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Testicular Cancer - Introduction

Approved by the Cancer.Net Editorial Board, 08/2022

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Testicular Cancer. Use the menu to see other pages. Think of that menu as a roadmap for this entire guide.

Testicular cancer begins when healthy cells in a testicle change and grow out of control, forming a mass called a malignant tumor. The term "malignant" means that the tumor can spread to other parts of the body.

Another name for testicular cancer is testis cancer.

About the testicles

Typically, under the penis in a sac-like pouch called the scrotum, there are 2 testicles. Testicles may also be called testes or gonads. The testicles are part of the reproductive system and produce sperm and testosterone. Testosterone is a hormone that plays a role in the development of male reproductive organs and other male characteristics.

About testicular cancer

Most types of testicular cancer develop in the sperm-producing cells known as germ cells and may be referred to as germ cell tumors. Germ cell tumors can start in several parts of the body:

  • The testicles, which is the most common location

  • The back of the abdomen near the spine, called the retroperitoneum

  • The central portion of the chest between the lungs, called the mediastinum

  • The lower spine (in children)

  • Very rarely, a small gland in the brain called the pineal gland (mainly in children)

Testicular cancer is almost always curable if found early, and it is usually curable even when found at a later stage.

Types of testicular cancer

There are 2 main categories of germ cell tumors that start in the testicles.

  • Seminoma. A tumor is only called a seminoma if it is 100% seminoma. This means that the cancer does not have any of the types of tumor listed below.

  • Non-seminoma. A non-seminoma contains at least 1 of the following types of tumor:

    • Choriocarcinoma

    • Embryonal carcinoma

    • Yolk sac tumor

    • Teratoma

Each of these can occur alone or in any combination. Most non-seminomas are a mix of at least 2 different subtypes of germ cell tumor, and all mixed germ cell tumors are categorized as non-seminomas. Non-seminomas may be partly seminoma at any percentage level less than 100%. For example, a tumor that is 99% seminoma and 1% yolk sac tumor is still diagnosed and treated as a non-seminoma.

Generally, non-seminomas tend to grow and spread more quickly than seminomas, but prompt diagnosis and treatment are important for both types of tumors.

Other, less common types of testicular tumors include:

  • Leydig cell tumor

  • Sertoli cell tumor

  • Carcinoma of the rete testis, which is a part of the testicles

  • Testicular lymphoma

This section provides information only on seminoma and non-seminoma of the testicles in those who have reached puberty. Testicular cancer is uncommon in those who have not yet reached puberty. Childhood testicular cancer that occurs before puberty is treated differently from cancer that develops after puberty in teenagers and adults.

Other types of cancer, such as lymphoma and leukemia, occasionally spread to the testicles. To find out more about cancer that started in another part of the body and spread to the testicles, read about that specific type of cancer.

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If you would like more of an introduction, explore the following item. Please note that this link will take you to another section on Cancer.Net:

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with testicular cancer and general survival rates. Use the menu to choose a different section to read in this guide.

Testicular Cancer - Statistics

Approved by the Cancer.Net Editorial Board, 03/2023

ON THIS PAGE: You will find information about the estimated number of people who will be diagnosed with testicular cancer each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors, and no 2 people with cancer are the same. Use the menu to see other pages.

Every person is different, with different factors influencing their risk of being diagnosed with this cancer and the chance of recovery after a diagnosis. It is important to talk with your doctor about any questions you have around the general statistics provided below and what they may mean for you individually. The original sources for these statistics are provided at the bottom of this page.

How many people are diagnosed with testicular cancer?

In 2023, an estimated 9,190 people in the United States will be diagnosed with testicular cancer. About 1 out of every 250 men and boys will be diagnosed with the disease during their lifetime. Worldwide, an estimated 74,458 people were diagnosed with testicular cancer in 2020.

Testicular cancer is the most commonly diagnosed cancer in men between the ages of 20 and 34. In 2020, there were an estimated 3,000 new cases of the disease in the United States among people aged 20 to 29 and 3,100 new cases in the United States among people aged 30 to 39.

The average age of diagnosis is 33. However, the disease can occur at any age. Approximately 6% of cases are diagnosed in children and teens. An estimated 8% of cases are diagnosed in men 56 or older.

For unknown reasons, the number of testicular cancer cases has increased for many decades. However, the rate of increase has slowed down recently.

It is estimated that 470 deaths from this disease will occur in the United States in 2023. These deaths are either from cancer that spread from the testicles to other parts of the body and could not be effectively treated with chemotherapy, radiation therapy, and/or surgery or from complications from treatment. In 2020, an estimated 9,334 people worldwide died from testicular cancer.

What is the survival rate for testicular cancer?

There are different types of statistics that can help doctors evaluate a person’s chance of recovery from testicular cancer. These are called survival statistics. A specific type of survival statistic is called the relative survival rate. It is often used to predict how having cancer may affect life expectancy. Relative survival rate looks at how likely people with testicular cancer are to survive for a certain amount of time after their initial diagnosis or start of treatment compared to the expected survival of similar people without this cancer.

Example: Here is an example to help explain what a relative survival rate means. Please note this is only an example and not specific to this type of cancer. Let’s assume that the 5-year relative survival rate for a specific type of cancer is 90%. “Percent” means how many out of 100. Imagine there are 1,000 people without cancer, and based on their age and other characteristics, you expect 900 of the 1,000 to be alive in 5 years. Also imagine there are another 1,000 people similar in age and other characteristics as the first 1,000, but they all have the specific type of cancer that has a 5-year survival rate of 90%. This means it is expected that 810 of the people with the specific cancer (90% of 900) will be alive in 5 years.

It is important to remember that statistics on the survival rates for people with testicular cancer are only an estimate. They cannot tell an individual person if cancer will or will not shorten their life. Instead, these statistics describe trends in groups of people previously diagnosed with the same disease, including specific stages of the disease.

The 5-year relative survival rate for testicular cancer in the United States is 95%.

The survival rates for testicular cancer vary based on several factors. These include the stage of cancer, a person’s age and general health, and how well the treatment plan works.

The survival rate is higher for people diagnosed with early-stage cancer and lower for those with later-stage cancer. For testicular cancer that has not spread beyond the testicles (stage 1), the 5-year relative survival rate is 99%.

For testicular cancer that has spread to the lymph nodes in the back of the abdomen, called the retroperitoneal lymph nodes, the 5-year relative survival rate is 96%. But this depends on the size of the lymph nodes with cancer.

For testicular cancer that has spread outside the testicles to areas beyond the retroperitoneal lymph nodes, such as to the lungs or other organs, the 5-year relative survival rate is 73%.  

Experts measure relative survival rate statistics for testicular cancer every 5 years. This means the estimate may not reflect the results of advancements in how testicular cancer is diagnosed or treated from the last 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publications, Cancer Facts & Figures 2023 and Cancer Facts & Figures 2020, the ACS website, the International Agency for Research on Cancer website, and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. (All sources accessed March 2023.)

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by testicular cancer. Use the menu to choose a different section to read in this guide.

Testicular Cancer - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 08/2022

ON THIS PAGE: You will find drawings of the main body parts affected by testicular cancer. Use the menu to see other pages.

This illustration shows a cross section of a man’s testicle, or testis, which is a rounded organ, located under the penis in a sac-like pouch. At the top of each testis is the epididymis, a tightly coiled tube. The head of the epididymis connects to the testis through a series of ducts, ductuli efferentes, ending at the mediastinum. The tail of the epididymis connects to the ductus deferens. The spermatic cord surrounds the epididymis and ductus deferens and the blood vessels that nourish the testis. Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk Factors. It describes the factors that may increase the chance of developing testicular cancer. Use the menu to choose a different section to read in this guide.

Testicular Cancer - Risk Factors

Approved by the Cancer.Net Editorial Board, 08/2022

ON THIS PAGE: You will find out more about the factors that increase the chance of developing testicular cancer. Use the menu to see other pages.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors can raise a person’s risk of developing testicular cancer. However, it is important to note that the cause of testicular cancer is not known.

  • Age. More than half of the people who are diagnosed with testicular cancer are between age 20 and 45. However, this disease can occur at any age, including in the teen years and well after age 45, so it is important that any symptoms of testicular cancer are checked out by a doctor

  • Cryptorchidism. Cryptorchidism is an undescended testicle, meaning that 1 or both testicles do not move down into the scrotum before birth. People with this condition have a higher risk of developing testicular cancer. This risk can be lowered by fixing the condition surgically. Some doctors recommend surgery for cryptorchidism between ages 6 months and 15 months to reduce the risk of infertility. Infertility is the inability to produce children. Because cryptorchidism is often fixed at a very young age, many people may not know if they had the condition.

  • Family history. Having a close relative, particularly a sibling, who has had testicular cancer brings an increased risk of developing testicular cancer.

  • Personal history. Having had cancer in 1 testicle brings an increased risk of developing cancer in the other testicle. It is estimated that out of every 100 people with testicular cancer, 2 will develop cancer in the other testicle.

  • Race. Although people of any race can develop testicular cancer, White people are more likely than those of other races to be diagnosed with testicular cancer. Testicular cancer is rare in Black people. However, Black people with testicular cancer are more likely to die of the cancer than White people, particularly if the cancer has spread to the lymph nodes or other parts of the body when it is diagnosed.

  • Human immunodeficiency virus (HIV). HIV or acquired immune deficiency syndrome (AIDS) caused by HIV slightly raises the risk of developing seminoma.

The next section in this guide is Screening. It explains how tests may find cancer before signs or symptoms appear. Use the menu to choose a different section to read in this guide.

Testicular Cancer - Screening

Approved by the Cancer.Net Editorial Board, 08/2022

ON THIS PAGE: You will find out more about screening for testicular cancer. You will also learn the risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

  • Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

  • Lower the number of people who develop the disease

Learn more about the basics of cancer screening.

Screening information for testicular cancer

Most often, testicular cancer can be found at an early stage. Many people find the cancer themselves while performing a self-examination. Or a sexual partner may notice a change that leads to a diagnosis.

Some doctors recommend a monthly self-examination to find any changes from age 15 to 55. Monthly testicular self-examinations, performed after a warm shower, can help find the cancer at an early stage, when it is more likely to be successfully treated. People who notice a lump, hardness, enlargement, pain, or any other change in 1 or both of their testicles should visit their doctor immediately.

The next section in this guide is Symptoms and Signs. It explains what changes or medical problems testicular cancer can cause. Use the menu to choose a different section to read in this guide.

Testicular Cancer - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 08/2022

ON THIS PAGE: You will find out more about changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with testicular cancer may experience a variety of symptoms or signs. Symptoms are changes that you can feel in your body. Signs are changes in something measured, like by taking your blood pressure or doing a lab test. Together, symptoms and signs can help describe a medical problem. Sometimes, people with testicular cancer do not have any of the symptoms and signs described below. Or, the cause of a symptom or sign may be a medical condition that is not cancer. Therefore, having these symptoms does not mean that a person definitely has cancer.

