Most testicular cancers are germ cell tumours¹. These fall into two categories:

• Seminomas These usually occur in men aged between 25 and 45 and develop slowly.

• Non-seminomas These are more common in younger men and can grow more quickly.

Testicular cancer often has minimal symptoms. However, symptoms may include:

• a lump or swelling in the testicles, which is usually painless
• change in size or shape in the testicles
• a heavy or uneven feeling in the scrotum
• aching in a testicle, back or abdomen
• back pain

Having any of these symptoms doesn’t necessarily mean you have testicular cancer, but you should see your doctor for a check-up.

There is no clear reason for testicular cancer. However, some factors appear to increase the risk. These include:

• family history of testicular cancer²
• an undescended testicle at birth³
• infertility⁴
• HIV or AIDS, although this link is weak⁵

Having any of these risk factors doesn’t mean you will develop testicular cancer, but you should see your GP if you are worried. It’s been proven that there’s no link between testicular cancer and sporting injuries or physical activity⁶.

If you are found to have testicular cancer, your doctor will give you details about how far your cancer has progressed.

Testicular cancer is commonly staged with the TNM system, which shows how advanced the cancer is. These letters stand for:

• Tumour: Your doctors will measure the size of the tumour and how much it has grown
• Nodes: Refers to whether cancer has spread to lymph nodes
• Metastasis: Refers to whether cancer has spread to other parts of the body

Whether you experience side effects and how severe they are, depends on the type and dose of chemotherapy treatment you are given and your reaction from one treatment cycle to the next. Most side effects are short-term and can be managed. These may include:

• fatigue
  
• nausea or vomiting
• constipation or diarrhoea
• hair loss
• temporary loss of libido
• temporary loss of erection
• lower sperm production

These symptoms tend to improve gradually once treatment stops. Talk to your doctor or nurse if you feel upset or anxious about how long treatment is taking or the impact of side effects.

• Get as much rest as possible
  
• Aim for a wholefood, varied diet, but we also encourage you to eat foods that interest you rather than what you think you should eat
• Appetite changes are common, and you may experience taste changes or nausea. Help manage this by eating small, frequent snacks and avoiding smells that make you nauseous
• Drink lots of water
• Reach out to support groups and others who have had chemotherapy
• Record your side effects in a diary or journal
• Take some gentle exercise, such as walking, if you feel up to it. Light to moderate exercise can reduce treatment-related fatigue and improve your mood. Plan your exercise for times in the day when you know you have more energy
• It is important to acknowledge when you are fatigued and rest when you need to
• Ask for and accept help from family, friends and neighbours
• Be open with employers about your treatment and discuss flexible working options if you need them

Side effects may include:

• soreness and swelling around the treatment area
• tiredness and lethargy for a few weeks after you finish
• fatigue
• nausea or bloating
• diarrhoea
• bladder irritation or infection
• temporary or permanent infertility
• radiation therapy has a small risk of causing a cancer, sometimes many years after the initial cancer treatment. Your radiation oncologist will talk to you about these risks

General side effects of testicular surgery include:

• pain and swelling
• inability to have sex for 2-4 weeks
• inability to drive for 2-4 weeks

If you have had lymph node surgery, side effects may include:

• inability to ejaculate
• retrograde ejaculation, where your sperm goes into your bladder and is mixed in with your urine. This can affect natural fertility

References

1. Testicular cancer: germ cell tumours. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4704678/
2. Risk of cancer in first- and second-degree relatives of testicular germ cell tumor cases and controls. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605179/
3. Age at Surgery for Undescended Testis and Risk of Testicular Cancer. https://www.nejm.org/doi/full/10.1056/nejmoa067588#:~:text=Cryptorchidism%20is%20associated%20with%20impaired,have%20a%20history%20of%20cryptorchidism.
4.  Increased Risk of Testicular Germ Cell Cancer Among Infertile Men. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881689/
5. Testicular tumors in men with human immunodeficiency virus. https://pubmed.ncbi.nlm.nih.gov/1552581/