Testicular cancer: Teenagers and young adults

It can be embarrassing to talk about your testicles and any changes to them that you’ve noticed. Understanding more about what they do might help.

Facts about testicles

Testicles are small and oval-shaped. They hang below your penis in a sac called the scrotum.

From puberty, your testicles produce a hormone called testosterone. This gives you a lower voice, hair on your face and body, and makes your muscles get bigger. You also need it for your sex drive and for getting an erection.

The testicles make sperm from puberty (around 13 to 14 years old) onwards. When sperm meets with a female egg during sex, this can cause pregnancy.

The testicles make millions of sperm a day, but if sperm are not ejaculated they are reabsorbed back into your body.

Sperm wait in the epididymis next to the testicle until they are ejaculated. At ejaculation, they travel up through the spermatic cord and mix with fluid from the prostate to make semen. They go out of the body through the urethra (this is the same tube you pass urine (pee) through).

Lymph nodes (glands)

Lymph nodes are small and round, and connect to each other by tiny tubes that carry fluid called lymph. We have lymph nodes throughout our bodies. They are part of the lymphatic system, which protects us from infections.

Sometimes cancer cells from the testicle can spread to lymph nodes at the back of the abdomen (tummy). You’ll have a scan to check your lymph nodes.

We have more information about:

• signs and symptoms of testicular cancer
• having tests for testicular cancer
• having treatment for testicular cance

If you're looking for information for all ages about testicular cancer, read our general testicular cancer section.

You may have tests done by your GP or at the hospital. They will help your doctors see whether you have testicular cancer.

Visiting your GP

If you think you might have some of the symptoms of testicular cancer, you should go to your GP. They'll be able to talk to you about your symptoms. If they think the symptoms could be because of cancer they can do tests to find out more.

If your doctor thinks there is a chance you might have cancer, they’ll examine your testicles. They might also arrange for you to have an ultrasound test. This uses sound waves to take a picture of the testicles.

At the hospital

If you need more tests you’ll be referred to a hospital. This could be a general hospital or a specialist cancer hospital.

You'll be seen by a specialist doctor (urologist), who will examine you and do the following tests:

• blood tests to check for chemicals in the blood called tumour markers – some testicular cancers (but not all) produce high levels of these
• an ultrasound scan of the scrotum and testicles (if you haven’t already had one) – this can usually tell the difference between a cancer and a cyst (a harmless lump filled with fluid)

Removing a testicle

If your ultrasound shows the lump is almost certainly cancer, an operation to remove a testicle (orchidectomy) is done. You’ll only have this operation if it’s necessary. Your specialist will explain this to you. After the operation a doctor will use a microscope to look for cancer cells in the removed testicle.

This may be the only operation you need. It will not stop you having sex or becoming a dad in the future. You can read more about this operation in our section on treatment for testicular cancer..

Further tests

If testicular cancer is diagnosed you will need some other tests:

• more blood tests to check how well your liver and kidneys are working, and to check your tumour markers again
• chest X-rays to check your lungs are healthy – this is sometimes done before the operation
• CT, MRI, or PET scans to find out if the cancer has spread to the lymph nodes at the back of your abdomen (tummy), or to anywhere else in your body

You’ll be seen by a cancer specialist and usually a specialist nurse at a cancer treatment centre to get your test results. The results will help your specialist plan the best treatment for you.

Having tests and waiting for the results can be a scary time. Talking about how you feel and getting support from your family, friends, specialist nurse and doctor can make it a bit easier.

If you need any further treatment you will have it at the cancer treatment centre.

We have more information about:

• the testicles
• symptoms of testicular cancer
• treatment for testicular cancer
• living with and after testicular cancer

If you're looking for information for all ages about testicular cancer, read our general testicular cancer section.

Treatment for testicular cancer can be very successful. Surgery and chemotherapy are the 2 main types of treatment. Often people have both treatments.

To make sure you have the right treatment, your specialist needs to know what stage the cancer is. The stage of a cancer describes the tumour and whether it has spread outside the testicle. You may need some more tests to confirm what stage you are at. Waiting to hear about the stage of the cancer can be worrying. But this information is important because it helps your doctors plan the right treatment.