Usually, an enlarged testicle or a small lump or area of hardness are the first signs of testicular cancer. Any lump, enlargement, hardness, pain, or tenderness should be evaluated by a doctor as soon as possible. Other symptoms of testicular cancer usually do not appear until after the cancer has spread to other parts of the body.

Symptoms of testicular cancer may include:

  • A painless lump or swelling on either testicle. If found early, a testicular tumor may be about the size of a pea or a marble, but it can grow much larger.

  • Pain, discomfort, or numbness in a testicle or the scrotum, with or without swelling.

  • Change in the way a testicle feels or a feeling of heaviness in the scrotum. For example, 1 testicle may become firmer than the other testicle. Or testicular cancer may cause the testicle to grow bigger or to become smaller.

  • Dull ache in the lower abdomen or groin

  • Sudden buildup of fluid in the scrotum

  • Breast tenderness or growth. Although rare, some testicular tumors make hormones that cause breast tenderness or growth of male breast tissue, a condition called gynecomastia.

  • Lower back pain, shortness of breath, chest pain, and bloody sputum or phlegm can be symptoms of later-stage testicular cancer.

  • Swelling of 1 or both legs or shortness of breath from a blood clot can be symptoms of testicular cancer. A blood clot in a large vein is called deep venous thrombosis or DVT. A blood clot in an artery in the lung is called a pulmonary embolism and causes shortness of breath. For some young or middle-aged people, developing a blood clot may be the first sign of testicular cancer.

Many symptoms and signs of testicular cancer are similar to those caused by noncancerous conditions. These conditions are discussed below:

  • Change in size or a lump in a testicle

    • A cyst called a spermatocele that develops in the epididymis. The epididymis is a small organ attached to the testicle that is made up of coiled tubes that carry sperm away from the testicle.

    • An enlargement of the blood vessels from the testicle called a varicocele.

    • A buildup of fluid in the membrane around the testicle called a hydrocele.

    • An opening in the abdominal muscle called a hernia.

  • Pain

    • Infection. Infection of the testicle is called orchitis. Infection of the epididymis is called epididymitis. If infection is suspected, a patient may be given a prescription for antibiotics. If antibiotics do not solve the problem, tests for testicular cancer are often needed.

    • Injury

    • Twisting

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If testicular cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. Managing symptoms may also be called "palliative care" or "supportive care." It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

Testicular Cancer - Diagnosis

Approved by the Cancer.Net Editorial Board, 08/2022

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

How testicular cancer is diagnosed

There are many tests used for diagnosing testicular cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

If you develop a testicular lump or something else that could be testicular cancer, it is important to see your primary care doctor. After this visit, your doctor may refer you to a urologist for more tests. A urologist is a doctor who specializes in treating testicular cancer and other conditions of the urinary tract.

A physical examination and an ultrasound are usually the first tests performed. If they show an abnormality that appears to be a tumor, then blood tests are done. In addition, the testicle may need to be surgically removed to look for signs of cancer. More details on each test are below.

Physical examination. The doctor will feel the testicles for any sign of swelling, tenderness, or hardening. The doctor will also feel the abdomen, neck, upper chest, armpits, and groin for evidence of enlarged lymph nodes, which may indicate that a cancer has spread. The breasts and nipples will also be examined to look for growth, and the legs will be examined for swelling. Leg swelling can be from blood clots in veins in the legs, pelvis, or abdomen.

Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. The sound waves produced by the ultrasound bounce off tissue in the scrotum. The echoes of the sound waves produce a series of images called a sonogram. These images of the testicle help the doctor find any tumors or other abnormalities. If there is a tumor large enough to be seen on an ultrasound, then the sonogram will show the size, location, and solidness of the tumor. A solid tumor inside the testicle is very likely to be cancerous.

Blood tests/tumor markers. The levels of serum tumor markers are measured before surgery to remove a testicle. Tumor markers are substances made by a cancer that are found at abnormally high levels in the blood of some people with cancer. Different types of cancer make different tumor markers. For testicular cancer, serum tumor marker levels are used to find out the cancer’s stage (see Stages) and to confirm whether a tumor is a pure seminoma (see Introduction). The following tumor markers are used to help stage and plan treatment for testicular cancer:

  • Alpha-fetoprotein (AFP). The AFP level is often, but not always, elevated in people with non-seminoma. AFP is not made by seminomas, so an increased level of AFP is a sign that the tumor is not a pure seminoma.

  • Beta human chorionic gonadotropin (beta-hCG). Beta-hCG is often, but not always, elevated in people with seminoma or non-seminoma. However, beta-hCG levels above 1,000 IU/L generally indicate that the cancer is a non-seminoma and not a seminoma.

Elevated levels of these tumor markers may indicate testicular cancer or another type of cancer. However, it is possible to have testicular cancer and have normal tumor marker levels. It is also possible to have elevated levels of these markers without having cancer.

Other tumor markers that may be used for testicular cancer include:

  • Lactate dehydrogenase (LDH). LDH is only used to determine how much chemotherapy to give for metastatic non-seminoma (see Types of Treatment). This is because many other cancers and non-cancerous conditions can increase LDH levels. LDH is not used to find testicular cancer.

  • Placental alkaline phosphatase (PLAP). PLAP is another tumor marker doctors may test for, although it is not commonly measured.

AFP, beta-hCG, and LDH levels will be tested regularly before and during the active treatment period to monitor the cancer. These tumor markers will also be tested at regular times during follow-up care (see the Follow-up Care section) after treatment is completed.

Learn more about ASCO's recommendations for tumor markers in adults with germ cell tumors. (Please note that this link takes you to a different ASCO website.)

Orchiectomy/surgical pathology tests. If testicular cancer is suspected, a surgeon will perform a radical inguinal orchiectomy. During this surgery, the entire testicle is removed through an incision in the groin. Then, a pathologist will examine very thin slices of tissue from the testicle under a microscope to diagnose the type of cancer. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. For testicular cancer, the pathologist determines if the tissue from the testicle contains cancer cells. If it does, the pathologist determines what type of cancer cells they are. Most testicular cancers are germ cell tumors, which are divided into 2 categories: seminoma and non-seminoma (see the Introduction for more information). If a person has only 1 testicle to begin with or the diagnosis is uncertain, the surgeon may remove only a small sample of tissue from the testicle. The testicle may still need to be removed if there are cancer cells. If the tissue sample does not show cancer, it may be possible to repair the damage from the tissue removal and replace the testicle in the scrotum during the same surgery. However, this procedure is very rarely done.

Other tests

If cancer is found, other tests will be needed to determine the stage of the cancer and find out if it has spread to other parts of the body (see Stages). Usually, doctors recommend imaging tests of the abdomen, pelvis, and chest. Imaging tests show pictures of the inside of the body. Images of the brain or bones are not as common but may be needed for some patients. This can include patients who have cancer that has spread widely, those who have a type of non-seminoma called choriocarcinoma, and those who have very high tumor marker levels of AFP or beta-hCG (see above).

X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. A chest x-ray is used to determine the stage of the cancer and for follow-up screening. If a more detailed picture of the lungs is needed, the doctor may recommend a chest CT scan (see below). But in many situations, an x-ray is preferred because it uses less radiation.

Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image of the body. This can help doctors find any abnormalities or tumors. If a tumor is visible on the CT pictures, the scan can be used to measure the tumor’s size. Often, a special dye called a contrast medium is given before the scan to provide a clearer image. Some dyes are injected into a patient’s vein, while others are given as a pill or liquid to swallow. Many times, both types of dye are given before a CT scan because they help your health care team see different parts of the body. A CT scan can be used to evaluate the abdomen, pelvis, chest/lungs, brain and other areas. A CT scan of the brain is rarely needed for testicular cancer because it is uncommon for this type of cancer to spread to the brain. However, if a scan of the brain is needed, MRI (see below) is generally preferred because the bones of the skull interfere with the ability of CT scans to show certain parts of the brain.

Magnetic resonance imaging (MRI) scan. An MRI scan uses magnetic fields to create a 3-dimensional picture of the inside of the body. An MRI can be used to measure the tumor’s size. For testicular cancer, MRI scans have recently begun to be used as an alternative to CT scans for imaging the abdomen and pelvis in patients who prefer to avoid CT scans, particularly for those undergoing surveillance for stage I seminoma. This depends on whether an MRI scanner is available as well as a radiologist with expertise in interpreting MRI scans. MRI scans are generally preferred to CT scans for examining the brain or the spine. A contrast medium is given before the scan to create a clearer picture. This dye is injected into a patient’s vein. For testicular cancer, CT scans (see above) are used more often than MRI scans for viewing the abdomen and pelvis because accurately reading MRI scans of the abdomen and pelvis requires more experience than reading CT scans. When MRIs of the abdomen are needed, contrast medium may be given as a pill or liquid to swallow.

MRI scanning of the brain and/or spine is used only in specific situations. For instance, an MRI of the brain might be recommended if a patient has symptoms or changes on a physical exam that suggest that the cancer may have spread to the brain. In addition, brain MRIs are often recommended for poor-risk metastatic testicular cancer (see Stageswith very high serum tumor markers or if the cancer has spread to the liver, to the bones, or extensively to the lungs. Spine MRI scans are only ordered if there is reason to suspect that the cancer has spread to the spine, which is not common in testicular cancer. Your doctor will explain which test is appropriate for you.

Positron emission tomography (PET) or PET-CT scan. PET scans are not generally used for testicular cancer. When PET scans are done, they are usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use more energy than healthy tissue, it absorbs more of the radioactive sugar. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects the sugar to produce images showing where the cancer is in the body. Studies of PET scans have shown that they are not helpful for diagnosing or staging testicular cancer and should not be used at these times. However, they can be helpful in cases of metastatic pure seminoma that does not entirely disappear after chemotherapy. In such instances, if a PET scan is planned, it should not be done until at least 6 weeks after chemotherapy ends.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Occasionally, a biopsy may be taken from the lung, retroperitoneum, or other location in the body if it appears that cancer may have spread.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

Testicular Cancer - Stages

Approved by the Cancer.Net Editorial Board, 08/2022

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

What is cancer staging?

Staging is a way of describing if and where a cancer has spread. Doctors use diagnostic tests, including computed tomography (CT) scans and blood tests, to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor recommend the best kind of treatment, and it helps predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

This page provides detailed information about the system used to find the stage of testicular cancer and the stage groups for testicular cancer, such as stage II or stage III.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. For testicular cancer, an S is added to the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes in the back of the abdomen (retroperitoneum)?

  • Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?

