The testicles

The testicles are sometimes called the testes. Theyre two small, oval-shaped organs, contained in a sac of skin called the scrotum, which hangs below the penis.
From puberty the collecting tubules inside the testicles produce sperm, which can fertilise a female egg. The testicles are the main organs of the male reproductive system. The tubules form a coiled tube called the epididymis. This feels like a soft swelling at the back of the testicle. The epididymis carries on to the outside of the testicle and widens to become the spermatic cord (or the vas deferens). This joins to theejaculatory duct where sperm is mixed with a fluid called semen (made by the prostate gland) before it is ejaculated out of the penis.

The structures of the testicle View a large version of the diagram of the structures of the testicles The testicles also produce the hormone testosterone. Hormones are chemical messengers that help to control different activities in our bodies. Testosterone is responsible for:

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your sex drive (libido) getting an erection having a low voice facial and body hair muscle development.

Lymph nodes
Sometimes cancer cells from the testicle can spread to nearby lymph nodes (also known as glands). Your doctors may talk to you about this, so it can be helpful to understand a bit more about it. Lymph nodes are small and round and we have lots of them throughout the body. Theyre connected to each other by a network of tiny lymphatic vessels that carry a fluid called lymph, which contains cells that help us fight infection. This is a part of our immune system the bodys natural defence against infection.

The lymph system in the abdomen Cancer cells can be picked up by the lymph fluid and carried to lymph nodes in other parts of the body. Lymph vessels in your testicles carry fluid to a collection of lymph nodes at the back of your tummy (abdomen). They lie just behind your bowel and in front of your spine and are called the retroperitoneal lymph nodes. Youll have a scan (CT scan) to check if any of these nodes are larger than normal.

Types of testicular cancer

Testicular cancers are also called germ cell tumours (GCT). In men germ cells produce sperm and as a result these tumours usually develop in the testicles.
In this section we use the term testicular cancer for all types of testicular tumours. After your operation to remove the testicle the tissue is examined under the microscope to find out the type of testicular cancer you have. There are two main types: seminomas and non-seminomatous germ cell tumours (NSGCTs).

Seminomas
These usually occur in men between 25 and 55 years of age.

Non-seminomatous germ cell tumours (NSGCTs)

We call this group of tumours teratomas. Although this isnt strictly accurate, its a term that was previously used and is still often used. Its also easier to say. This group of tumours usually affects younger men from about 15 to 35 years old. It includes different types of tumours such as teratomas and embryonal tumours. Many are a mixture of these types and other tumours, including seminoma. Most importantly, although there are some minor differences, these tumours behave and are treated in similar ways. Rare types of testicular cancer Sometimes a type of cancer called non-Hodgkin lymphoma can occur in the testicle. This is treated as a non-Hodgkin lymphoma.

Other rare types are Leydig and Sertoli cell tumours. For more information about these tumours you can contact our cancer support specialists.

Causes and risk factors

Around 2000 men are diagnosed with testicular cancer in the UK each year. We dont know what causes testicular cancer, but research into this is ongoing.
There are factors which can increase the chance of getting testicular cancer. These include:

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having had an undescended testicle a family history of testicular cancer carcinoma in situ having had cancer in the other testicle ethnicity and social status body size

Undescended testicle (known as cryptorchidism)

Usually the testicles develop inside the abdomen of the unborn child and come down (descend) into the scrotum at birth or by the time the child is one year old. Men whove needed an operation to bring the testicle down into the scrotum have a higher chance of getting testicular cancer.

Family history
Men with a brother or father who have had testicular cancer are slightly more at risk of getting it (although the risk is still small). Research shows that a particular gene is the cause of testicular cancer in some men. Its possible that this gene is inherited and may be why testicular cancer sometimes happens in brothers or sons of men whove had it.

