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Testicular cancer is an uncommon cancer disease. Most people get rid of the disease after treatment, even though the disease has spread.

Symptoms of testicular cancer

Here are the most common symptoms of testicular cancer. You can have one or more of them:

  • There is a lump in the testicle.
  • The testicle has a different size and can feel different.
  • The testicle feels heavier.
  • It hurts the testicle.

Some do not experience any symptoms until cancer has spread. Then you can get hurt where there are metastases. For example, you may get a stomach and back pain.

The symptoms may have other causes, for example, that the testicle has twisted or the bite has become inflamed. The biticle is a small organ located at the back of the testicle. There, the sperm is stored and matured.

When and where should I seek care?

If you think you have testicular cancer, contact a health care provider. You can contact many receptions by logging in.

Testicular changes are often benign, but it can still be important to be examined.

Investigations

The doctor usually starts by sensing the scrotum and can sometimes rule out cancer in that way. Often more investigations are needed.

Most are examined with ultrasound

It is common to be examined with ultrasound. Often the doctor can see directly if the change is a tumor or if it is due to something else, such as an inflammation of a bite.

The investigation is conducted according to a standardized course of care

You are offered an examination according to a standardized course of care if your doctor thinks you may have testicular cancer.

Standardized care is a way of organizing the investigation so that it goes as quickly as possible. Among other things, there are times set for the examinations you may need.

The doctor who writes the referral to the standardized course of treatment tells you why you should be examined according to a standardized course of care, what it means and when you can be told whether you have cancer or not.

It is often quick to get calls for examinations in a standardized course of care. It is good if you are clear about how the staff most safely reach you so that you do not miss any time.

You need surgery if the ultrasound shows that there is a tumor

The doctor needs to examine the testicle more closely if there is a tumor. Then you are operated on.

You get anesthetized or get anesthesia back. The testicle is lifted out of the scrotum by an incision above the groin. The doctor examines the testicle but puts it back in the scrotum if there is no cancer.

The testicle is removed if there is evidence of cancer. It is then examined under a microscope so that the doctor will know if it is cancer, what kind of testicular cancer it is and whether it has spread.

You get a prosthesis if you want

You can have a silicone prosthesis implanted at the same time as the testicle is removed if you wish. The prosthesis is available in three sizes. A prosthesis always becomes rounder and feels firmer than a regular testicle.

During surgery, the doctor usually examines cancer in the other testicle as well. The doctor then takes a tissue sample from the testicle through an incision in the scrotum. The tissue sample is examined under a microscope.

It is unusual to have cancer in both testicles.

Most people can leave the hospital the day after surgery. You may need to be on sick leave for one to two weeks.

Leave sperm before surgery

Treatment can affect your ability to have children. Therefore, you are offered to freeze sperm before surgery. Read more in the chapter How is life affected by testicular cancer?

Blood tests can provide more information

Before and after the operation, you are given blood tests that can show if there are tumor markers. These are proteins that some testicular cancer tumors give off.

The test answer can be helpful when the doctor is to diagnose or see how the treatment affects the disease.

Studies that can show if cancer has spread.

You need to be examined more if the doctor thinks you may have testicular cancer. The chest and abdomen are examined with computed tomography to see if there are metastases.

Treatment after surgery may vary

Testicular cancer is always operated on. You can read more about the operation in the chapter Investigations and investigations.

After the surgery, you may need more treatment. A group of specialists in the treatment of testicular cancer suggests, the treatment they consider to be best for you based on the examinations that have been done. Then you and your doctor talk about it.

You can read more in the following chapters about other treatments that may also be needed.

Treatment of seminoma testicular cancer after surgery

Treatment varies depending on whether the disease has spread or not.

Seminomas that have not spread

Most often, it is sufficient to have the testicle removed if you have seminomas that have not spread and if the cancer tumor was small. After the surgery, you will be able to come to regular checkups that can show if cancer has returned.

Sometimes the doctor recommends treatment with cytostatic drugs. This depends, among other things, on the size of the cancer tumor. The purpose of the treatment is to reduce the risk of cancer coming back.

You only need to get cytostatic drugs at one point in treatment. It is given as a drop in the blood.

Seminomas that have spread

Metastases can be formed in other parts of the body if cancer spreads. Metastases are usually treated with a mixture of various cytostatic drugs. You get the cytostatic as a drop in the blood.

It is common for the treatment to be given in cures. Most often, a cure means you get treatment every day for five days. The cure is repeated every three weeks. Ten days after a cure, you get a little more cytostatic.

Usually, three to four cures are needed. Then you are done after nine to twelve weeks. Sometimes more cures with partly other cytostatic drugs are needed.

Radiation treatment sometimes

Radiation therapy to the lymph nodes along the spine in the abdomen is sometimes recommended. You are treated every weekday for two to three weeks.

Treatment of non-seminoma testicular cancer after surgery

Treatment varies depending on whether the disease has spread or not.