  • Serum tumor marker (S): Are the serum tumor markers alpha-fetoprotein (AFP), beta human chorionic gonadotropin (beta-hCG), and lactate dehydrogenase (LDH) elevated (see Diagnosis)? If so, how high are they?

The results are combined to determine the stage of cancer for each person. There are 3 stages of testicular cancer: stages I, II, and III (1, 2, and 3). The stage provides a common way of describing how advanced the cancer is so that doctors can work together to plan the best treatment. Stage I is the least advanced or earlier stage, and stage III is the most advanced or later stage. Patients with the least advanced stages are more likely to be cured and often need less aggressive treatment than patients with a more advanced stage.

Staging for testicular cancer can also be clinical or pathological:

  • Clinical staging is based on the results of tests other than surgery or biopsy, which may include physical examinations and imaging tests (see Diagnosis). For example, clinical stage II testicular cancer means that the retroperitoneal lymph nodes are enlarged when viewed with a CT or magnetic resonance imaging (MRI) scan.

  • Pathological staging is based on what is found during surgery. For example, pathological stage II testicular cancer means that cancer has been found when tissue removed from the retroperitoneal lymph nodes is examined under a microscope. In general, pathological staging provides the most information to determine a patient’s prognosis, but this type of staging is not always needed.

  • It may be helpful to note that nearly all people with testicular cancer are diagnosed by having a testicle removed. The difference between clinical staging and pathological staging in testicular cancer mainly depends on whether or not surgery was performed to remove retroperitoneal lymph nodes (this is called a retroperitoneal lymph node dissection or RPLND; see Types of Treatment). Imaging scans can only show whether or not the lymph nodes are enlarged or if there is a mass somewhere. Normal-size lymph nodes may contain cancer, and enlarged lymph nodes may not contain cancer. Surgery or biopsies can prove whether cancer is present in a lymph node or mass. This means that people with clinical stage I cancer have had surgery to remove the cancerous testicle and there is no evidence of metastatic cancer on imaging studies, such as CT scans (see Diagnosis), and blood tests. People with pathological stage I cancer have no evidence of metastatic cancer in imaging scans and blood tests and have also had a RPLND that found no cancer in the lymph nodes. Similarly, people with clinical stage II cancer have enlarged retroperitoneal lymph nodes in imaging scans and people with pathological stage II cancer have cancerous lymph nodes found during surgery.

Here are more details on each part of the TNM system for testicular cancer:

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Tumor size is measured in centimeters (cm). A centimeter is roughly equal to the width of a standard pen or pencil.

Stage may also be divided into smaller groups that help describe the tumor in even more detail. For testicular cancer, the T stage can only be determined when tissue removed during surgery is examined under a microscope. This means that the T stage is only determined after the testicle is removed, and the T stage is always a pathological stage and never a clinical stage. The “p” before the T stage indicates that it is a pathological stage. Specific tumor stage information is below.

pTX: The primary tumor cannot be evaluated. If the testicle(s) have not been surgically removed, the term "TX" is used.

pT0 (T zero): There is no evidence of a primary tumor in the testicles.

pTis: This stage describes germ cell neoplasia in situ (GCNIS). This is a precancerous condition in which there are germ cells that appear cancerous but are not yet behaving the way cancer cells do. GCNIS becomes cancer when the cells grow into parts of the testicle(s) where they do not normally belong.

pT1: The primary tumor is only in the testicle, which may include the rete testis. It has not grown into blood vessels or lymph vessels in the testicles. The tumor may have grown into the inner membrane layer surrounding the testicle, called the tunica albuginea. It has not spread to the outer membrane layer surrounding the testicle, called the tunica vaginalis.

For a pure seminoma, this stage is further divided based on the size of the tumor:

  • pT1a. The tumor is smaller than 3 centimeters (cm).

  • pT1b. The tumor is 3 cm or larger.

pT2: The tumor is in the testicle, which may include the rete testis, and it has grown into 1 or more of the following parts of the testicle:

  • Blood vessels or lymphatic vessels in the testicle

  • The epididymis

  • The fatty tissue next to the epididymis, called the hilar soft tissue

  • The tunica vaginalis

pT3: The tumor has grown into the spermatic cord.

pT4: The tumor has grown into the scrotum.

Node (N)

The “N” in the TNM staging system stands for lymph nodes. These small, bean-shaped organs help fight infection. Lymph is a fluid that flows from the different tissues and organs of the body and eventually drains into the bloodstream. It passes through specialized tubes called lymphatic vessels and is filtered along the way by the lymph nodes. Cancer cells often build up and grow in lymph nodes before they spread to other parts of the body.

The first place the lymphatic fluid from the testicles drains to is the retroperitoneal lymph nodes located in the back of the abdomen in front of the spine, an area called the retroperitoneum. These are called the regional lymph nodes for testicular cancer.

Lymph nodes in the pelvis, chest, or other parts of the body are called distant lymph nodes, even though the testicles are closer to the pelvis than to the retroperitoneum.

For testicular cancer, lymph nodes usually are not biopsied or removed. Instead, the N stage (lymph node stage) is most often estimated by using CT scans. N stage that is based on CT scans is the clinical stage. When the N stage is based on a biopsy or removal of the lymph nodes (such as with a retroperitoneal lymph node dissection, or RPNLD), it is the pathological stage. When a stage has been determined pathologically, the letter “p” is added as the first letter of the stage (for example pN1). The letter "c" stands for clinical stage.

NX: The regional lymph nodes cannot be evaluated.

cN0 (N zero): There is no spread to regional lymph nodes as seen on imaging tests.

pN0 (N zero): There is no cancer found in lymph nodes removed during a RPLND.

cN1: Imaging tests show signs that the cancer has spread to 1 or more lymph nodes in the retroperitoneum. None of the lymph nodes are bigger than 2 cm.

pN1: There is cancer in 1 to 5 lymph nodes, and none is larger than 2 cm.

cN2: Imaging tests show at least 1 enlarged lymph node or lymph node mass in the retroperitoneum that is larger than 2 cm but not larger than 5 cm.

pN2: Either or both of the following conditions:

  • There is cancer in more than 5 lymph nodes, but none is larger than 5 cm.

  • There is cancer in at least 1 lymph node, and the largest lymph node or lymph node mass is between 2 cm and 5 cm in size.

cN3: Imaging tests show at least 1 enlarged lymph node or a lymph node mass in the retroperitoneum larger than 5 cm.

pN3: There is cancer in at least 1 enlarged lymph node or lymph node mass that is larger than 5 cm.

Metastasis (M)

The "M" in the TNM system describes whether the cancer has spread to other parts of the body, called metastasis. When testicular cancer spreads, it most commonly spreads to the lung and the lymph nodes of the chest, pelvis, and the base of the neck. More advanced stages may have spread to the liver and bones. Testicular cancer rarely spreads to the brain unless the primary tumor is a choriocarcinoma.

MX: Metastasis cannot be evaluated.

M0 (M zero): The disease has not metastasized to distant lymph nodes or other organs.

M1: There is at least 1 area of metastasis.

  • M1a: There is cancer in the lungs or lymph nodes other than the retroperitoneal lymph nodes.

  • M1b: The cancer has spread to organs other than a lung. The lungs may or may not also be involved. For example, a testicular cancer that has spread to the liver or the bones is stage M1b.

Serum tumor markers (S)

Serum tumor markers also help to stage testicular cancer. Blood tests for tumor markers will be done before and after surgical removal of the testicle(s). Tumor marker levels usually decrease after the surgery. Generally, the levels need to be tested until they stop decreasing or begin to rise to determine the correct "S" stage. For patients who will receive chemotherapy, the tumor marker levels on the first day of chemotherapy are used to determine the risk group (see below).

SX: Tumor marker levels are not available, or the tests have not been done.

S0 (S zero): Tumor marker levels are normal.

S1: At least 1 tumor marker level is above normal.

  • LDH is less than 1.5 times the upper limit of the normal range

  • Beta-hCG is less than 5,000 mIu/mL

  • AFP is less than 1,000 ng/mL

S2: At least 1 tumor marker level is substantially above normal.

  • LDH is 1.5 to 10 times the upper limit of the normal range

  • Beta-hCG is 5,000 to 50,000 mIu/mL

  • AFP is 1,000 to 10,000 ng/mL

  • None of the tumor markers is elevated high enough to qualify as S3 (see below)

S3: At least 1 or more tumor marker level is very highly elevated.

  • LDH is more than 10 times the upper limit of the normal range

  • Beta-hCG is more than 50,000 mIu/mL

  • AFP is more than 10,000 ng/mL

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Stage groups for testicular cancer

Doctors combine the T, N, and M classifications and the S level information to say what stage the cancer is.

Stage 0: Refers to carcinoma in situ, also called intratubular germ cell neoplasia. (pTis, N0, M0, S0)

Stage I: Cancer is at any T level, and there is no evidence of spread to either lymph nodes or other organs. Serum tumor marker levels have not been done or are not available.

  • Stage IA: The cancer is only in the testicle. It may have grown into the rete testis, but it has not grown into the epididymis, hilar soft tissue, or lymphatic or blood vessels in the testis. It has not spread to lymph nodes or distant sites. The tumor in the testis may have grown into the inner membrane surrounding the testis, called the tunica albuginea, but not the outer membrane, called the tunica vaginalis. Serum markers are normal. (pT1, N0, M0, S0)

  • Stage IB: The testicular tumor has grown into the epididymis, hilar soft tissue, tunica vaginalis, the blood or lymphatic vessels within the testicle, the spermatic cord, or the scrotum. The cancer has not spread to lymph nodes or distant sites. Serum markers are normal. (pT2, pT3, or pT4, and N0, M0, S0)

  • Stage IS: Cancer is of any T stage and has not spread to lymph nodes or distant sites. Serum markers remain higher than normal levels after the cancerous testicle has been removed. Stage IS non-seminoma testicular cancer is treated the same as stage III testicular cancer. Stage IS pure seminomas are rare, and it is not known how they are best treated. (any T, N0, M0, and S1–S3)

Stage II: The cancer has spread to any number of regional lymph nodes but not to lymph nodes in other parts of the body or distant organs. Serum markers are unavailable.

  • Stage IIA: Cancer has spread to retroperitoneal lymph nodes, either clinical or pathological stage N1, but none is larger than 2 cm. If a lymph node dissection has been done, no more than 5 lymph nodes contain cancer. In addition, serum tumor marker levels are normal or only slightly high. There are no signs of cancer having spread anywhere other than the retroperitoneum. (any T, N1, M0, S0 or S1)

  • Stage IIB: Cancer has spread to lymph nodes in the retroperitoneum, and the largest lymph node with cancer or lymph node mass is between 2 cm and 5 cm in size. If a lymph node dissection has been done, cancer has spread to at least 1 lymph node (or lymph node mass) between 2 cm and 5 cm or to more than 5 lymph nodes, with none larger than 5 cm. Serum marker levels are normal or slightly high. There is no evidence of cancer having spread anywhere other than the retroperitoneum. (any T, N2, M0, S0 or S1)

  • Stage IIC: Cancer has spread to at least 1 lymph node (or lymph node mass) that is larger than 5 cm. Serum marker levels are normal or slightly high. There is no evidence of cancer having spread anywhere other than the retroperitoneum. (any T, N3, M0, S0 or S1)

Stage III: Cancer has spread to distant lymph nodes or to any organ. Serum tumor marker levels vary depending on the subgroup.