Carcinoma in situ (CIS)

This is abnormal cells in the testicle which (if left) can develop into testicular cancer. CIS tends to be discovered when men have a biopsy of the testicle to investigate infertility (inability to have children). The testicle with the CIS is usually removed.

Cancer of the other testicle

A small percentage (34%) of men whove previously been treated for testicular cancer will go on to develop a cancer in the other testicle.

Ethnicity and social status

Testicular cancer is more common in white men than African-Caribbean or Asian men. Its also more common in wealthier social groups. We dont know the reasons for this.

Body size
Men who are taller appear to have a higher risk of testicular cancer, but its not clear why. Sometimes an injury to a testicle or the groin may bring a testicular cancer to your doctors attention. But theres no evidence to suggest that injury to a testicle increases your risk of getting cancer. Having a vasectomy doesnt increase the risk of getting testicular cancer either.

Symptoms of testicular cancer

The most common symptom is a lump in a testicle. But there may also be other symptoms depending on whether the cancer has spread outside the testicle.
Symptoms can include:

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swelling or a lump in a testicle, which is usually painless occasionally the swelling may suddenly increase in size and become painful pain or heaviness in the scrotum.

If the cancer has spread to the lymph nodes or other parts of the body there may be some of the following symptoms: pain in the back, groin, or lower abdomen this can be caused by the spread of the cancer to lymph nodes in the back of the abdomen a cough or breathlessness if lymph nodes in the chest area are affected, or rarely if the cancer has spread to the lungs nipple/breast tenderness or breast swelling (gynaecomastia) this isnt common but can be caused by hormones produced by the cancer.

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Testicular self examination (TSE)

Testicular cancer is usually curable. Its also easier to treat when its found early.
From puberty onwards its important that men check their testicles regularly (once a month) for anything unusual like a lump or swelling. When you do this youll soon get to know what feels normal for you. The best time to check your testicles is during or right after a warm bath or shower, when the scrotal skin is relaxed. Hold your scrotum in the palm of your hand and use your fingers and thumb to examine each testicle. Feel for lumps, anything unusual, or differences between your testicles. Its normal for the testicles to be slightly different in size and for one to hang lower than the other.

y y Testicular self-examination View a larger version of the image here. A normal testicle should feel smooth and firm (not hard). The epididymis (tube that carries sperm) lies at the top of the back part of each testicle. It feels like a soft coiled tube. Its not uncommon to get harmless cysts or benign lumps in the epididymis. y

What to do if you notice a lump or something different

Lumps or swellings can be caused by other conditions, and most lumps arent cancer. But its very important that you have anything unusual checked by your doctor as soon as possible. Doctors are used to dealing with problems like this on a regular basis. Remember that testicular cancer is nearly always curable, particularly when its found and treated early.

How testicular cancer is diagnosed

Usually you begin by seeing your family doctor (GP), wholl examine you. If your GP suspects that you may have testicular cancer youll be referred to a hospital specialist for further tests.

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Waiting for test results Ultrasound Removing the testicle (orchidectomy)

The specialist will usually be a urologist who is experienced in treating testicular, prostate, bladder and kidney problems. Theyll give you a full physical examination and take your medical history. Youll have an ultrasound examination of the scrotum and the testes. If your scan results show that the lump is highly likely to be cancer, the only way of confirming this is to do an operation to remove the testicle. Your doctor will also take blood from you which will be tested to find out if you have raised levels of certain chemicals in the blood called tumour markers. They are produced and released into the blood by some testicular tumours.

Waiting for test resultsBack to top

After youve had all the tests you need, your specialist will know the type of cancer you have and if its just within the testicle or has spread further. Itll probably take a week or more for the results of your tests to be ready and a follow-up appointment will be made for you. This waiting period can be a stressful time. Talking things over with family or close friends can often help. You can also call our cancer support specialists or a support organisation.