Non-seminomas that have not spread

Sometimes the doctor suggests that you get cytostatics for safety. This is because there may be metastases that are too small for them to be detected despite various examinations and tests.

The most common thing is to receive cytostatic treatment that drops into the blood every day for five days. After ten days, you will receive a syringe or drip with more cytostatic drugs.

Non-seminoma that has spread

You are treated with a mixture of various cytostatic drugs. The treatment is given as a drop in the blood. It is common for the treatment to be given in cures. Most often, a cure means you get treatment every day for five days. The cure is repeated every three weeks. Ten days after a cure, you get a little more cytostatic.

Usually, three to four cures are needed. Then you are done after nine to twelve weeks. Sometimes more cures with partly other cytostatic drugs are needed.

Occasionally there are remnants of disseminated cancer left after the cytostatic treatment. Then you can sometimes be operated on again.

Radiation therapy is not used very often

It is unusual but sometimes metastases are treated with radiation. How many radiation doses you receive depends, among other things, on where in the body the metastases are.

Pre-cancerous stage of the second testicle

The second testicle is irradiated if the sampling shows that there is a precursor to cancer there. It is usually enough to get treatment for two weeks on nine occasions.

Side effects and sick leave

Treatment with cytostatic or radiotherapy can cause various side effects. For example, you may get tired, feel sick or become extra susceptible to infections.

Many side effects can be relieved and often they go away when the treatment is complete. Talk to your doctor.

Most people can leave the hospital after every treatment. You may need to be on sick leave throughout the treatment period and even a few weeks afterward

You may need treatment in another location

You may need to be operated on again if you have been treated for spread cancer and there are remnants of cancer left, for example in the stomach.

Check after treatment

Most people need to come to check-ups to be examined several times when the treatment is complete. This is for the doctor to see that all the cancer is gone or if it has come back. For example, you may be examined by x-ray and have blood tests.

It is common to have to go under control three to four times in the first two years because the risk is greatest when cancer comes back. Then fewer inspection visits are usually sufficient.

After five to ten years, no more inspection visits are usually needed.

How often and for how long you need control visits depends, among other things, on the type of cancer it is and how much it had developed before you received treatment.

You can also get help during the control visits if you have any problems that are due to the treatment.

If cancer comes back

Relapse is when cancer comes back. Most often you can get the treatment that will get you rid of cancer again if you have a relapse.

How is life affected by testicular cancer?

Most people get rid of the disease after treatment. But testicular cancer and the treatment of testicular cancer will affect your life in some way.

How big the changes will be for you depends on what treatment you need, if you have other illnesses and how you feel otherwise.

What you feel and how you feel can also vary from one period to another.

Cytostatics and radiotherapy sometimes cause lasting problems

Cytostatic or radiation therapy can cause problems. Often they go over, but sometimes the hassles can be lasting. This depends, among other things, on how much treatment you have received, or what kind of cytostatics you have been treated with.

The trouble can sometimes come a long way after the treatment is complete.

Here are some things you can experience after treatment for testicular cancer.

The ability to have children can be affected

It is not possible to say in advance how the production of sperm will be affected by the treatment with cytostatics or radiation. In many, production decreases for a while but recovers when treatment is complete. In others, production decreases without recovering.

Sometimes the treatment causes the sperm to be led back when you get ejaculation. Then you can still be fertile but need help if you want to use your sperm in a pregnancy.

Avoid pregnancy for a while

It may take time before the sperm that is formed are healthy if sperm production recovers after treatment. Wait for six months after treatment before trying to get pregnant with your sperm. Use a condom or other contraceptive to avoid pregnancy.

Freezing of sperm

You are offered to freeze sperm before surgery. Then you can get help using them after the cancer treatment if you need it to try to have children. Read more in the text Fertility after cancer treatment.

Usually to feel tired

It is common to feel very tired when you have a cancer disease. The fatigue remains even though you have slept. You may become more easily irritated and may not be able to cope with the things and relationships you usually use. 
Fatigue can have one or more causes, for example:

  • The disease can affect the body in different ways so that you get tired.
  • You get in too little energy.
  • The treatment can be tiring in various ways.
  • You feel great anxiety or have depression.

Tell the health care provider if you are very tired. Make sure you and any close associates gain knowledge about the fatigue and what it is due to. It can also help and increase the understanding of the surroundings.

Fresh air and easier physical activities can make you feel less tired. 
Several short rest breaks are usually better than a single, longer rest break.

Sexuality and closeness

Most have a good sex life and cohabitation after testicular cancer. But sometimes it takes time. 
The illness and treatments can make you think differently about yourself and your body. Some lose their appetite because they feel anxious or depressed or because of testosterone deficiency.

It can be difficult to talk about the changed situation. You can get help, for example by a psychotherapist or a sexologist. You can get help whether you have a partner or not. If you have a partner, you can, for example, get call support or help discover new ways of being together. You can read more in the text about cancer and sexuality.