  • Stage IIIA: Cancer has spread to distant lymph nodes and/or the lungs. Serum marker levels are normal or only mildly increased. (any T, any N, M1a, S0 or S1)

  • Stage IIIB: Cancer has spread to any lymph nodes and/or the lungs but not to any other organs. At least 1 serum marker is substantially elevated. (any T, N1–N3, M0, S2; or any T, any N, M1a, S2)

  • Stage IIIC: Either or both of the following:

    • At least 1 serum marker is extremely high, and the cancer has spread to at least 1 lymph node or organ. (any T, N1–N3, M0, S3, or any T, any N, M1a, S3)

    • The cancer has spread to an organ other than the lungs. (any T, any N, M1b, any S)

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017), published by Springer International Publishing.

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Risk groups for later-stage testicular cancer

If the disease has spread to lymph nodes or other organs, the following system is used to classify a germ cell tumor into a good, intermediate, or poor risk group. This helps to determine the treatment plan and the likelihood of cure. Patients with a tumor in the intermediate and poor risk groups usually receive more chemotherapy than patients with a tumor in the good risk group.

The differences between good, intermediate, and poor risk are the same as the differences between stage IIIA (good risk), stage IIIB (intermediate risk), and stage IIIC (poor risk), as described above.

Good risk

  • Non-seminoma. The cancer has not spread to an organ other than the lungs. Serum tumor marker levels are normal or slightly elevated, which means:

    • AFP less than 1,000 ng/mL

    • Beta-hCG less than 5,000 iU/L

    • LDH less than 1.5 times the upper limit of the normal range (in practice, most experts use a higher cutoff point for LDH, 3 times the upper limit, to distinguish good risk from intermediate risk nonseminomas)

  • Seminoma. The cancer has not spread to an organ other than the lungs.

Intermediate risk

  • Non-seminoma. The cancer has not spread to an organ other than the lungs. The serum tumor marker levels are intermediate, which means:

    • AFP between 1,000 and 10,000 ng/mL

    • Beta-hCG between 5,000 and 50,000 iU/L

    • LDH between 1.5 and 10 times the upper limit of the normal range (in practice, most experts use between 3 and 10 times the upper limit to categorize LDH levels as intermediate risk, because mildly elevated LDH can be caused by many different conditions and may not be related to cancer)

  • Seminoma. The cancer has spread to an organ other than the lungs.

Poor risk

  • Non-seminoma. The cancer has spread to an organ other than the lungs or the serum tumor marker levels are poor, which means:

    • AFP is 10,000 ng/mL or higher

    • Beta-hCG is 50,000 iU/L or higher

    • LDH is 10 times the upper limit of the normal range or higher

  • Seminoma. There is no poor risk category for seminoma.

Source: Journal of Clinical Oncology.

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Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

Testicular Cancer - Types of Treatment

Approved by the Cancer.Net Editorial Board, 08/2022

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with testicular cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for testicular cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How testicular cancer is treated

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For testicular cancer, this team includes a urologist and a medical oncologist. A medical oncologist is a doctor who specializes in treating cancer with medication. Sometimes, patients may also see a radiation oncologist. A radiation oncologist is a doctor who specializes in giving radiation therapy to treat cancer. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. The first treatment for testicular cancer is usually surgery to remove the testicle. In rare cases, chemotherapy is given first if the cancer has already spread beyond the testicle when diagnosed and the patient's condition is unstable and requires urgent treatment of the metastatic disease.

After surgery, chemotherapy or radiation therapy may be recommended. Germ cell tumors are highly sensitive to chemotherapy and are usually curable even if the cancer has spread. But chemotherapy is not very effective for a specific type of germ cell tumor called a teratoma. This type needs to be removed with surgery. Because many non-seminomas are a mixture of teratoma and other types of germ cell tumor, successful treatment often requires chemotherapy followed by surgery to remove any of the remaining tumor.

Radiation therapy may be recommended to treat early-stage seminoma or cancer that has spread to the brain.

People with testicular cancer usually have concerns about how their treatment will affect their sexual health and fertility, as well as their quality of life. Discuss these topics with your doctor before treatment begins because there is often more than 1 treatment option available. The final choice of a treatment plan depends on your specific situation.

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Learn more about making treatment decisions.

The common types of treatments used for testicular cancer are described below, followed by treatment options by the cancer’s stage. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

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Surgery

Surgery for cancer involves the removal of the tumor and, sometimes, some surrounding healthy tissue during an operation. For testicular cancer, the diagnosis is most often made by removing the cancerous testicle through an incision in the groin. This is called a radical inguinal orchiectomy. In addition to a radical orchiectomy, other types of surgery may be done for testicular cancer at different times in the treatment schedule. Each of these types of surgery is described below. Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery.

Radical inguinal orchiectomy

Treatment of testicular cancer usually starts with surgery to remove the testicle with cancer, called a radical inguinal orchiectomy. This operation is done through an incision in the groin along the beltline. During the surgery, the entire testicle and most of the spermatic cord are removed. The spermatic cord contains the blood supply to the testicle and the channel through which sperm travel from the testicle toward the penis.

Cancer may develop in both testicles at the same time or at different times. However, this is rare, occurring in about 2% of people with testicular cancer. Then, both testicles usually need to be removed in a procedure called a bilateral orchiectomy. In some cases where testicular cancer is in both testicles, testicle-sparing surgery can be performed on one side so that part of 1 testicle remains, but this is not commonly done.

Orchiectomy is used to diagnose and treat both early-stage and later-stage seminoma and non-seminoma. For later-stage cancer, a radical inguinal orchiectomy may, occasionally, not be done until treatment with chemotherapy has finished (see "Chemotherapy," below).

If a decision is made to perform an orchiectomy, a sample of blood will be collected before surgery to test for levels of serum tumor markers because they are often helpful in planning treatment and follow-up care. (See Diagnosis for more information about serum tumor markers.) For example, increasing or consistently high alpha-fetoprotein (AFP) or beta human chorionic gonadotropin (beta-hCG) after surgery is a sign that the cancer has spread. In this situation, a patient usually needs chemotherapy (see below), even if the metastases cannot be seen on imaging tests.

Side effects of orchiectomy

The removal of 1 testicle usually does not affect the body's testosterone level if there is still another testicle and it is normal size. When testosterone level is reduced, symptoms may include depression or other mood changes, fatigue, decreased sex drive, inability to achieve a normal erection, and hot flashes, as well as loss of muscle and bone mass in the long term. People with low testosterone levels after orchiectomy can be treated with supplemental testosterone.

Orchiectomy is unlikely to make someone unable to produce a biological child because the remaining testicle will still produce sperm. However, about 25% of people with testicular cancer are infertile even before they are diagnosed with cancer. It appears that the cancer itself and/or factors that contributed to the development of the cancer may cause some people to become infertile. Sperm counts often improve after the testicle with cancer is removed.

If both testicles are removed, the body will no longer produce sperm or testosterone and the person will not be able to biologically produce children. If the doctor recommends removing both testicles or the testicle in someone with 1 testicle, semen is usually analyzed before surgery to evaluate sperm count and function. If adequate numbers of functional sperm are present, then sperm banking is usually recommended, so that producing children in the future may be a possibility. In addition, testosterone replacement therapy will be needed if both testicles are removed. Learn more about preserving fertility and sexual health.

Reconstructive surgery after orchiectomy

Patients can decide if they want an artificial or prosthetic testicle implanted in the scrotum. A prosthetic testicle generally has a weight and texture that is similar to a normal testicle but not exactly the same. Some people find that a prosthetic testicle is uncomfortable, and some prefer not to have one at all. You are encouraged to talk with your doctor about whether you want one and the best timing for this implantation, if wanted. Some people prefer to wait until after the active treatment period is over to give this option full consideration.

Surveillance after orchiectomy

After having a radical inguinal orchiectomy, an option for people with clinical stage I testicular cancer (seminoma or non-seminoma) may be surveillance. The advantage of surveillance is that patients may avoid additional treatment that may not be needed. With surveillance, the patient is monitored closely, and active treatment begins only if the cancer recurs. This option involves regular doctor appointments for physical examinations, blood tests for tumor markers, computed tomography (CT) scans, and chest x-rays. This approach requires dedication by the doctor and patient to stick to the surveillance schedule so that any recurrence can be detected at an early stage. It is only considered as an option if AFP and beta-hCG levels are normal or return to normal after the testicle with cancer is removed.

The main advantage of surveillance is that it avoids any further treatment after orchiectomy — such as chemotherapy, radiation therapy, or additional surgery — for the 82% of patients with seminoma and 75% of patients with non-seminoma who will not have the disease return after orchiectomy. For an individual patient, the risk of recurrence may be higher or lower based on risk factors determined by the pathologist’s examination of the tumor after the testicle has been removed.

Retroperitoneal lymph node dissection (RPLND)

This is surgery to remove the retroperitoneal lymph nodes, which lie at the back of the abdomen in front of the spine. RPLND is usually performed as an open operation with an incision, or cut, down the middle of the abdomen. RPLND is a complex surgery requiring experience and skill to remove all of the appropriate lymph nodes and to lessen the side effects of the operation. RPLND should only be done by a surgeon who is highly experienced with this operation. Some surgeons perform laparoscopic RPLND, which uses several smaller incisions instead of the 1 large incision, but that approach is still being studied, requires a surgeon skilled in the procedure, may not be as effective, and may have risks.

Read below to learn more about when RPLND may be used.

RPLND for stage I and IIA non-seminoma

RPLND as a main treatment for stage I and stage IIA non-seminoma helps reduce the risk of recurrence and is used to stage the cancer. About 25% of patients with clinical stage I non-seminoma who have an RPLND are found to have lymph nodes with cancer, which means they have stage II disease. Doctors are now able to better determine which stage I tumors are more likely to have spread to the lymph nodes or beyond, based on the results of the pathology tests performed on the tumor in the testicle after it is removed. Decisions about whether to have an RPLND may be based on the patient’s risk factors. RPLND is a reasonable treatment option when a patient can see a urologist with extensive experience with RPLND. If an RPLND is chosen for stage I non-seminoma, it is usually done within 6 weeks after orchiectomy.

