Testicular Cancer – Prevention

There are no proven ways to prevent testicular cancer. But 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-exams. Most cases of testicular cancer are discovered during a self-exam or during a routine physical done by a doctor.
* Be aware of any pain or discomfort in your scrotum, pelvis, or lower back. If you have any discomfort in these areas, see your doctor 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]

Testicular Cancer – Medications

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

Chemotherapy can cause nausea and vomiting. Your doctor may prescribe medicines to control nausea and vomiting to take before, during, or after your treatments.
Medication Choices

Some common medicines 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 medicines:
o Cisplatin
o Bleomycin
o Etoposide
* Ifosfamide and paclitaxel.

Medicines to control and prevent nausea and vomiting may include:

* Serotonin antagonists, such as ondansetron (Zofran), granisetron (Kytril or Sancuso), or dolasetron (Anzemet). These medicines more effectively prevent nausea and vomiting caused by chemotherapy when they are combined with corticosteroids, such as dexamethasone.
* Phenothiazines.
* 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 doctor 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 doctor can use other medicines to help relieve some of these side effects.

Although uncommon, chemotherapy for the treatment of testicular cancer has also been linked to 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.1 Generally, these long-term side effects have been linked to 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 about the long-term side effects of chemotherapy.

Fertility and chemotherapy. Chemotherapy for testicular cancer has been linked to 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. 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.

Testicular Cancer – Treatment Overview

If you are diagnosed with testicular cancer, your doctor 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 doctor 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 which type of cancer cells are 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 doctor 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 medicines 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 medicines. 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 exams 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 doctors think watchful waiting is a legitimate treatment option.

If you are diagnosed with a stage I seminoma or nonseminoma (NSGCT), you may have a choice for your next course of treatment. It is important to understand that each treatment option, including watchful waiting, has its own risks. Ask your doctor to 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 harder 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, talk with your doctor. 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 doctor regularly for years to come, so it’s a good idea to develop a relationship based on trust and the sharing of information. Your doctor 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 exam, 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

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). It’s hard to decide when to stop medical treatment aimed at prolonging life and shift the focus to palliative care. For more information, see the topics Care at the End of Life and Hospice Care.

Testicular Cancer – When To Call a Doctor

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

Call your doctor 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

After 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 watch your condition. If there is no change in your condition, you may continue watchful waiting. If your cancer returns, your doctor will recommend treatment with medicines (chemotherapy), radiation therapy, or surgery.

It is important to know 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, talk to your doctor right away. 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.

Testicular Cancer – What Increases Your Risk

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.

Testicular Cancer – Symptoms

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 doctor if you have any of the above symptoms. It is also important to know 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

Testicular Cancer – Cause

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 baby is born or during the first 3 months of infancy. A man is at a higher risk even if the testicle is moved down surgically.
* 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 ages 15 to 40 perform a monthly testicular self-examination (TSE). Others do not believe a monthly TSE is needed for men who are at average risk for testicular cancer. Monthly TSEs may be recommended for men at high risk for testicular cancer, including those who have one or more of the above risk factors. Sometimes changes in the testes do not cause pain. So you may not notice these changes during a self-exam. If you have increased risk, see your doctor regularly for testicular exams.