Ultrasound Back to top

This test can help to tell whether a lump is a cancer, or due to other causes such as a cyst (harmless lump filled with fluid). Ultrasound uses sound waves to build up a picture of the testes and scrotum. Its a painless test and only takes a few minutes. Once youre in a comfortable position, a gel is spread onto your scrotum and testes. A small device like a microphone, which produces sound waves, is then passed over this area. The sound waves are converted into a picture by a computer. If your scan results show that cancer is highly likely, you'll have an operation to remove the testicle.

Removing the testicle (orchidectomy)

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Removing the testicle is the only way to definitely diagnose testicular cancer. An expert in examining cells and diagnosing the type of cancer (pathologist) will then examine the testicle under a microscope. The operation (orchidectomy) also treats the cancer by removing it. If the cancer hasnt spread outside the testicle and theres a low risk of it coming back this may be the only treatment youll need. Its natural to have concerns about having this operation. Your specialist will explain why its absolutely necessary and will talk things over with you. You may also be referred to a specialist nurse who can give you information and support.

The operation
Your operation will be carried out under a general anaesthetic. It may be done as day surgery or during a short hospital stay. The surgeon will make a small cut (incision) through the lower tummy (abdomen) in the groin on your affected side. The testicle is pushed up from the scrotum and removed through the incision on your lower tummy. During the operation the surgeon can insert an artificial testicle (known as an implant or prosthesis) into your scrotum so that it looks the same as before. Your specialist can give you more details about this.

After the operation

After the operation youll probably feel a bit sore, but youll be given painkillers to take regularly until the pain settles down. Youll be encouraged to get up and about and start walking as soon as possible. About 510 days after your operation your stitches will be removed, unless theyre the self-dissolving type. Its not unusual to have some discomfort around the scar for a couple of weeks, but this can be controlled with painkillers. Wearing supportive underpants and loose trousers might help you feel more comfortable. You may have numbness around the area but this usually gradually improves. But in some men it may always feel a little different to the other side. Your specialist will advise you not to drive or do any heavy lifting for a few weeks after your operation. The amount of time youll need to take off work will depend on the type of work you do.

You might worry that the operation may make you feel less of a man. The operationdoesnt make you infertile (unable to father a child), or unable to have sex. Its not unusual to go off sex for a while if youre in some discomfort and feeling anxious. Most men find that any negative feelings gradually go away. After a while, if youre still struggling with difficult feelings or problems with your sex life, your doctor or specialist nurse can suggest sources of help and support. Some men may be offered sperm banking (storing samples of sperm) before their operation. The sperm is frozen and can be used later if treatment has affected your ability to father a child.

Further tests for testicular cancer

Once your diagnosis is definite your specialist will arrange for you to have further tests. These are done to find out if the cancer has spread to other parts of the body. The results help your doctors decide on the best treatment for you.
Occasionally some men with testicular cancer that has spread are diagnosed through scans to investigate their symptoms. You may have one or more of the following tests:

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blood tests - to check general health and to look for specific signs of cancer a chest x-ray - to check the health of your heart and lungs a CT scan - uses a computer to build up detailed, three-dimensional views of the inside of the body an MRI scan - uses magnetic fields to build up a series of cross-sectional pictures of the body a PET scan - a scan that shows how tissues inside your body are working.

Waiting for test results

After youve had all the tests you need, your specialist will know the type of cancer you have and if its just within the testicle or has spread further. Itll probably take a week or more for the results of your tests to be ready and a follow-up appointment will be made for you. This waiting period can be a stressful time. Talking things over with family or close friends can often help. You can also call our cancer support specialists, use online support or contact asupport organisation to help you. You may find our section on talking about your cancer helpful.

What the tests involve

Blood tests
Some testicular cancers produce chemicals called tumour markers, which are released into the bloodstream. These can be measured in simple blood tests. Other blood tests will also be taken to check how well organs, such as your liver and kidneys, are working.

Chest x-ray
You may have a chest x-ray to check that your lungs are healthy before your operation to remove your testicle.

