Testicular cancer: symptoms, tests, treatment and survival

The NHS says testicular cancer usually only affects one testicle, but it can affect both. It stresses that these symptoms are very common and can be caused by many different conditions, so having them does not definitely mean you have testicular cancer, but it is important to get them checked.

NHS inform adds persistent discomfort in the groin and ongoing back pain to the list of reasons to contact your GP practice. It advises checking your testicles regularly from puberty onwards, and says that if testicular cancer is found early it is very curable.

• A lump or swelling in your testicle.

• Your testicle getting bigger.

• An ache or pain in your testicle or scrotum (the skin that covers the testicles).

• Your scrotum feeling heavy, firm or hard.

• Less commonly, if the cancer has spread: an ache or pain in your back or lower tummy, losing weight without trying, a cough, difficulty breathing or swallowing, or a sore or swollen chest.

The NHS says to see a GP if you have a lump or swelling on one or both testicles, if one or both testicles are getting bigger, if your scrotum feels heavy, firm or hard, if you have an ache or pain in your scrotum or testicles, or if you notice a change in one or both testicles that is not normal for you.

At the appointment the GP will ask about your symptoms and general health and check your testicles and the lymph nodes at the top of your legs. NHS inform says that if your GP thinks your symptoms may be linked to testicular cancer, they will refer you to a hospital to be seen within 2 weeks. The NHS says an urgent referral does not definitely mean you have cancer.

Cancer Research UK describes testicular cancer as abnormal cells in a testicle starting to divide and grow in an uncontrolled way. The testicles are part of the male reproductive system. From puberty they produce sperm, and they also produce the hormone testosterone.

Most testicular cancers develop in germ cells, the cells that make sperm. The two main types of testicular germ cell tumour are seminoma and non-seminoma. NHS inform says seminomas usually affect those aged 15 to 50 and non-seminomas usually affect those aged 15 to 35. It is common for testicular cancer to spread to the lymph nodes in the back of the tummy.

NHS inform says testicular cancer is not infectious and you cannot pass it on to other people.

The NHS says testicular cancer is often treatable. The treatment you have depends on the size and type of cancer, whether it has spread, and your general health. It will usually include surgery to remove the testicle. This may be your only treatment, or you may also have chemotherapy or radiotherapy. A specialist team will explain the treatments, their benefits and side effects and create a treatment plan with you, and you will have regular check-ups during and after treatment.

NHS inform explains that after surgery your doctors and specialists meet as a multidisciplinary team to talk about the best further treatment, which depends on the stage, whether it is seminoma or non-seminoma, and the risk of the cancer coming back. If the cancer comes back, it can still usually be cured.

The NHS says that if a GP refers you to a specialist you may need blood tests and an ultrasound scan of your testicles. It can take a few weeks to get the results. NHS inform says an ultrasound is the quickest and most accurate test for diagnosing testicular cancer, painless and takes a few minutes, and can tell your doctor whether a lump is a harmless cyst or likely to be a cancer. Some hospitals have one-stop testicular clinics where you see a urologist and have an ultrasound on the same day.

Some testicular cancers make chemicals called tumour markers that are released into the blood, so blood tests may be used. NHS inform notes that you may still have testicular cancer even if these are not raised.

If the ultrasound shows the lump is highly likely to be cancer, NHS inform says the only way to get a definite diagnosis is surgery to remove the whole testicle, because taking a small piece (a biopsy) may miss a cancer. After diagnosis you will usually have more tests, such as a CT or MRI scan, to find out the stage, which is the size of the cancer and whether it has spread.

The NHS says it is not always clear what causes testicular cancer. NHS inform adds that doctors do not yet know what causes it and that having one or more risk factors does not mean you will get it, and not having any does not mean you will not.

The NHS lists the following as things that may make you more likely to get it.

• You have or had undescended testicles (when one or both testicles did not drop down into the usual place in the scrotum).

• Your brother or father has had testicular cancer.

• You have had testicular cancer before.

• You have or had hypospadias, where the hole that pee and sperm come out of is not at the tip of the penis.

• You have HIV or AIDS.

• You are from a white British background.

Cancer Research UK says that, generally for men with testicular cancer in the UK, almost 100 out of every 100 survive for 1 year or more, more than 95 out of 100 survive for 5 years or more, and more than 95 out of 100 survive for 10 years or more. These figures are for men diagnosed in England and Wales between 1971 and 2018, and apply to all stages combined. Survival depends on the stage and type of cancer.

For testicular cancer that has spread, Cancer Research UK gives outlook figures from a large international study: around 95 in 100 men with good-prognosis disease (pure seminoma or non-seminoma) survive 5 years or more, and more than 65 in 100 with poor-prognosis non-seminoma. Your own outlook depends on the stage, tumour marker levels and type, so your specialist is the best person to explain it.

The NHS says some treatments for testicular cancer, such as chemotherapy, can affect fertility, which means you might not be able to have children. Before you start treatment you will be offered the option to collect and store your sperm (sperm banking) to use in fertility treatment in the future. Having a testicle removed does not usually affect your fertility.

NHS inform adds that if the other testicle is healthy, an orchidectomy will not affect your ability to get an erection or your fertility, and that treatments do not usually affect your ability to have sex or make someone pregnant, although it is common to worry about this. Talk to your care team about the effect treatment may have.

NHS inform says you will have regular check-ups at the hospital after treatment finishes, during which your doctor will examine you and check your remaining testicle. These may be every month to begin with. Some side effects take a long time to improve or may develop years later, such as hearing problems, changes in sensation in the hands and feet, or heart or lung problems. You may not have any of these.

The NHS says if you have any symptoms or side effects that you are worried about, you do not need to wait for your next check-up. A clinical nurse specialist will be your main point of contact during and after treatment.

On the NHS, a suspected testicular cancer is assessed through an urgent GP referral to a urology team, where ultrasound and blood tests are done, followed by surgery and any further treatment under a specialist cancer team. Some people choose to see a private urologist for a quick scrotal ultrasound or a second opinion. Either way, results and treatment plans should be shared with your GP so your records stay complete.