member about how you are feeling. Infertility can be very upsetting for you and your family, and you may have many mixed emotions about the future.
Adjusting to appearance changes
Any type of cancer treatment can change the way you feel about yourself. You may feel less confident about who you are and what you can do, particularly if your body has changed physically. Some people find that their sense of identity or masculinity is affected by their cancer experience.
Give yourself time to get used to any changes to your body. Try to see yourself as a whole person (body, mind and personality) instead of focusing on the parts of you that have changed. Try talking to other men who have had a similar experience and let your partner, if you have one, know how you are feeling. You may also find it helpful to talk to a psychologist if you are having trouble adjusting to any changes.
If you continue to be concerned about your appearance, you may wish to speak to your medical team about getting an artificial testicle (prosthesis).
Treatment for testicular cancer usually has a good outcome and the majority of people with early stage cancer will be cured. Only about 2–3% of people who have had cancer in one testicle develop cancer in the other testicle. However, some people have a recurrence of cancer in another part of the body.
If this does happen, treatment will depend on whether the cancer is in the other testicle, where it has spread to, and what type of testicular cancer it is. It’s important to go to all your follow-up appointments, as tests can detect cancer recurrence early.
This checklist may be helpful when thinking about questions to ask your doctor.
- What type of testicular cancer do I have?
- Has the cancer spread? If so, where has it spread? How fast is it growing?
- Are the latest tests and treatments for this cancer available in this hospital?
- What treatment do you recommend? What is the aim of the treatment?
- If I don’t have the treatment, what should I expect?
- How long do I have to make a decision?
- Should I be treated in a centre that specialises in testicular cancer?
- I’m thinking of getting a second opinion. Can you recommend anyone?
- How long will treatment take? Will I have to stay in hospital?
- Are there any out-of-pocket expenses not covered by Medicare or my private health cover? Can the cost be reduced if I can’t afford it?
- How will we know if the treatment is working?
- Are there any clinical trials or research studies I could join?
- What are the risks and possible side effects of each treatment?
- Will I have a lot of pain? What will be done about this?
- Can I work, drive and do my normal activities while having treatment?
- Will my fertility be affected? What are my options for preserving fertility?
- Will the treatment affect my sex life?
- Should I change my diet or physical activity during or after treatment?
- Are there any complementary therapies that might help me? After treatment
- How often will I need check-ups after treatment?
- If the cancer returns, how will I know? What treatments could I have?
Understanding Testicular Cancer
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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, Consumer; 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.
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The information on this webpage was adapted from Understanding Testicular Cancer - A guide for people with cancer, their families and friends (2020 edition). This webpage was last updated in June 2021.