CT (computerised tomography) scan

This is the most common scan thats used. A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of your body. Its done to check for any signs that the cancer has spread to the lymph nodes in your abdomen or to the lungs. Usually youll have x-ray pictures taken of the chest, abdomen and pelvis. The pictures are fed into a computer to give a detailed picture. The scan is painless and takes 1030 minutes. You may be asked not to eat or drink anything for several hours beforehand.

A CT scan is painless, but takes 10-30 minutes View a larger version of the image here. Most people who have a CT scan are given a drink or injection of dye before the scan. This helps the doctor to see particular areas more clearly. f you are allergic to iodine or have asthma tell the doctor and the person doing the test before you have the injection or drink, as you may be at higher risk of reacting to the dye. Most people feel hot and flushed for a few minutes after having the injection. Youll probably be able to go home as soon as the scan is over.

Magnetic resonance imaging (MRI) scan

This test is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure that its safe for you to have an MRI scan because the scanner is a powerful magnet. The checklist asks about any metal implants you may have, for example a pacemaker, surgical clips or bone pins. You should also tell your doctor if you have ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body its likely that you wont be able to have an MRI scan. In this situation another type of scan can be used. Before having the scan, youll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm. This doesnt usually cause discomfort. The dye is called a contrast medium and can help the images from the scan to show up more clearly.

During the test you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. Its also noisy, but youll be given earplugs or headphones. You will be able to hear, and speak to, the person operating the scanner.

PET (positron emission tomography) scan

A PET scan uses low-dose radioactive sugar to measure the activity of cells in the body. A very small amount of a mildly radioactive sugar is injected into a vein in your hand or arm. You then have the scan. Areas of cancer are normally more active than surrounding tissue and absorb more of the sugar, which shows up on the scan. There are only a few PET scanners in the UK, so you may have to travel to a specialist centre if you need one. But this scan is rarely needed in testicular cancer.

Tumour markers
Some testicular cancers produce chemicals known as tumour markers, which are released into the blood and can be measured by simple blood tests.
Not all men with testicular cancer have raised markers. If your cancer produces markers youll become familiar with having these measured. The main tumour markers are:

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AFP (alpha-fetoprotein) usually raised in teratoma HCG (human chorionic gonadotrophin) usually raised in teratoma and sometimes in seminoma LDH (lactic dehydrogenase) usually raised when testicular cancers have spread PLAP (placental alkaline phosphatase) can be raised in seminoma.

Tumour markers have a number of different uses. They can be used to: diagnose testicular cancer find out if it has spread monitor you after surgery watch how youre responding to treatment check that the cancer hasnt come back.

Tumour markers are measured before and usually a week after your operation. How quickly tumour marker levels fall gives doctors information about the risk of the cancer coming back. This helps them to plan your treatment.

Staging of testicular cancer

The stage of a cancer describes its size and whether its spread from where it started in the body. Knowing the stage of the cancer helps doctors decide on the most appropriate treatment.
There are several staging systems for testicular cancer. A staging system commonly used in the UK is the TNM system:

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T refers to the size of the tumour. N refers to whether lymph nodes are affected. M refers to whether cancer has spread to other parts of the body (metastases).

Tumour size (T)

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TIS (testicular carcinoma in situ) Cancer cells are in the tubules of the testes but havent moved into the surrounding tissue of the testicle. T1 The tumour is only in the testicle and epididymis. T2 The tumour has started to grow into blood vessels or lymph vessels. T3 The tumour has grown as far as the spermatic cord (and possibly also the blood vessels or lymph vessels). T4 The tumour has grown into the scrotum.

Lymph nodes (N)

The N refers to whether the cancer cells have spread into the lymph nodes nearby and, if so, what size of lymph node is affected (some are larger than others). If lymph nodes are affected theyre said to be positive.