You may get dry triggers if you have surgery in your stomach and lymph nodes need to be removed. Then the ejaculation is led back into the bladder instead of out through the penis. It does not usually affect sexual pleasure or ability to orgasm.

You may need testosterone treatment

Testosterone is a hormone that is formed in the testes. It allows you to feel sexual desire and get a hold but is also needed for you to feel good in several other ways. The disease and the treatment can make you get insufficient testosterone. Sometimes the testosterone from the testicle you have is not enough. You can get testosterone syringes every few months or you get a gel that you grease your skin with every day.

Hearing and feeling can be affected

Treatment with cytostatic drugs can sometimes affect the hearing or cause tinnitus. Some get reduced hands and feet. Hands and feet can also become more sensitive to cold. The trouble usually subsides over time.

Some feel missing

The testicles are part of the genitals. They can be an important part of who you are – whether you’ve already used your sperm to get pregnant or can’t or don’t want to.

It may be the cause if you feel sadness and missing after treatment for testicular cancer. Here you can read more about how you can get help with thoughts and feelings about cancer.

Quality of life

It can feel difficult and some life can be different after treated testicular cancer. Most people still think they have a good quality of life.

What is testicular cancer?

Testicular cancer occurs in the part of the testicle where the sperm are formed. There are mainly two types of testicular cancer: seminoma and non-seminoma. They are about as common but are treated a little differently, depending on whether cancer has spread or not.

Sometimes the cancer has spread when the disease is discovered. Then metastases are formed elsewhere in the body. Metastases are the same as daughter tumors. Early metastases are usually found in the stomach, near the spine. This is because this is where the testes were formed during fetal life. The testicles are still connected there through their blood vessels and lymph vessels. Cancer cells are spread through blood vessels and lymph vessels.

Cancer can also spread to the lungs and form metastases there.

Most people get rid of cancer even though it has spread

Most people who get testicular cancer get rid of the disease after treatment. This is true even if you already have metastases when the disease is detected.

Testicular cancer is uncommon

How does cancer occur?

The body consists of many billions of cells. The cells divide to form new cells so that the body can function. Sometimes it gets wrong when a cell divides. Usually it does nothing or the cell can stop the error from spreading to more cells at the next cell division. But sometimes it doesn’t work. Then more and more altered cells can be formed for each cell division. Eventually, cancer cells can form and become a cancerous tumor. The cancer cells divide uncontrollably and do not die when they should. You can read more in the article What is Cancer?

What is the cause of testicular cancer?

It is not possible to say exactly why someone gets testicular cancer, but there are things that can be important, for example:

  • You have genetic relatives who have had the disease.
  • One of the testicles did not come down to the scrotum by itself when you were a child. 

Can I reduce the risk of testicular cancer?

There is no way to prevent testicular cancer, but it is good if you examine your wallet at least once a month. Then you will learn how your testicles usually feel so that you can more easily detect any change.

Getting a cancer message

There are many ways to respond to a cancer message. Often, you need plenty of time to talk to your doctor and other healthcare professionals about what the message means.

If possible, please let a relative accompany you. The related person can act as a support and can help remember what has been said.

You can also ask to have the information printed so that you can read it peacefully. Ask questions if you don’t understand. You have the right to receive information in your own language. You also have the right to receive interpreting assistance if you have a hearing impairment.

You can get support from several directions

In many hospitals, there are special nurses called contact nurses who can provide support and also help with various practical things. You can also talk to the hospital’s curator.

For many, it usually feels easier once treatment has begun and they know what is going to happen.

Children also need to know

A minor child has the right to receive information and support based on his or her own needs if a relative is ill. You can get help with what you can say if you want to tell the child yourself.

Often it is good to make children as involved as possible, regardless of their age. That doesn’t mean you have to tell everything. You can read more in the text Getting a cancer message.

Be involved and influence your care

You have the right to be involved in your care as much as possible. The healthcare staff should tell you what treatment options are available. They should make sure you understand what the different options mean, what side effects are available and where you can get treatment.

This way, you can help decide which treatment is right for you, for example, if you want to preserve the possibility of using your sperm in pregnancy after the treatment.

Questions that are important to you

You can make a care plan together with the contact nurse, the doctor and other staff. The care plan should answer questions that are important to you, such as how to get the rehabilitation you may need. Here you can read more about the contact nurse and the care plan.

You can get a new medical assessment

You may get a new medical assessment from another doctor if you have a life-threatening or particularly serious illness. Obtaining another doctor’s assessment can help you, for example, if you are unsure of which treatment or treatment is best for you.

Being related

Sometimes it can be difficult to be close to someone who is ill. It is common to want to give support while having a strong concern and feeling bad.

If possible, try to let people in your vicinity support you. It can be family members, friends or acquaintances. Often it will be easier for other people to help you if you tell them how it feels and shows if you are worried or sad.

You can get help from the contact nurse or a curator at the hospital if you are close and need supportive calls.

Muhammad Nadeem

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