What are the symptoms of testicular cancer?

Common symptoms of testicular cancer include:

• A swelling and/or lump in one or both of the testes. You may or may not have pain in the testes or scrotum.
• A heavy feeling in the scrotum.
• A dull pain or feeling of pressure in the lower belly or groin.

Sometimes these symptoms can be caused by other problems, such as a hydrocele or epididymitis.

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 belly.
• Lack of energy, sweating for no clear reason, fever, or a general feeling of illness.
• Shortness of breath, coughing, or chest pain.
• Headache or confusion.

In most cases, the first sign of testicular cancer is a change in the size or shape of one or both testicles (testes). Often this change doesn't cause pain, though pain may be present. If unnoticed or untreated, testicular cancer may spread (metastasize) to other areas of the body.

After you are diagnosed with testicular cancer, you and your doctor will start to plan your treatment. Nearly everyone who has testicular cancer has surgery. After surgery, you may have other treatments, if they are needed. This depends on your choices, the type of cells involved, and the stage of your cancer.

Testicular cancer is one of the most curable forms of cancer, especially during its early stages. If you have symptoms, see a doctor as soon as possible.

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. You may or may not have pain in the testicles or scrotum.
• A heavy feeling in the scrotum.
• A dull pain or feeling of pressure in the lower belly or groin.

Surveillance

Some early-stage testicular cancers are successfully managed with a "wait-and-see" approach after surgery. This option involves frequent exams as well as blood tests and imaging tests to watch your condition. Surveillance may let you avoid the side effects from other follow-up treatments, such as chemotherapy and radiation therapy.

If testicular cancer is suspected, your doctor will do some testing. Tests can include a testicular ultrasound, which may be used to rule out other possible causes of an enlarged or painful testicle. Blood tests may be done to measure the levels of certain tumour markers in your blood. Or you may have a chest X-ray or CT scan of the chest, abdomen, and pelvis.

If these tests suggest cancer, you will have surgery to remove the testicle. It will be checked for cancer. If cancer is found, you may have other tests to find out the stage of your cancer.

Screening tests for testicular cancer

Testicular cancer is not common. It is often first discovered by the person or a sex partner as a lump or an enlarged and swollen testicle. In the early stages of testicular cancer, the lump, which may be about the size of a pea, usually is not painful. Testicular cancer has a high cure rate.

The Canadian Cancer Society (CCS) recommends that all men should know how their testicles normally look and feel and that men should talk to their doctor if they notice any changes in their testicles.

Monthly testicular self-exams (Figure 2) may be recommended for those who are at high risk for testicular cancer. This includes anyone who has a history of an undescended testicle or a family or personal history of testicular cancer.

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Treatment for testicular cancer is based on the type and stage of the cancer and other things, such as your overall health. The main treatment is:

Surgery.

Surgery to remove the testicle may be the only treatment you need. In some cases, surgery may also be done to remove lymph nodes in the belly.

After surgery, you may need only active surveillance. Or you may have more treatment, such as:

Chemotherapy.

These medicines kill fast-growing cells, including cancer cells and some normal cells.

Radiation therapy.

This uses high-dose X-rays to destroy cancer cells and shrink tumours.

For advanced cancer, treatment may include a stem cell transplant or a clinical trial.

Before you have surgery or any treatment for testicular cancer, talk to your doctor about sperm banking. Some cancer treatments can cause infertility.

Your doctor will talk with you about your options and then make a treatment plan.

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Hospice palliative care is a type of care for people who have a serious illness. It's different from care to cure your illness, called curative treatment. Hospice palliative care provides an extra layer of support that can improve your quality of life—not just in your body, but also in your mind and spirit. Sometimes hospice palliative care is combined with curative treatment.

The kind of care you get depends on what you need. Your goals guide your care. You can get both hospice palliative care and care to treat your illness. You don't have to choose one or the other.