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N0 The lymph nodes have no cancer cells. N1 The lymph nodes affected are less than 2cm wide. N2 At least one affected lymph node is 25cm wide. N3 At least one affected lymph node is more than 5cm wide.

Metastases (M)
Metastases refer to how far the cancer has spread.

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M0 The cancer hasnt spread to other organs. M1a The cancer has spread to the lungs or to distant lymph nodes (those furthest away from the testicles such as near the collarbone). M1b Other organs are affected for example, the brain or the liver.

Early testicular cancer (stage 1)Back to top

For some men surgery to remove the testicle (orchidectomy) may be the only treatment needed. Youll be asked to come back to clinic regularly to have tumour markers measured (if the cancer produces markers) and tests. This is called surveillance. If the cancer comes back itll be picked up early, and treatment can cure it. Attending your surveillance appointments is very important. If you move house, make sure the hospital knows your new address. Often men have surgery followed by treatment with chemotherapy or radiotherapy. This is known as adjuvant treatment. It is given to reduce the small risk of cancer coming back. If you have a teratoma youll usually have two sessions of adjuvant chemotherapy. The size of the tumour, how it looks under the microscope, and tumour marker levels (if present) help doctors to decide if you need adjuvant treatment. If you have a seminoma youll usually be offered a single dose of adjuvant chemotherapy. Or you can have radiotherapy to the lymph nodes at the back of the abdomen; both these treatments seem equally effective. Youll probably want to discuss the side effects and how the individual treatments are likely to affect your day-to-day life. If you need adjuvant treatment your doctor will explain why its advisable for you. Some men may decide not to have adjuvant treatment and to have surveillance instead. They may want to avoid treatment that might not be necessary. Talk this through carefully with your doctor and make sure you have enough information to help you make your decision.

Surgery for testicular cancer

Removing the testicle (orchidectomy) allows your doctor to make an exact diagnosis and is usually the first treatment for testicular cancer.

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Retroperitoneal lymph node dissection (RPLND) Possible complications Keyhole surgery (laparoscopic retroperitoneal dissection) Surgery to other parts of the body

If the cancer is completely contained in the testicle (stage 1) this operation may be the only treatment youll need. After chemotherapy some men may need further surgery if a CT scan shows that the lymph nodes at the back of the tummy (retroperitoneal nodes) are enlarged. These nodes may contain cells that could become cancerous in the future. Surgery to remove them is the only certain way of finding this out. After the operation the nodes are examined under a microscope.

Rarely these lymph nodes are removed in men with early teratoma who prefer to avoidsurveillance or adjuvant chemotherapy, as a way of finding out if the cancer has spread.

Retroperitoneal lymph node dissection (RPLND)Back to top

The operation to remove the nodes is called a retroperitoneal lymph node dissection. Its a major operation which is carried out by experienced surgeons in specialist centres. Your surgeon and specialist nurse will explain what is involved and the possible complications and side effects of this operation. Before the operation you will usually be seen at a clinic to have blood tests and tests to check that your heart and lungs are healthy. Youll be given information and advice about preparing for the operation. You may be asked to cut down on fibre (eg fruit, vegetables and pulses) in your diet for a few days before your operation. When youre admitted to hospital youll be given laxatives to empty your bowel. This is because the bowel, which is near the lymph nodes, will be handled during the operation. The operation is done under a general anaesthetic. Your surgeon will make a long cut from the top of your tummy (near your breastbone) to below your belly button. To remove the lymph nodes your surgeon moves your bowel and other organs aside.