If 5 or fewer lymph nodes have cancer and none is larger than 2 cm (pN1), this surgery alone is successful for 80% to 90% of patients, while about 10% to 20% of patients will have a recurrence. If more lymph nodes have cancer (pN2 or pN3), surgery alone is successful for about 50% of patients, while the other 50% will have a recurrence. The advantage of the RPLND is that it can cure most patients with small amounts of cancer in the lymph nodes, provide a more accurate assessment of the extent of disease, and avoid the need for frequent CT scans of the abdomen during follow-up care. It also reduces the chance that someone with early-stage (stage I) testicular cancer will need chemotherapy.

Just as RPLND may show cancer in lymph nodes that appeared normal on CT scans for people with clinical stage I non-seminoma, surgery may also show that there is no cancer in lymph nodes that were enlarged on a CT scan, called clinical stage II disease. For people with clinical stage IIA testicular non-seminomas, as many as 20% to 30% will actually have pathological stage I cancer, meaning that the cancer has not spread to any lymph nodes. In these situations, RPLND can help avoid unnecessary chemotherapy.

The main disadvantage of this surgery for stage I non-seminoma is that 70% of patients are cured by removing the testicle. For these patients, a RPLND offers no curative benefit, although it does allow the patient to avoid regular CT scans and may offer peace of mind.

Despite the surgery, about 10% of testicular cancers come back even if the lymph nodes were not found to have cancer. If lymph nodes with cancer are found during the RPLND, 2 courses of chemotherapy (see below) can help lower the chance of recurrence to about 1%. However, surveillance is also an option, beginning treatment with chemotherapy only if the cancer recurs. This is because this type of testicular cancer has a greater than 90% chance of being cured with 3 cycles of chemotherapy if the recurrence is diagnosed early through regular monitoring. A study that compared chemotherapy to surveillance for men who had cancer in lymph nodes removed by RPLND found that there was no difference in survival, but chemotherapy did reduce the risk of the cancer coming back. In practice, most centers recommend surveillance after RPLND for pathological stage IIA disease, and chemotherapy after RPLND for pathological stage IIB and IIC disease.

RPLND to remove residual tumors after chemotherapy in patients with non-seminomas

RPLND is recommended for people with stage II or stage III non-seminoma who have retroperitoneal masses that remain after finishing chemotherapy (see below). In people with non-seminoma, any masses larger than 1 cm that remain after chemotherapy are removed, if it is possible. About 35% to 50% of patients having an RPLND will have a mass that contains teratoma. About 10% to 15% will have 1 of the other types of germ cell cancers. The other 35% to 50% will have no cancer or teratoma found and there will only be scarring and/or normal lymph node tissue.

Most experts believe that RPLND after chemotherapy is only needed if there are lymph nodes larger than 1 cm seen on scans taken after chemotherapy ends. However, some treatment centers will perform an RPLND after chemotherapy in those who had enlarged retroperitoneal lymph nodes before chemotherapy, even if the lymph nodes return to less than 1 cm after chemotherapy.

Treatment after post-chemotherapy RPLND depends on what is found at surgery. If only teratoma or benign tissue is found, no additional treatment is given after RPLND. If surgery reveals seminoma, embryonal carcinoma, yolk sac tumor, or choriocarcinoma, 2 additional cycles of chemotherapy are generally recommended after RPLND.

RPLND for stage I and IIA pure seminoma

Historically, RPLND has not been done as primary treatment for seminomas. Recently, a number of centers have been investigating RPLND for clinical stage II seminomas with the goal of sparing patients from undergoing chemotherapy or radiation therapy. However, this approach remains experimental while the results of such treatment are studied. The results thus far indicate that a majority of patients may be cured with RPLND and thus avoid chemotherapy and radiation, but the recurrence rates have been higher than the recurrence rates after chemotherapy or radiation therapy, and we do not yet have long-term follow-up. It is possible that recurrence rates after RPLND will rise with longer follow-up.

RPLND to remove residual tumors after chemotherapy in patients with seminomas

Masses smaller than 3 cm are usually left in place and monitored for changes with CT scans. Patients with pure seminoma who have masses larger than 3 cm after chemotherapy may also have CT scans to monitor the masses for growth. An alternative for patients with masses 3 cm or larger is to get an FDG PET-CT scan after chemotherapy and use the results of the PET scan to guide the treatment plan. If masses light up on the PET scan, surgery is generally used to find out whether the masses contain cancer. Sometimes, residual masses may light up on a PET scan but turn out not to have any cancer when they are removed surgically or biopsied. Therefore, different experts have different opinions on the usefulness of PET scans in this setting.

Side effects of RPLND

Some patients may experience temporary side effects from RPLND, such as bowel obstruction (blockage) or infection. This procedure should not affect the ability to have an erection, orgasm, or sexual intercourse. However, it may cause infertility because it can damage the nerves that control ejaculation, which can cause the inability to ejaculate. RPLND performed after chemotherapy is a more complex surgery and is more likely to cause the loss of ejaculation and other side effects.

Patients are encouraged to consider banking sperm before RPLND for fertility preservation. There are surgical techniques that are usually successful at sparing the nerves involved with ejaculation when RPLND is done as the initial treatment for stage I or stage II cancer. However, these techniques are much less effective when RPLND is done to remove residual masses after chemotherapy. Talk about these concerns with your doctors before surgery.

Other types of surgery to remove cancer remaining after chemotherapy

After chemotherapy (see below), some cancer may still remain in the lungs, liver, or other organs or in the lymph nodes in the pelvis, chest, or neck. For people with non-seminoma, these tumors should also be removed if it is safe to do so. This may involve surgery in more than 1 part of the body. This type of surgery is complex and requires an experienced team of surgeons. If only some of the remaining tumors can be removed, then surgery may not be performed.

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Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Chemotherapy for testicular cancer is given directly into a vein so that it enters the bloodstream and reaches cancer cells throughout the body. There are also types of chemotherapy that can be taken by mouth, but they are not generally used for testicular cancer.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles of treatment given over a set period of time. A cycle of chemotherapy for testicular cancer typically lasts 3 weeks. Testicular cancer may be treated with 1 to 4 cycles of chemotherapy, depending on the stage of the cancer. During treatment, a patient may receive 1 drug at a time or a combination of different drugs given at the same time.

The following drugs are used for testicular cancer, usually in the combinations listed further below. However, the drugs used for testicular cancer change, and drugs other than those mentioned below may be used. Talk with your doctor about your options for chemotherapy.

  • Bleomycin (available as a generic drug)

  • Carboplatin (available as a generic drug)

  • Cisplatin (available as a generic drug)

  • Etoposide (available as a generic drug)

  • Gemcitabine (Gemzar)

  • Ifosfamide (Ifex)

  • Oxaliplatin (Eloxatin)

  • Paclitaxel (available as a generic drug)

  • Vinblastine (available as a generic drug)

The following chemotherapy regimens may be used for testicular cancer.

  • BEP: bleomycin, etoposide, and cisplatin

  • Carboplatin (for stage I pure seminoma only)

  • EP: etoposide and cisplatin

  • TIP: paclitaxel, ifosfamide, and cisplatin

  • VeIP: vinblastine, ifosfamide, and cisplatin

  • VIP: etoposide, ifosfamide, and cisplatin

  • High-dose carboplatin and etoposide

  • Gemcitabine, paclitaxel, and oxaliplatin

In general, later-stage disease is treated with more chemotherapy. The appropriate chemotherapy regimen depends on the stage of the cancer, whether it is a seminoma or a non-seminoma, and whether chemotherapy has previously been used to treat the cancer. In addition, how high AFP and beta-hCG levels are helps the doctor determine how much chemotherapy is needed. Chemotherapy regimens for specific stages are discussed further below.

Learn more about the basics of chemotherapy.

Side effects of chemotherapy

Chemotherapy works very well for testicular cancer but can cause side effects and complications. Common side effects from chemotherapy include fatigue, nausea and vomiting, numbness and tingling in the hands and feet, high-pitch hearing loss, and ringing in the ears. There is also a risk of severe infections, so you should talk with your health care team about what you should do if you develop symptoms of infection. The drug bleomycin is linked with dangerous inflammation in the lungs, so it is important to tell your health care team immediately if you have shortness of breath, difficulty breathing, or a persistent cough. People who received treatment for testicular cancer also have a higher risk of blood clots, particularly when they start treatment with chemotherapy. Tell your health care team right away if you have any signs of a blood clot, such as shortness of breath, chest pain, or swelling in 1 or both legs or arms.

Most side effects from chemotherapy usually go away after treatment is finished, but some can show up much later. These are called late effects. Late effects from chemotherapy for testicular cancer include long-lasting fatigue, heart disease, and second cancers. Recent data indicates that people with testicular cancer who are treated with chemotherapy and/or radiation therapy have a shorter life expectancy, mainly due to an increased risk of death from second cancers. Chemotherapy and radiation therapy have also both been associated with an increased risk of heart and vascular disease.

Balancing the risks and benefits of chemotherapy is an important issue for people with testicular cancer. However, metastatic testicular cancer (see further below) can generally only be cured with chemotherapy. So, for those with metastatic testicular cancer, the benefits of chemotherapy generally greatly outweigh the risks. For people with stage I testicular cancer,  the risks of chemotherapy may outweigh the benefits because overall survival rates for testicular cancer are very high regardless of which treatment is given. Talk with your health care team about the potential short-term and long-term side effects of chemotherapy for testicular cancer.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases.

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Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body.

For testicular cancer, the radiation therapy is generally directed at lymph nodes in the abdomen for stage I or stage II pure seminoma. Sometimes, the radiation therapy is directed at the lymph nodes on the same side of the pelvis as the testicle where the cancer started.

Radiation therapy for stage I seminoma is now used less often. Surveillance or, less commonly, chemotherapy with carboplatin (see above, under Chemotherapy) is usually used instead of radiation therapy as the preferred treatment of stage I seminoma at many treatment centers because of the risk that radiation therapy may cause other cancers and heart disease. However, radiation therapy remains an option for stage I, IIA, and IIB pure seminoma. It is also sometimes used to treat brain metastases from either seminoma or non-seminoma, but testicular cancer rarely spreads to the brain.

Side effects from radiation therapy

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, loose bowel movements, and peptic ulcers. Medications may be helpful to prevent or reduce nausea and vomiting during radiation therapy. Most side effects go away soon after treatment is finished. Radiation therapy may cause problems with sperm production, but this is less common now with newer radiation techniques that can help preserve fertility.

Radiation therapy increases the risk of secondary cancers many years after treatment and may increase the risk of heart problems and gastrointestinal disease. Recent data indicates that people with testicular cancer who are treated with chemotherapy and/or radiation therapy have a shorter life expectancy, mainly due to an increased risk of death from second cancers and from diseases of the digestive system. Talk with your doctor about your risk of long-term side effects before starting radiation therapy.

Learn more about the basics of radiation therapy.