Hospice palliative care can help you manage symptoms, pain, or side effects from treatment. It may help you and those close to you better understand your illness, talk more openly about your feelings, or decide what treatment you want or don't want. It can also help you communicate better with your doctors, nurses, family, and friends.

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• Take your medicines exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine.
• Eat healthy food. If you do not feel like eating, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss. Drink liquid meal replacements for extra calories and protein. Try to eat your main meal early.
• Get some physical activity every day, but do not get too tired.
• Get enough sleep and take time to do things you enjoy. This can help reduce stress.
• Think about joining a support group. Or discuss your concerns with your doctor, counsellor, or other health professional.
• If you are vomiting or have diarrhea:
  • Drink plenty of fluids to prevent dehydration. Choose water and other clear liquids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
  • When you are able to eat, try clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
• Take care of your urinary tract to prevent problems such as infection. Limit drinks with caffeine, drink plenty of fluids, and urinate every 3 to 4 hours.
• If you have not already done so, prepare an advance care plan. An advance care plan provides instructions to your doctor and family members about what kind of care you want if you become unable to speak or express yourself.

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Testicular cancer may be treated with:

• Surgery to remove a testicle (radical inguinal orchiectomy). Nearly everyone with testicular cancer has this surgery.
• Surgery to remove lymph nodes in the pelvis and lower back (retroperitoneal lymph node dissection, or RPLND). This may be used for non-seminoma cancer.
• Surgery to remove other areas of cancer if it has spread in the body. This is done for non-seminoma cancer, either before or after having chemotherapy.

In most cases, removing a testicle doesn't cause long-term sexual problems or make you unable to have biological children. But if you had these problems before treatment, surgery may make them worse. And other treatments for cancer may cause you to become infertile. You may want to think about saving sperm in a sperm bank. Talk to your doctor if you have any questions or concerns about sexual problems or whether you can have biological children.

You can choose to get an artificial, or prosthetic, testicle. A surgeon places the artificial testicle in the scrotum to keep the natural look of the genitals.

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Some people use complementary therapies along with medical treatment. They may help relieve the symptoms and stress of cancer or the side effects of cancer treatment. Therapies that may be helpful include:

• Acupuncture to relieve pain and other symptoms.
• Meditation or yoga to relieve stress.
• Massage and biofeedback to reduce pain and tension.
• Breathing exercises to help you relax.

Talk with your doctor about any of these options you would like to try. And let your doctor know if you are already using any complementary therapies. They are not meant to take the place of standard medical treatment. But they may help you feel better and cope better with treatment.

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Relationships take on new importance when you're faced with cancer. Your family and friends can help support you. You may also want to look beyond those who are close to you.

• Reach out to your family and friends.

  Remember that the people around you want to support you, and asking for help isn't a sign of weakness.

• Tell them how they can help.

  Your friends and family want to help, but some of them may not know what to do. It may help to make a list. For example, you might ask them to:

  • Run errands or pick up kids.
  • Deliver meals or groceries to your home.
  • Drive you to appointments.
  • Go to doctor visits with you and take notes.
• Look for help from other sources.

  Places to turn for support include:

  Counselling.

  Counselling can help you cope with cancer and the effect cancer is having on your life. Different types of counselling include family therapy, couples therapy, group counselling, and individual counselling.

  Your health care team.

  Your team should be supportive. Be open and honest about your fears and concerns. Your doctor can help you get the right medical treatments, including counselling.

  Spiritual or religious groups.

  These groups can provide comfort and may be able to help you find counselling or other social support services.

  Social groups.

  Social groups can help you meet new people and get involved in activities you enjoy. Focus on activities that bring you comfort, such as spending time outdoors or being with children.

  A cancer support group.

  Cancer support groups offer support and practical advice. You can hear others talk about:

  • What it's like to live with cancer.
  • Practical ways to manage your cancer treatment and its side effects.
  • Ways to cope with your illness.

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