After your operation

When you get back to the ward youll have a drip of fluid and salts going into your vein until youre able to eat and drink normally. Youll have drainage tubes from your wound to stop any excess fluid collecting, and to help the wound heal. The tubes will only be needed for a short time and will be taken out before you go home. After your operation youll be encouraged to start moving about as soon as possible. This helps to reduce complications like getting a chest infection or a blood clot. Youll also have support stockings to wear that help prevent blood clots in your legs. A physiotherapist or specialist nurse may give you some gentle leg and breathing exercises to do. Youll be given painkilling drugs regularly to control any pain. If you still have pain, let your nurse or doctor nurse know so they can increase the dose of your painkiller or change it. How long you need to be in hospital depends on how quickly you recover and whether you have any complications. Your staples are usually removed 710 days after the operation. It may be up to 10 days before youre ready to go home. If necessary a district nurse can change your wound dressings at home. It may take a few months before you feel fully recovered from your operation. Youll be left with a long vertical wound which will be red and swollen to begin with, but will eventually fade.

Possible complicationsBack to top

All operations have possible complications and your surgeon will discuss these with you beforehand. The most common complications are bleeding and infection in the wound. The bowel may also take a while to start working normally again. However, after your operation youll be monitored very closely and may be looked after in a high dependency/intensive care unit for the first few days. Your doctors and nurses will do regular checks to look for signs of complications. This means that if any occur they can be treated straight away.

Effect on fertility
Another possible complication of this operation is infertility (inability to father children), which is due to nerve damage during the operation. Youll still be able to ejaculate but your semen will go into your bladder and passes out harmlessly the next time you pass urine. This is known as retrograde ejaculation or dry climax. However, this is becoming less of a problem as surgeons use new nerve-sparing techniques to help protect the nerves. This operation wont usually have any physical effect on your ability to get an erection or to have an orgasm. Before the operation, your doctor should advise you about sperm banking (storing samples of sperm).

Chemotherapy for testicular cancer

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate in the bloodstream and can reach cancer cells anywhere in the body.

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Adjuvant chemotherapy If the cancer has spread or comes back after surveillance High-dose chemotherapy with stem cell support How chemotherapy is given Side effects Contraception Effects on fertility

The drugs most commonly used to treat testicular cancer are cisplatin, etoposide andbleomycin. This is known as BEP chemotherapy. Other combinations of drugs are also used depending on the stage of the cancer, or if its come back after treatment. Chemotherapy for testicular cancer is given:

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after surgery, to reduce the risk of testicular cancer coming back (known asadjuvant chemotherapy) to treat testicular cancer that has spread outside the testicle or come back after orchidectomy to treat testicular cancer thats come back after initial chemotherapy.

Radiotherapy for testicular cancer

Radiotherapy treats cancer by using high-energy rays which destroy the cancer cells, while doing as little harm as possible to the normal cells.

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External radiotherapy Side effects

Radiotherapy is a very effective treatment for seminoma but it isnt usually used to treatteratoma. The most likely place for seminoma to come back in or to spread to is the lymph nodes at the back of the abdomen (retroperitoneal nodes). You may need radiotherapy to this area either to:
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reduce the risk of the cancer coming back (known as adjuvant radiotherapy) if you have seminoma which hasn t spread outside the testicle get rid of the cancer if it has already spread to these lymph nodes.

Occasionally radiotherapy may be used to treat testicular cancer that has spread to other parts of the body.

External radiotherapyBack to top

The treatment is normally given in the hospital radiotherapy department as a series of short daily sessions. The treatments are usually given from Monday to Friday, with a rest at the weekend. Each treatment takes 1015 minutes. Your doctor will discuss the treatment and possible side effects with you. A course of radiotherapy for seminoma may last from two to three weeks. Its usually given as an outpatient.

External radiotherapy does not make you radioactive and it is perfectly safe for you to be with other people, including children, after your treatment.

Planning radiotherapy
Radiotherapy has to be carefully planned to make sure that it is as effective as possible. It may take a few visits. On your first visit to the radiotherapy department, youll be asked to have a CT scan or lie under a machine called a simulator, which takes x-rays of the area to be treated. The treatment is planned by a cancer specialist (clinical oncologist). Marks are usually drawn on your skin to help the radiographer (who gives you your treatment) to position you accurately and to show where the rays will be directed. These marks must stay visible throughout your treatment, and permanent marks (like tiny tattoos) may be used. These are tiny, and will only be done with your permission. It may be a little uncomfortable while being done.