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Treatment by stage of testicular cancer

Different treatments may be recommended for each stage of testicular cancer. The general options by stage are described below. For more detailed descriptions, see “How testicular cancer cancer is treated,” above. Clinical trials may also be a treatment option for each stage. The treatment choices for testicular cancer depend on whether the cancer is a seminoma or non-seminoma (see Introduction) and the stage of the cancer (see Stages). After a physical examination, staging tests, and the removal of the cancerous testicle, you and your doctor will discuss your options and decide on your personal treatment plan.

Clinical stage I non-seminoma testicular cancer

About 75% of patients with clinical stage I non-seminoma are cured when the testicle with cancer is removed. But about 25% of patients will have small areas of metastatic cancer that cannot be seen with CT scans when diagnosed. Over time, these areas can grow unless additional treatment is given after orchiectomy. Most recurrences of stage I non-seminoma occur within 9 months after diagnosis and occur in the retroperitoneum. People with clinical stage I disease have the following options after surgery:

  • Surveillance. This option involves CT scans of the abdomen and pelvis every 3 to 6 months for the first year, every 4 to 12 months in the second year, and every 6 to 12 months in the third to fifth year. Physical examinations and tumor marker tests to measure beta-hCG and AFP are done every 1 to 2 months for the first 12 months, every 2 to 3 months in the second year, every 3 to 4 months in the third and fourth years, every 6 months in the fifth year, and then once a year. A chest x-ray is usually needed at every other visit. If the cancer recurs, 3 cycles of chemotherapy successfully treats the cancer for more than 95% of patients. RPLND may be used to treat recurrent cancer if it is limited to the retroperitoneal lymph nodes.

  • RPLND. As described above, this is surgery to remove the retroperitoneal lymph nodes in the back of the abdomen. After RPLND, the risk of recurrence is about 10% on average if no cancer is found in those lymph nodes. Most recurrences after RPLND occur in the lungs or the lymph nodes in the chest, and they almost always occur within 2 years after the RPLND.

  • Chemotherapy. This option involves receiving chemotherapy shortly after the testicle has been removed surgically, called adjuvant chemotherapy. The most commonly used approach has been to give 1 cycle of BEP chemotherapy that lasts 3 weeks. Sometimes, 2 cycles of BEP chemotherapy may be used, but 1 cycle is more common. The advantage of this approach is that it lowers the recurrence rate from 25% to less than 3%. The main disadvantage is that 75% of patients do not need chemotherapy because they have already been cured with the surgical removal of the testicle. Therefore, some doctors do not recommend chemotherapy for clinical stage I non-seminoma, while others may recommend using adjuvant chemotherapy only for those who have a higher risk of recurrence, so that fewer people receive unnecessary treatment.

Clinical stage I seminoma testicular cancer

More than 80% of people with clinical stage I seminoma are cured with orchiectomy alone, while the remaining 15% to 20% will have a recurrence if they are given no additional treatment. Most recurrences occur within 12 months after diagnosis, and the location of the recurrence is typically in the retroperitoneum. Recurrences of stage I seminoma can almost always be cured with radiation therapy, although a few patients will need chemotherapy.

  • Surveillance. Surveillance is the standard method of managing stage I seminoma. Using a surveillance program, the risk of death from stage I seminoma is less than 1%. Unlike surveillance for non-seminoma, someone receiving surveillance for seminoma does not need to visit the doctor as often. While this can vary, a common schedule includes doctor visits every 3 to 6 months for the first 2 years, every 6 to 12 months in the third year, and then yearly until at least 5 years after the original diagnosis. A physical exam should be done at each visit, and some doctors check serum beta-hCG and AFP, although these are not mandatory because they rarely find recurrences that are not seen on CT scans. A CT scan of the abdomen and pelvis should be done every 6 months for the first 2 years, every 6 to 12 months the third year, and then every 12 to 24 months until the patient is 5 years out from orchiectomy. Sometimes chest x-rays are also obtained, but they rarely make a difference because it is uncommon to have the cancer spread to the lungs without also spreading to the abdomen, where it is seen on CT scans.

  • Adjuvant radiation therapy. This is radiation therapy given after surgery. Seminoma is different from non-seminoma, and early-stage seminoma can be effectively treated with radiation therapy. The chance of recurrence can be decreased to less than 5% with 10 to 15 treatments of radiation therapy to the retroperitoneum. Additional radiation therapy to the pelvis does not reduce the overall risk of recurrence, but it does reduce the risk of a recurrence in the pelvis. Some doctors prefer to treat only the retroperitoneum. Others prefer to include the pelvis to prevent recurrences in that area, which means that follow-up with imaging tests of the pelvis is not needed to watch for a recurrence.

    The disadvantage of radiation therapy for clinical stage I seminoma is that more than 80% of patients receive treatment that they do not need because they were cured with the orchiectomy. This is a concern because radiation therapy increases the risk of developing other types of cancer, as well as digestive and heart and vascular disease.

  • Adjuvant chemotherapy. This is chemotherapy after surgery. Chemotherapy for stage I seminoma is a newer and more controversial treatment option than surveillance or radiation therapy. Using carboplatin, studies have shown that the risk of recurrence after orchiectomy can be reduced from 18% to about 2% with 2 doses of carboplatin and to about 5% to 6% with 1 dose of carboplatin. Because the use of carboplatin is a newer approach, there is less information on the long-term effects of treatment, and this treatment is controversial. Many experts believe that more information is needed before recommending this treatment approach, while many other experts have accepted carboplatin as a new treatment option for stage I seminoma. Currently, it is listed as a standard treatment option in most testicular cancer treatment guidelines. The hope is that carboplatin will cause fewer problems than radiation therapy, but it won’t be known whether this is the case until the health of those who have received carboplatin has been monitored for a longer period of time. Some problems from cancer treatments do not appear until 10 to 20 years later.

Metastatic testicular cancer

If cancer has spread to another location in the body, it is called metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan. However, testicular cancer is fast-growing, so it is important to start treatment right away. If you want to get a second opinion, talk with the doctor within 1 or 2 weeks after diagnosis.

Your treatment plan is based on many individual factors, including the stage of the cancer (that is, where the cancer has spread) and how high the serum tumor markers are, such as AFP, beta-hCG, and lactate dehydrogenase (LDH). Initial treatment of metastatic testicular cancer is usually chemotherapy. Palliative care will also be important to help relieve symptoms and side effects.

For many people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

Clinical stage II non-seminoma testicular cancer

Surgery to remove the testicle is done first, followed by additional treatment. The choice of treatment after orchiectomy depends on a patient’s serum tumor marker levels and the size of retroperitoneal lymph nodes. The treatment options available for people with clinical stage II non-seminoma after surgery are described below. You are encouraged to consider sperm banking for fertility preservation before these treatments begin due to the risk of infertility.

  • Chemotherapy. Chemotherapy is a standard option for anyone with stage II testicular cancer. A combination of drugs is usually given after surgery to remove the testicle. Chemotherapy is the most common treatment for stage IIB and IIC disease and for people with stage IIA disease whose serum tumor markers remain elevated after orchiectomy. For people with stage IIA disease and normal serum tumor markers, chemotherapy or RPLND may be recommended.

  • RPLND. As described above, this is surgery to remove the retroperitoneal lymph nodes in the back of the abdomen. This is a standard treatment option after orchiectomy when the serum tumor marker levels have returned to normal, none of the lymph nodes are larger than 2 cm, and there are no more than 5 enlarged lymph nodes. Chemotherapy may be recommended after RPLND if a large amount of cancer is found in the removed lymph nodes.

Clinical stage II seminoma testicular cancer

Surgery to remove the testicle and lymph nodes with cancer is done first, followed by additional treatment, usually chemotherapy. The main factor in the treatment decision after surgery for a stage II seminoma is the size of the retroperitoneal lymph nodes. You are encouraged to consider sperm banking for fertility preservation before the following treatments begin due to the risk of infertility.

  • Chemotherapy. Chemotherapy with a combination of drugs is given after surgery to remove the testicle. Chemotherapy is a standard treatment option for all stage II seminoma (IIA, IIB, and IIC) and is preferred for stage IIB and stage IIC because it is more likely to get rid of the cancer.

  • Radiation therapy. When lymph nodes are less than 3 cm (stage IIA and early stage IIB), surgery may be followed by radiation therapy to the lymph nodes in the abdomen and pelvis. Sometimes, chemotherapy may be used instead of radiation therapy. Experts disagree about whether radiation therapy or chemotherapy is the preferred option for patients with stage IIA and early stage IIB. Both approaches cure 90% or more of patients with these stages of disease. One advantage of radiation therapy is that it does not increase the risk of developing serious infections, while chemotherapy does. Both chemotherapy and radiation therapy are associated with an increased risk of second cancers and certain other health problems in the future.

Stage III non-seminoma testicular cancer

The following treatment options are available for people with stage III non-seminoma. You are encouraged to consider sperm banking for fertility preservation before treatment begins due to the risk of infertility.

  • Chemotherapy. Chemotherapy is used to treat non-seminoma that has spread beyond the testicles. The most common regimen given is BEP, which is a combination of bleomycin, etoposide, and cisplatin (see "Chemotherapy," above). The treatments are given as 3-week cycles and patients receive either 3 or 4 cycles of chemotherapy for a total treatment period of 9 to 12 weeks. Each drug is given by IV. Cisplatin and etoposide are given each day on the first 5 days. IV fluid is given before and after the cisplatin to reduce the risk of damaging the kidneys. The treatment takes about 6 hours on these days. Bleomycin is given once each week, typically on the first, eighth, and 15th day of the 21-day cycles. The treatment takes about 30 minutes on the days when only bleomycin is given. For patients for whom bleomycin is considered too risky due to age or other factors, 4 cycles of EP chemotherapy can be used for good-risk disease and 4 cycles of VIP chemotherapy can be given for intermediate-risk or poor-risk disease. Both EP and VIP regimens involve giving all of the medications on the first 5 days of a 3-week treatment cycle. VIP chemotherapy is often given in the hospital during a 5-day hospital stay because the treatment lasts for many hours each day.

    An important part of the treatment is surgery to remove any remaining masses after chemotherapy ends. The likelihood of chemotherapy successfully treating this cancer depends on the risk group category (see Stages). More than half of metastatic non-seminoma testicular cancers are classified as good risk, and more than 90% of these will be successfully treated with 3 cycles of BEP chemotherapy or 4 cycles of EP chemotherapy.

    About 25% of metastatic non-seminomas are intermediate risk, and 80% of these are successfully treated with 4 cycles of BEP plus surgery to remove any remaining masses. About 15% of metastatic non-seminomas are poor risk, and about 50% to 70% of these are cured with 4 cycles of BEP plus surgery to remove any remaining masses. For patients with intermediate risk or poor risk who cannot have bleomycin due to side effects, 4 cycles of VIP chemotherapy has been shown to work just as well as 4 cycles of BEP.