Treatment for testicular cancer can be really successful. Most young men with testicular cancer are cured, even if the cancer has spread. If you have any questions about your treatment, don't be afraid to ask your doctor or nurse.

Surgery

Surgery to remove the testicle is one of the main treatments for testicular cancer. The operation is called an orchidectomy. It can be done as a day patient or during a short stay in hospital.

You may feel shocked and scared at the thought of having this done. Your doctor and nurse will tell you more about it so that you know what to expect.

The surgeon makes a small cut (incision) through your lower abdomen (tummy) in the groin on the affected side. The testicle is pushed up from the scrotum and removed through the cut.

During the operation the surgeon can put a false testicle into your scrotum so that you’ll look the same as before. Your surgeon will explain this to you before the operation, or you can ask them about it. If this wasn’t done at the time of the operation, but now you think you would like this, talk to your doctor or nurse. It is a small operation to put this in later on.

After the operation

You'll have a small dressing where the cut was made. This can usually be removed a day or so after the operation. The stitches in the wound will dissolve by themselves over the next few months.

You'll probably feel a bit sore and you’ll be given painkillers to take regularly. Let your nurse or doctor know if they’re not controlling the pain. Wearing fitted briefs or shorts that support you and loose trousers like jogging bottoms can feel more comfortable after your operation.

You’ll probably feel tired and need to take things easy for about a week. You can expect to make a quick recovery after this operation.

If one of your testicles is removed, you will still be able to have sex and make someone pregnant. Your other testicle should produce enough of the hormone testosterone and sperm.

It isn't common to have both testicles removed. If you’ve had this done then you’ll be prescribed testosterone so you'll still be able to have sex. But you won't be making sperm now, so you won’t be able to make someone pregnant through sex. Your doctor will talk to you about sperm banking before your surgery. Storing your sperm before the operation can help you to become a dad in the future. Our sections on sex and relationships and fertility have more information as well as ways of coping.

Surveillance

If after surgery the chance of the cancer coming back is very low, your doctor might suggest you have surveillance. This means having regular checks to look for signs of the cancer coming back. If it does come back and it’s picked up very early, then it’s easy to cure. If the cancer doesn’t come back then you’ve avoided having unnecessary treatment. At each clinic appointment, your doctor will examine you and you may have blood tests and chest X-rays.

Going to all your surveillance appointments is really important. You could put a reminder in your phone.

Chemotherapy

Chemotherapy is when you’re given anti-cancer drugs to destroy the cancer cells.

You might be given chemotherapy:

• after the operation to remove your testicle, to reduce the chance of the cancer coming back
• to destroy cancer cells that have already spread outside the testicle
• if the cancer comes back
• occasionally before surgery, if the cancer has spread

Chemotherapy can affect your fertility. Before your chemotherapy starts, your doctor will talk to you about storing some of your sperm. This is called sperm banking. We have more information about fertility issues.

Chemotherapy is given into a vein as injections or drips. You have your chemotherapy through one of the following:

• a fine tube called a cannula
• a line into a vein in the chest (called a central line)
• a line into the arm (PICC line) that leads into a vein in the chest

Find out more about how chemotherapy is given.

The amount of chemotherapy you have depends on the stage of the cancer. If the stage is low then you will have 1 to 2 cycles (sessions) of chemotherapy. If the stage is higher, or if the cancer comes back during surveillance, you’ll usually have 3 to 4 cycles of chemotherapy.

The drugs most often used to treat testicular cancer are cisplatin, etoposide and bleomycin. Giving these drugs together is called BEP.

Chemotherapy is given in cycles of treatment. A cycle usually takes 3 weeks. If you have BEP, you’ll usually spend 3 to 5 days of the first week having your chemotherapy as a day patient, or you might need to stay in hospital overnight. After this you’ll come back to the clinic for another injection of chemotherapy a week later, and again the following week.

If the cancer has spread to other parts of the body, or if it isn’t going away completely with BEP, then different chemotherapy drugs can be given.