Treatment sessions
At the beginning of each session, the radiographer will position you carefully on the couch, and make sure you are comfortable. During your treatment youll be left alone in the room but you can talk to the radiographer who will watch you from the next room. Radiotherapy is not painful but you do have to lie still for a few minutes during the treatment.

Positioning the radiotherapy machine

View a large version of the image here

Side effectsBack to top

Radiotherapy to the tummy (abdomen) can cause side effects, but these can usually be controlled well with medicines. Your doctor or specialist nurse will tell you more about what to expect. These side effects usually disappear gradually once your course of treatment has finished.

Skin changes
The skin in the area being treated may become red (if you have white skin) or darken (if you have black or brown skin), but this will improve after your treatment finishes. Youll be given advice on looking after your skin and your specialist can prescribe cream if your skin is uncomfortable.

Feeling sick
Radiotherapy to the tummy area may make you feel a bit sick. Your doctor will prescribe medicine to prevent or stop this (anti-emetics). Youll probably be advised to take these regularly during treatment. Let your doctor know if the tablets arent working for you as there are other medicines they can prescribe.

Tiredness
Youre likely to become tired and need to take things more slowly. Try to pace yourself and avoid doing things that dont really need to be done. Gentle exercise, such as short walks, can help to improve tiredness. Its good to balance this with plenty of rest. Sometimes tiredness can last up to eight weeks or longer after treatment finishes. You may find it helpful to read our information on coping with fatigue.

Diarrhoea
You might get some diarrhoea but this can usually be controlled with medicines, which your doctor can prescribe. Let them know if this is a problem and make sure you drink plenty of fluids and cut down on foods that are high in fibre. Its important to let your doctor know if youre having any problems. Most of the side effects are mild and can be treated successfully with medicines.

Effect on fertility
Radiotherapy to the nodes at the back of the abdomen doesnt usually cause infertility. Your specialist may advise you to think about storing sperm before your treatment starts.

Contraception
A small dose of radiation reaches the remaining testicle. The radiotherapy may affect your sperm, so its advisable during treatment to use effective contraception.

Theres no evidence that radiotherapy has any effect on children fathered after the treatment, but youre usually advised to use contraception for 612 months afterwards. You can talk this over with your doctor or specialist nurse.
Our section on radiotherapy has more information about the treatment and its side effects.

How treatment for testicular cancer might affect your fertility and sex life
It's understandable to worry about the effects of testicular cancer and its treatment on your sex life, and your ability to father a child.

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Effects of treatment on sex life and fertility Contraception during treatment Effects of treatment on children fathered after treatment Your sex drive (libido)

Different treatments can have different effects on your sex drive and fertility, and these changes may be temporary or permanent. Depending on your individual situation, you may also need to consider contraception during treatment, having children in the future, testosterone replacement and storing sperm (sperm banking).

Effects of treatment on sex life and fertilityBack to top

Heres how different treatments may affect you:

Surgery
Removing a testicle wont affect your sexual performance or your ability to father children. The healthy testicle thats left will produce more testosterone and sperm to make up for the testicle thats been removed.

Men who have an operation to remove the lymph nodes at the back of the abdomen may get nerve damage that causes retrograde ejaculation. This means that their sperm goes backwards into the bladder instead of coming out through the penis (its passed out harmlessly when you pass urine).
The operation doesnt stop you from getting an erection but your orgasm will feel different because its dry (dry climax). Fortunately, new surgical techniques mean that this problem can usually be avoided. However, your specialist may still advise you to think about storing sperm if you need this operation.