  • Surgery after chemotherapy. After chemotherapy is finished, x-rays and CT scans are done again to see if there are any remaining masses. If there are masses, they are removed with surgery if possible. The chance of the surgery curing the cancer is higher if serum tumor marker levels are normal after chemotherapy. This surgery is difficult and requires an experienced surgeon who regularly performs such operations. Very rarely, if the mass is pressing on the kidney or major blood vessels in the retroperitoneum, the kidney and/or a portion of the blood vessels may need to be removed. Often in this situation the nerves that are responsible for ejaculation cannot be saved.

    During surgery, there is about a 35% to 50% chance that only scar tissue will be found, a 35% to 50% chance there will be a teratoma, and a 10% to 15% chance of some other type of germ cell tumor, such as embryonal carcinoma, seminoma, yolk sac tumor, or choriocarcinoma. If only scar tissue and/or a teratoma is found, then no additional treatment is needed. If cancer is found, 2 more cycles of chemotherapy may be given. The chemotherapy regimen used is typically either EP, TIP, VeIP, or VIP.

  • Clinical trials. Patients with poor-risk testicular cancer are also encouraged to consider clinical trials as a treatment option.
Stage III seminoma testicular cancer

The following treatment options are available to treat stage III seminoma. You should consider sperm banking for fertility preservation before treatment begins because of the risk of infertility.

  • Chemotherapy. Chemotherapy for metastatic seminoma is the same as for metastatic non-seminoma (see above). About 90% of metastatic seminomas are good risk and are successfully treated with 3 cycles of BEP or 4 cycles of EP. Around 10% of metastatic seminomas are intermediate risk and are generally treated with 4 cycles of BEP or VIP, if bleomycin is considered too risky due the the individual patient's characteristics.

  • Surgery after chemotherapy/radiation therapy. It is quite common for a mass to be found on imaging tests after chemotherapy or radiation therapy is finished. There is less than a 10% chance that this mass contains cancer and almost no chance that it contains a teratoma. The main treatment options are active surveillance or surgery. Such surgery is often very difficult due to a “scar-like” reaction that makes the mass difficult to remove. This is unique to seminoma. Many oncologists recommend surveillance of remaining masses in people with seminomas. Because larger masses are more likely to be cancerous, some doctors recommend surveillance when a mass is smaller than 3 cm and surgery when a mass is 3 cm or larger.

    A specific type of positron emission tomography (PET) scan called an FDG PET scan may be used to learn more about the mass. After the PET scan is done, the surgeon will operate only if the scan showed signs of cancer in the remaining mass. The main benefit of a PET scan is to avoid surgery to remove masses that are not cancerous. But recent studies have suggested that PET scan results in these situations may not be accurate. A PET scan may find masses that look like they have cancer, but these masses do not actually contain cancer once they are removed and tested.

    If surgery is recommended but the surgeon determines that the mass cannot be removed, a biopsy is often done to try to find out whether the mass is cancerous. If cancer (seminoma) is found, then additional chemotherapy is given. This is called "second-line chemotherapy." If active surveillance is recommended and the mass grows, second-line chemotherapy is the preferred treatment. Surgery can be considered if the mass remains after the chemotherapy.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

Regular follow-up examinations to check for signs that the cancer may be returning are extremely important. If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). Testicular cancer does not often return as a local recurrence because the entire testicle is removed. Increasing beta-hCG or AFP levels may be a sign that the cancer has returned and more treatment is needed. People who have had a testicular cancer recurrence are encouraged to see a doctor who is an expert in treating recurrent testicular cancer before choosing a treatment approach.

If testicular cancer comes back, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent testicular cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

For recurrent testicular cancer, treatment usually includes chemotherapy and surgery. If the cancer was stage I and returns during active surveillance, then the most common treatment is chemotherapy with 3 or 4 cycles of BEP or 4 cycles of EP, depending on the stage of the cancer. If the cancer is only in the retroperitoneal lymph nodes and is a pure seminoma, then radiation therapy or chemotherapy are both treatment options . If the cancer is only in the retroperitoneal lymph nodes, the serum tumor markers are normal, and the cancer is a non-seminoma, then RPLND or chemotherapy may be recommended. If serum tumor markers are elevated, chemotherapy is generally preferred.

The standard treatment for recurrent testicular cancer that has previously been treated with chemotherapy is either 4 cycles of standard-dose chemotherapy or 2 to 3 cycles of high-dose chemotherapy. The standard-dose chemotherapy regimens include VeIP and TIP. High-dose chemotherapy usually includes carboplatin, etoposide, and sometimes other drugs. It is not known if high-dose chemotherapy works better than standard-dose chemotherapy. If chemotherapy is given, any remaining masses are treated the same way that they are after initial chemotherapy (see above). Third-line chemotherapy options may include oxaliplatin plus gemcitabine, and sometimes paclitaxel is given in addition to those 2 medications.

When the cancer has certain mutations, immunotherapy with pembrolizumab (Keytruda) may also be a treatment option. Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells. Learn more about the basics of immunotherapy.

A recurrence more than 2 years after treatment should be removed with surgery, if possible. Chemotherapy may or may not be recommended after surgery.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with a cancer recurrence.

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If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

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The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

Testicular Cancer - About Clinical Trials

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ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are studied to see how well they work. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are often looking for better ways to care for people with testicular cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. Every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Clinical trials are used for all types and stages of testicular cancer. Many focus on new treatments to learn if a new treatment is safe, effective, and possibly better than the existing treatments. These types of studies evaluate new drugs, different combinations of treatments, new approaches to radiation therapy or surgery, and new methods of treatment.

People who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and the chance that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Others volunteer for clinical trials because they know that these studies are a way to contribute to the progress in treating testicular cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future people with testicular cancer.

Insurance coverage and the costs of clinical trials differ by location and by study. In some programs, some of the expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” When used, placebos are usually combined with standard treatment in most cancer clinical trials. Study participants will always be told when a placebo is used in a study. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, people must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the treatment options, so that the person understands the standard treatments and how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different than the risks of standard treatment.

  • Explain what will be required of each person in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

  • Describe the purposes of the clinical trial and what researchers are trying to learn.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together. You will need to meet all of the eligibility criteria in order to participate in a clinical trial. Learn more about eligibility criteria in clinical trials.

People who participate in a clinical trial may stop participating at any time for personal or medical reasons. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that people participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if they choose to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for testicular cancer, learn more in the Latest Research section.

Cancer.Net offers more information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

PRE-ACT, Preparatory Education About Clinical Trials

In addition, you can find a free video-based educational program about cancer clinical trials in another section of this website.

The next section in this guide is Latest Research. It explains areas of scientific research for testicular cancer. Use the menu to choose a different section to read in this guide.

Testicular Cancer - Latest Research

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ON THIS PAGE: You will read about the scientific research being done to learn more about testicular cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about testicular cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

Since treatment is successful for most people with testicular cancer, one of the major goals for the future is to reduce the side effects of treatment for people with early-stage or good-risk cancers. In addition, treatments for poor-risk and recurrent cancers are being studied in clinical trials, along with research on the causes and genetics of testicular cancer.

  • High-dose chemotherapy followed by stem cell transplantation. Higher doses of chemotherapy can put recurrent testicular cancer into remission. A stem cell transplant (bone marrow transplant) is a medical procedure in which diseased bone marrow is replaced by highly specialized cells, called hematopoietic stem cells. Hematopoietic stem cells are blood-forming cells found both in the bloodstream and in the bone marrow. For testicular cancer, the patient’s own stem cells are removed from the body before high-dose chemotherapy is given. After chemotherapy, blood stem cells are put back into the patient’s vein to replace the bone marrow and restore normal blood cell levels. Despite many studies, this has not been proven to be better than either the standard chemotherapy combination of BEP as a first-line therapy for patients with poor-risk disease or the standard chemotherapy regimens of VeIP or TIP for people who have a recurrence after BEP. Researchers are currently comparing standard chemotherapy (VeIP or TIP) to high doses of the drug combination TICE, which is paclitaxel, ifosfamide, carboplatin, and etoposide, along with stem cell transplantation, to find out if high-dose chemotherapy works better. (See Types of Treatment to learn more about chemotherapy combinations for testicular cancer.)

  • New chemotherapy schedules. Researchers are looking into shorter schedules of BEP for people with advanced testicular cancer.

  • Genetic studies. Researchers are analyzing the DNA from tumor samples of testicular cancer to find out if any specific genes are associated with testicular cancer. In addition, there are studies underway to look at possible inherited genetic factors leading to cryptorchidism and higher risk of testicular cancer (see Risk Factors).

  • Palliative care/supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current testicular cancer treatments that can improve comfort and quality of life for patients. Because more people are surviving testicular cancer, doctors are researching the long-term effects of high-dose chemotherapy on brain function, such as memory loss, decreased speed of processing information, lowered attention span, anxiety, depression, and fatigue. Other studies focus on sperm quality and heart disease risk for testicular cancer survivors. This research is being done to help provide the best survivorship care to people treated for testicular cancer.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in testicular cancer, explore these related items that take you outside of this guide:

  • To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases.

  • Visit the Cancer.Net Blog to review news and information about testicular cancer, including research announced at recent scientific meetings or in ASCO’s peer-reviewed journals.

  • Listen to podcasts from ASCO experts discussing specific clinical trials in testicular cancer from 2022, 2021, and 2020.

  • Visit the website of Conquer Cancer, the ASCO Foundation, to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment. It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

Testicular Cancer - Coping with Treatment

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ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people do not experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. This part of cancer treatment is called palliative care or supportive care. It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for testicular cancer are described in the Types of Treatment section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.

You may find it helpful to keep track of your side effects so it is easier to talk about any changes with your health care team. Learn more about why tracking side effects is helpful.

Sometimes, side effects can last after treatment ends. Doctors call these long-term side effects. Side effects that occur months or years after treatment are called late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects after a cancer diagnosis. This may include dealing with a variety of emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, people find it difficult to express how they feel to their loved ones. Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer.

You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with the costs of cancer care

Cancer treatment can be expensive. It may be a source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost of medical care stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations in a separate part of this website.

Coping with barriers to care

Some groups of people experience different rates of new cancer cases and experience different outcomes from their cancer diagnosis. These differences are called “cancer disparities.” Disparities are caused in part by real-world barriers to quality medical care and social determinants of health, such as where a person lives and whether they have access to food and health care. Cancer disparities more often negatively affect racial and ethnic minorities, people with fewer financial resources, sexual and gender minorities (LGBTQ+), adolescent and young adult populations, older adults, and people who live in rural areas or other underserved communities.

If you are having difficulty getting the care you need, talk with a member of your health care team or explore other resources that help support medically underserved people.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they likely to happen?