Side effects

Different chemotherapy drugs cause different side effects. You will probably have a few side effects, but it's hard to know exactly how it's going to be you. Your doctor will do everything they can to treat any side effects you have.

Most side effects are short-term and gradually disappear once treatment stops. The most common temporary side effects are:

• hair loss
• tiredness
• feeling sick or being sick (which can be controlled with medicines)
• being more at risk of getting an infection

There’s more information in the chemotherapy section.

Sometimes side effects can be long-term. For example, although chemotherapy usually only affects fertility for a year or so, sometimes it’s permanent. Read Macmillan's fertility section for more information.

There may be other late effects of treatment and your specialist can talk to you about this.

Further surgery

If the lymph nodes at the back of your tummy area are still swollen after chemotherapy, they’re usually removed with an operation. Lymph nodes are part of the body's immune system and help fight infection. The lymph nodes in the tummy are called the retroperitoneal lymph nodes, so the operation is called a 'retroperitoneal lymph node dissection'. The operation will be done by experienced surgeons in specialist centres.

The lymph nodes might contain cells that could become cancerous in the future, so having them removed is the only certain way to find this out.

You might be in hospital for up to 10 days. The surgeon usually makes a cut from the top of your tummy (near your breastbone) to below your belly button. This leaves you with a scar but it’ll gradually fade until it ends up looking like a fine line.

Sometimes you have surgery to remove any abnormal cells in areas like the lung or the lymph nodes in the chest.

After the operation

You’ll have a drip in your arm to give you fluids until you’re able to eat and drink normally. You’ll also have drainage tubes from the wound to stop any extra fluid collecting. The nurses will keep a check on the dressing over your wound and change it when needed. You’ll be given painkillers to take regularly. Your staples (like metal stitches) are removed 7 to 10 days after the operation.

It might take a few months to get back to the level of fitness you had before.

This operation can affect your fertility, because the nerves that control the release of sperm (ejaculation) may be damaged by surgery. Surgeons use 'nerve-sparing’ techniques to try to stop this happening. The operation doesn’t usually stop you getting an erection or having an orgasm.

We also have more information about:

• symptoms of testicular cance
• having tests for testicular cancer
• living with and after testicular cancer
• the testicles

If you're looking for information for all ages about testicular cancer, read our general testicular cancer section.

Being diagnosed with cancer can have a big impact on your life, even after you've finished treatment.

After treatment

Once you finish your treatment, you’ll have regular follow-up appointments at the hospital. You’ll have blood tests for tumour markers and sometimes other scans or X-rays. If the tumour markers go up, this can be a sign that the cancer has come back. This means you need more treatment, which can still cure the cancer.

How will I feel?

You might find it embarrassing to talk about your private parts and how the cancer or cancer treatment has affected them. It can feel awkward talking to doctors or your family about this.

Try not to let this put you off talking about things. It can be really helpful to let someone know how you're feeling, so that you don't bottle things up.

Sex and fertility

Fertility is the ability to have children. Some cancers and cancer treatments can affect a young man’s fertility, but your doctors will always think about this when planning your treatment. Your doctor will talk to you about sperm banking prior to treatment if this might happen.

If only 1 of your testicles has been removed, the one left should continue to make sperm and produce enough testosterone so that your fertility is not affected. You can still have sex.

If you have chemotherapy, your ability to produce sperm might be affected. After chemotherapy you can have a sample checked to see if this has happened. You can still have sex, but when you are on chemotherapy (and for a few months afterwards) you should always wear a condom to protect your partner from the chemotherapy.

If you had an operation to remove both of your testicles or the lymph nodes at the back of your tummy (abdomen), your fertility and your ability to have sex may be affected. This is a really tough thing to cope with on top of everything else that you’re going through. Your specialist nurse will provide support and help you find more advice and support if you feel you need it. There are things which can be done to help so that you can still have sex.

We also have more information about:

• symptoms of testicular cancer
• having tests for testicular cancer
• treatment for testicular cancer
• the testicles

If you're looking for information for all ages about testicular cancer, read our general testicular cancer section.