Diagnosed with testicular cancer? What next?

Cancer is always something that happens to other people, until you’re the one who has it. That’s what it was like for 37-year-old Simon A. when he was diagnosed with testicular cancer five years ago. He is clear of cancer now, but he remembers the day of his diagnosis only too well. “I was completely unprepared for the diagnosis. I thought: why me?” 

Cancer is a collective term for various diseases in which body cells multiply uncontrollably and undergo pathological changes. Tumours develop as a result. Malignant tumours usually grow quickly into the surrounding healthy tissue and destroy it. The cancer cells can also colonise other parts of the body via the bloodstream, resulting in metastases.

In most cases, it is unclear why someone develops cancer. The same is true of testicular tumours – they can affect any man. There are certain risk factors, however, such as undescended testicles, a family history of testicular cancer, previous testicular cancer, infertility or hypogonadism. 

Symptoms of testicular cancer

In the vast majority of cases, testicular cancer only spreads within one testicle. It is very rare for both testicles to be affected. If the cancer spreads, it grows into the epididymis and spermatic cord, where it displaces healthy testicular tissue. The most common symptom of testicular cancer is a noticeable lump in the testicle: a usually painless, palpable hardening or enlargement. Sometimes this is also accompanied by a feeling of heaviness or a pulling sensation in the testicles or groin area. Other symptoms that may be signs of advanced testicular cancer: 

• Infertility
• Swelling of the mammary gland (development of breast tissue)
• Shortness of breath
• Back pain
• Headaches
• Fatigue and lethargy

Blood in the urine is not a sign of testicular cancer, but should be shown to a doctor – unless the cause of red urine is the consumption of red fruits or vegetables such as beetroot. Blood in semen is not usually due to a serious problem. It only indicates prostate or testicular carcinoma in rare cases. If the bleeding continues for a long time, recurs and is associated with pain or a lump in the testicle, you should see a doctor. 

Discovering testicular cancer 

Most of those affected discover the lump themselves. Simon felt the hardening by chance. “I didn’t take it seriously at first, or perhaps I buried my head in the sand. Luckily, my girlfriend made me go to the doctor.” Changes to the testicles should always be examined by a urologist.

The doctor first takes down details of the patient’s medical history. Then he palpates the testicles to check whether the lymph nodes are enlarged. He also checks whether the mammary glands are swollen. This is usually followed by an ultrasound examination (testicular sonography), which provides information about the tissue of the testicles.

Further examinations are required to provide a definitive diagnosis of testicular cancer. Depending on the findings of the initial clarification, the blood is examined for tumour markers, a tissue sample is taken and/or a computer tomography (CT) scan is performed. 

Check-ups for testicular cancer

Self-checks are the most effective method of preventive care. Men between the ages of 15 and 45 should check their testicles for changes once a month. This is the best way to detect testicular cancer early on. It doesn’t matter whether you examine one testicle, then the other, or both together.

According to the Swiss Cancer League, there is no specific method for the systematic early detection of testicular cancer. The key is to know your body so you can identify any changes. The easiest way to perform the check is to stand under a warm shower, because heat relaxes the skin around the testicles, making it easier to detect any changes. And remember: not every change means you have a malignant tumour! You shouldn’t immediately fear the worst, but you should certainly see a doctor. 

Different types of testicular cancer

Various types of cancer can develop in the testicles. The vast majority of cancers of the testicle start in cells known as germ cells. These are the cells that make sperm. Testicular tumours are therefore also called germ cell tumours. These are divided into three groups: Seminomas (the most common type of testicular cancer) and the mixed forms of tumors non-seminomas and teratomas.

This distinction is important because not every type of cancer responds to the same treatment. Teratomas, for example, do not respond to radiotherapy and have to be surgically removed. There are also forms of testicular cancer that do not originate from the germ cells but from connective tissue cells. These stromal tumours are usually benign and can be surgically removed without having to remove the testicle. 

Treatment for testicular cancer

Which therapy is suitable for testicular cancer depends on the type of cancer. However, the first treatment step for all malignant tumours is usually the surgical removal of the affected testicle (orchiectomy). If the tumour is still in stage I, i.e. if it has not yet metastasised and the lymph nodes are not affected, usually no further treatment is required. However, the patient is monitored and has to go for regular check-ups.

If the testicular cancer is more advanced (stage II or III) and metastases have already formed, the patient will need chemotherapy, where cell-damaging or growth-inhibiting drugs are passed throughout the body via the bloodstream in order to kill the cancer cells. Side effects vary from person to person and depend on the drugs used, dosage and the sensitivity of the person affected, and can be very severe. Radiotherapy can only be carried out for certain types of cancer. With this treatment, the local radiation damages the cancer cells so that they die. Side effects can also occur during radiotherapy. 

Fertility and planning a family with and after testicular cancer

“On top of the worries about my health, there was the question of whether I’d still be able to have children. My girlfriend and I were ready to start a family,” says Simon, expressing a concern common among people diagnosed with cancer. And it’s true that testicular cancer, or rather the treatment for it, can affect fertility. So, if you’re planning on having children, it’s advisable to freeze your sperm before treatment starts, just to be on the safe side. However, having only one testicle removed shouldn’t really impair fertility and nothing stands in the way of having children.

Your sex drive and potency aren’t affected either, because the second testicle produces sufficient testosterone and sperm. If your testosterone levels do fall, the hormone can be supplemented with medication. It’s a different story with chemotherapy or radiotherapy. Both can affect your fertility. What’s more, contraception should be used during chemotherapy and for around two years afterwards, because the treatment may damage a developing baby and increase the risk of miscarriage.

At what age is testicular cancer most common?

“I never really thought about cancer,” says Simon, “I’m still young, I do a lot of sport and I eat healthily. My grandfather had prostate cancer, so I saw cancer as something that old people got.” That’s actually true for prostate cancer , but testicular cancer mainly affects young men.

Testicular cancer occurs most frequently between the ages of 20 and 40. Statistically, men between the ages of 35 and 39 are the most affected (see Swiss Cancer Report 2021). However, it is possible for men to develop testicular cancer at the age of 60 or very young men at the age of 15 – however, both possibilities are very rare. Nevertheless, young men should routinely check their testicles themselves during puberty. 

Chances of survival and course of the disease

Testicular cancer isn’t a common type of cancer, accounting for only 2% of all types of cancer in men. On average, 470 men in Switzerland contract the disease every year, and around 15 of them die as a result. However, the survival rate for testicular cancer is very high – at over 95%. Even if the tumour is discovered late and has already spread, the chances of recovery are still good. Nevertheless, the earlier the treatment starts, the better.

At an early stage, the treatment is less intensive and the probability that the disease will recur is lower. Without treatment, however, life expectancy with testicular cancer is limited, as metastases form in the lymph nodes of the posterior abdominal cavity, in the lungs and, more rarely, in the liver, brain and bones. Testicular cancer is fatal without treatment. 

Even though the chances of recovery were good, the cancer diagnosis was a shock for Simon. “From one moment to the next, you’re no longer healthy. And even though I knew the statistics, my initial reaction was fear.” Talking to a psychologist and others who’d received the same diagnosis helped. “You have to find out for yourself what does you good. That’s very important.”