  • What can we do to prevent or relieve them?

  • When and who should we call about side effects?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you do not think the side effects are serious. This discussion should include physical, emotional, social, and financial effects of cancer.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with testicular cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away. Being a caregiver can also be stressful and emotionally challenging. One of the most important tasks for caregivers is caring for themselves.

Caregivers may have a range of responsibilities on a daily or as-needed basis, including:

  • Providing support and encouragement

  • Talking with the health care team

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

A caregiving plan can help caregivers stay organized and help identify opportunities to delegate tasks to others. It may be helpful to ask the health care team how much care will be needed at home and with daily tasks during and after treatment. Use this 1-page fact sheet to help make a caregiving action plan. This free fact sheet is available as a PDF, so it is easy to print.

Learn more about caregiving or read the ASCO Answers Guide to Caring for a Loved One With Cancer in English or Spanish.

Looking for More on How to Track Side Effects?

Cancer.Net offers several resources to help you keep track of your symptoms and side effects. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Fact Sheets: Read 1-page fact sheets on anxiety and depression, constipationdiarrhea, and rash that provide a tracking sheet to record details about the side effect. These free fact sheets are available as a PDF, so they are easy to print, fill out, and give to your health care team.

The next section in this guide is Follow-up Care. It explains the importance of checkups after cancer treatment is finished. Use the menu to choose a different section to read in this guide.

Testicular Cancer - Follow-Up Care

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ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. People who had testicular cancer usually receive follow-up screening for at least 10 years after their treatment ends.

For people with non-seminoma and advanced seminoma, it is important that follow-up care includes testing of tumor marker levels. Increases in the tumor marker levels are often the first sign that the cancer has returned. ASCO recommends the following schedule for testing tumor marker levels:

Non-seminoma. Alpha-fetoprotein (AFP) and beta human chorionic gonadotropin (beta-hCG) should be measured at regular times. ASCO recommends the following schedule:

  • Year 1. Every 1 to 2 months.

  • Year 2. Every 2 to 4 months.

  • Years 3 and 4. Every 3 to 6 months.

  • Year 5. Every 6 months.

  • Years 6 to 10. Once a year.

Advanced seminoma. ASCO recommends only checking tumor marker levels for advanced seminoma using the following schedule:

  • Year 1. Every 2 to 4 months.

  • Year 2. Every 3 to 4 months.

  • Years 3 and 4. Every 4 to 6 months.

  • Years 5 to 10. Once a year.

However, even after this specific follow-up period ends, people should let any doctor treating them know that they have a history of testicular cancer. This includes your general or primary care doctor, who can then monitor for possible long-term side effects throughout your lifetime.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

The anticipation before having a follow-up test of waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress.

Managing long-term side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Below are some of the long-term side effects that are possible after treatment for testicular cancer.

Lung problems. Nine doses of bleomycin can cause lung damage for about 5% of patients and is fatal for less than 1% of patients receiving the drug. Lung scarring is another possible long-term side effect. The risk factors for lung scarring are being older than 70, smoking tobacco or other drugs, previous lung injury, previous radiation therapy to the chest, poor kidney function, or receiving additional doses of bleomycin. It is rare to have lung effects without any of these risk factors. Therefore, if someone has these risk factors and good-risk disease, 4 cycles of EP chemotherapy can be used instead of 3 cycles of BEP chemotherapy. If 4 cycles of chemotherapy are needed, ifosfamide can be used instead of bleomycin, but it is linked with more short-term side effects, such as infections.

Bleomycin also makes the lungs more sensitive, and patients who need to receive extra oxygen during surgery may have a higher risk of lung damage from bleomycin.

Important issues are:

  • Patients who smoke should stop smoking for many health reasons, but in particular to reduce the risk of lung damage from bleomycin.

  • The doctor should examine the patient’s lungs before each cycle of chemotherapy and stop bleomycin treatment if lung damage is seen.

Kidney damage. Cisplatin can cause kidney damage. However, it is a very important drug to treat testicular cancer. Also, cisplatin has fewer side effects than carboplatin, which has also been shown to be less effective. The best way to prevent this problem is for cisplatin to be flushed out by giving the patient at least 1 liter of IV fluid before and after the drug is given. This reduces the risk of kidney damage. Research studies looking at kidney function years after receiving cisplatin have shown low rates of long-term kidney damage and when it does occur, it is generally mild.

Heart and blood vessel problems. A condition called Raynaud’s phenomenon may be caused by bleomycin. This condition is associated with narrowing blood vessels and changes in skin color, such as becoming pale, then blue, and then red when exposed to certain triggers, such as cold. This is especially common in the hands. Less than 10% of patients develop Raynaud’s phenomenon. More people develop this condition when vinblastine and bleomycin are combined, but this regimen is almost never used now. Avoiding the triggers, such as preventing the fingers from becoming cold, is the main treatment.

People who receive BEP chemotherapy may have higher cholesterol and blood pressure levels and an increased risk of heart disease and/or stroke. Radiation therapy has also been associated with an increased risk of heart disease. The increased risk is small and outweighed by the fact that it is necessary to treat the cancer. However, these side effects are more important when the doctor considers chemotherapy or radiation therapy to prevent the cancer from coming back for people with clinical stage I disease. A healthy diet, exercise, not smoking, and medications to lower cholesterol, control high blood pressure, or treat diabetes are ways to reduce the risk of heart disease and stroke. Learn more about heart problems.

Nerve damage. Cisplatin can sometimes damage the nerves, causing feelings of numbness or “pins and needles.” When this occurs, it most often starts during the chemotherapy and lessens and goes away with time. It may take months or even years to completely go away. Rarely, it can affect a person’s function, such as making it difficult to button a shirt. Learn more about nerve problems or neuropathy.

Hearing problems. Sometimes, people who received cisplatin may notice that they can no longer hear high-pitch sounds. This is more common with higher doses, and it is more likely for older adults or those with previous hearing problems. It rarely affects young people but may be relevant for musicians or others who depend on having very fine hearing abilities. Another hearing-related side effect of cisplatin may be tinnitus, which is ringing in the ears. Learn more about hearing problems.

Second cancers. People who receive chemotherapy and/or radiation therapy for testicular cancer have an increased risk of developing other types of cancer in the future. The thought of developing another cancer can be concerning and difficult to face. However, if the testicular cancer has metastasized (stage II or III), then the cancer needs to be treated effectively. Chemotherapy and radiation therapy often play important roles in treating testicular cancer when the goal is to cure the disease. Even though they pose some risk, chemotherapy and radiation therapy are sometimes the best options for controlling cancer growth and lengthening your life. The issue of second cancers may be particularly important for people with stage I disease and early stage II disease that can be cured with surgery alone. In such cases, patients may have a choice between surgery alone versus surgery plus chemotherapy or radiation therapy. Talk with your doctor about the role of chemotherapy and radiation therapy in your treatment, including why it is recommended and what the risks and benefits are. Learn more about second cancers.

Fertility. The issue of fertility in people with testicular cancer is a complex topic because patients with testicular cancer often have a lower sperm count even before any treatment is given. Someone who has fertility problems after treatment should talk with their doctor about these factors:

  • Sperm count before chemotherapy

  • Whether chemotherapy or radiation therapy was given previously

  • How long ago the treatment was given

  • Whether an experienced surgeon performed a nerve-sparing RPLND to preserve ejaculation

A low sperm count does not necessarily mean that a person will be infertile after treatment because most patients will develop very low to no sperm counts while receiving chemotherapy. The chance of fertility returning after treatment increases over time, but it is lower for those with no or low sperm counts before chemotherapy. It is also important to ask about fertility preservation, including sperm banking, before treatment.

Low testosterone. In addition to damage to the ability to make sperm, the cells that make testosterone may be damaged. If there is a low testosterone level, then hormone replacement therapy can be used. As outlined in Types of Treatment, symptoms of a reduced testosterone level include decreased sex drive, inability to achieve a normal penile erection and orgasm, fatigue, hot flashes, depression, mood changes, muscle and bone loss, as well as metabolic syndrome. Metabolic syndrome is a set of conditions, including obesity, high levels of blood cholesterol, and high blood pressure, that increases a person’s risk of heart disease, stroke, and diabetes.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

Testicular Cancer - Survivorship

Approved by the Cancer.Net Editorial Board, 08/2022

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” is complicated because it means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and continues during treatment and through the rest of a person’s life.

For some, even the term “survivorship” does not feel right, and they prefer to use different language to describe and define their experience. Sometimes extended treatment will be used for months or years to manage or control cancer. Living with cancer indefinitely is not easy, and the health care team can help you manage the challenges that come with it. Everyone has to find their own path to name and navigate the changes and challenges that are the results of their cancer diagnosis and treatment.

Survivors may experience a mixture of feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life. Feelings of fear and anxiety may still occur as time passes, but these emotions should not be a constant part of your daily life. If they persist, be sure to talk with a member of your health care team.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make lifestyle changes.

People recovering from testicular cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, exercising regularly, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health.

Talk with your health care team to develop a survivorship care plan that is best for your needs.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting someone diagnosed with testicular cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Guide to Cancer Survivorship: Get this 48-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print.

  • Survivorship Resources: Cancer.Net offers information and resources to help survivors cope, including specific sections for children, teens and young adults, and people over age 65. There is also a main section on survivorship for people of all ages.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.

Testicular Cancer - Questions to Ask the Health Care Team

Approved by the Cancer.Net Editorial Board, 08/2022

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

  • What type of testicular cancer do I have?

  • Are other tests or surgery needed to confirm this diagnosis?

  • What stage is my cancer? What does this mean?

  • Can you explain my pathology report (laboratory test results) to me? Could I have a copy?

Questions to ask about choosing a treatment and managing side effects

  • What treatment options do I have?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend?

  • Is this the standard treatment?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the possible side effects of each treatment option, both in the short term and the long term?

  • How often do you treat people with testicular cancer?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • How can I keep myself as healthy as possible during and after treatment?

  • What support services are available to me? To my family?

  • If I have questions or problems, who should I call?

Questions to ask about having surgery

  • What type of surgery will I have? Will lymph nodes be removed?

  • How experienced is the surgeon in orchiectomy and/or RPLND?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term effects of having this surgery?

Questions to ask about having chemotherapy or immunotherapy

  • What specific drugs are recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • Will I receive this treatment at a hospital or clinic? Or will I take it at home?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term or late effects of having this treatment?

  • What can be done to prevent or relieve the side effects?

Questions to ask about having radiation therapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term or late effects of having this treatment?

  • What can be done to prevent or relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will those tests be needed?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.

Testicular Cancer - Additional Resources

Approved by the Cancer.Net Editorial Board, 08/2022

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Testicular Cancer. Use the menu to go back and see other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Testicular Cancer. Use the menu to choose a different section to read in this guide.