Chemotherapy
Although chemotherapy wont affect your ability to have sex, the side effects might reduce your sex drive for a while. Chemotherapy often causes infertility that is usually temporary, so your doctor will talk to you about storing sperm before your treatment. High-dose chemotherapy has a much higher risk of causing infertility.
The rate at which the sperm count recovers varies from person to person. It generally starts to return to normal around 18 months after treatment. Men having high-dose chemotherapy may become permanently infertile. Some men with testicular cancer have a low sperm count when theyre diagnosed. Sometimes successful treatment with chemotherapy improves sperm production.

Radiotherapy
Radiotherapy to

the nodes in the abdomen wont affect your ability to have sex and doesnt usually cause infertility. But your specialist might still suggest that you store sperm.

Contraception during treatmentBack to top

While youre being treated with chemotherapy or radiotherapy its important to avoid getting your partner pregnant. This is because treatment can damage your sperm and could possibly harm a baby conceived at this time. Your doctor will usually advise you to carry on using contraception for up to six months to a year after your treatment.

Effects of treatment on children fathered after treatmentBack to top

Theres no evidence that cancer treatments can harm children fathered after treatment is over. But doctors usually advise you to avoid fathering a child for about a year after your treatment. This allows time for your sperm to recover from any damage that treatment may have caused. Many men whove been treated for testicular cancer go on to have families when theyve recovered.

Your sex drive (libido)Back to top

Being diagnosed with testicular cancer brings up a lot of different emotions. Some men might find that it affects their feelings of masculinity. Coping with all of this can of course make you feel less interested in having sex. Its also common for the side effects of treatment, such as tiredness or sickness, to have an effect on your libido.
Although its worrying at the time this is usually temporary. Youll re-discover your sex drive when your feelings are easier to cope with and youre recovering from treatment.

Testosterone replacement therapy

usually affect your sex drive as the other testicle makes enough testosterone to compensate. Occasionally the remaining testicle doesnt produce enough testosterone, or rarely a man has to have both testicles removed (because of cancer).
A lack of testosterone can affect your ability to get an erection and reduce your sex drive. It can also cause tiredness, low mood and problems such as thinning of the bones (osteoporosis). Its important to let your doctor know if youre having these or other symptoms that you think may be caused by low testosterone. Your testosterone level can be measured by a blood test. If its low your doctor can prescribe testosterone replacement therapy. This will help to improve problems such as low sex drive and feeling constantly tired. It can be given as a gel, injection into a muscle, as an implant, or as a patch that is stuck on the skin. Your doctor can give you more information about testosterone replacement therapy. Removing one testicle doesnt

Support with sexual difficulties

Sexual difficulties are very personal. But talking openly with your partner about any problems you may be having can help. This can be difficult but you might find that you understand each other better. Having testicular cancer doesnt mean that your partner will no longer find you sexually attractive. You can also talk to your doctor or nurse about any sexual difficulties. Try not to feel embarrassed. Theyre likely to have experience of talking to other men with testicular cancer who have gone through similar problems. Some hospitals also have counsellors who are specially trained to help people having sexual difficulties. Your doctor can refer you to a counsellor.

We have a section on sexuality and cancer, which has lots more helpful information. We also have a list of useful support organisations.
A common worry is that cancer cells can be passed on to your partner during sex. This isnt true. Cancer isnt infectious and its perfectly safe for you to have sex.

Living with and after cancer

Cancer can affect many areas of your life such as your finances, work, your emotions and relationships. Find information and advice about what the effects might be, how to deal with them and how we can help.

Financial support
Find practical advice on the possible financial impact of a cancer diagnosis, including what benefits you might be entitled to.

Practical issues
Information on dealing with day-to-day problems, including work, travel, and travel insurance.

Emotional effects
Information on the emotions you might experience as a result of your cancer diagnosis, ways that you might manage them and other sources of support.

Relationships and communication

Advice on how to talk to other people, talking to children, relationships and sexuality.

How we can help

Find out about the ways in which Macmillan can offer you information and suppor