Testicular Cancer
Testicular cancer is one of the most treatable cancers there is. Surgery and chemotherapy lead the way, and radiation is used selectively — mainly for seminoma.
About testicular cancer
Testicular cancer is uncommon, and it responds very well to treatment, including when it has spread. It falls into two broad groups. Seminomas tend to grow slowly and are notably sensitive to radiation. Non-seminomas, which include several subtypes, grow faster and are not treated with radiation at all — they are managed with surgery, chemotherapy and surveillance.
Almost everyone starts with an operation to remove the affected testicle, called an orchiectomy, done through a small incision in the groin. That operation both confirms the diagnosis and removes the tumor. What happens next depends on the pathology, the stage and your own preferences.
For early-stage seminoma, there are usually several reasonable options: careful surveillance with regular scans and blood work, a short course of chemotherapy, or radiation to the lymph nodes in the back of the abdomen where this cancer spreads first. All three have excellent results. Surveillance has become the most common choice for stage I disease, in part because it avoids treatment for the majority of men who would never have needed it. Radiation remains a good option for men who prefer definitive treatment now, or who are unlikely to keep up with a demanding follow-up schedule. We will walk you through the trade-offs, including the small long-term risks of radiation, and the decision is genuinely yours to make.
Signs and symptoms
Most testicular cancer is found by men themselves, which is why any change is worth having checked promptly.
- A painless lump or firm area in one testicle
- Swelling or a change in the size or feel of a testicle
- A feeling of heaviness in the scrotum
- A dull ache in the lower abdomen or the groin
- Sudden collection of fluid in the scrotum
- Pain or discomfort in a testicle or the scrotum
- Tenderness or growth of breast tissue
- Back pain, which can happen if lymph nodes in the abdomen are involved
When to call
These symptoms have many possible causes, most of them not cancer. But they are worth a conversation. If something has changed and hasn't resolved, contact your primary care physician — early evaluation is what makes treatment straightforward.
How we treat it
Your urologist leads the surgical part of your care and your medical oncologist leads chemotherapy. Radiation has a narrower role, and we want to be straightforward about that. When we do use it for seminoma, we treat the lymph nodes along the back wall of the abdomen at a low dose — far lower than most other cancers require — which keeps side effects mild. We shield the remaining testicle during treatment to protect fertility as much as possible, and we recommend talking with you about sperm banking before any treatment begins.
External beam radiation therapy (EBRT) to the abdominal lymph nodes
This is the main way radiation is used in testicular cancer. After orchiectomy for seminoma, we treat the lymph nodes in the back of the abdomen where the cancer would travel first. The dose is low compared with most radiation courses and the treated area is a narrow strip, so most men get through it with little difficulty. It is generally reserved for seminoma, and it is not used for non-seminoma.
Three-dimensional conformal radiation therapy (3D-CRT)
3D-CRT uses a CT model of your anatomy to shape a small number of beams to match the outline of the lymph node area. For the low doses used in seminoma, this straightforward and well-proven approach is often all that is needed, and it keeps the total dose to the body as low as possible.
Intensity-modulated radiation therapy (IMRT)
IMRT shapes the dose more tightly around an irregular target and is used when the anatomy calls for it — for instance when the treatment area sits close to a kidney, or when a horseshoe kidney or previous surgery has changed the usual layout. We use it selectively here rather than by default.
Image-guided radiation therapy (IGRT)
IGRT is imaging taken on the treatment table before the beam turns on, so we can confirm your position and make small corrections. It lets us keep the treated area narrow, which is one of the reasons modern treatment is gentler than it was a generation ago.
Palliative radiation
In the uncommon situation where testicular cancer has spread and is causing symptoms, a short course of radiation can relieve pain or pressure. Stereotactic radiosurgery may be used for a small number of brain metastases. These are focused, symptom-directed treatments alongside chemotherapy.
What treatment involves
Treatment begins with a simulation, a planning appointment lasting about 45 minutes. You lie on your back on a CT scanner while we map the treatment area. A protective shield is positioned to keep radiation away from the remaining testicle, and we place a few small marks on your skin so the therapists can line you up the same way each day.
Before anything starts, ask us about sperm banking if you may want children in the future. It is easier to arrange before treatment than after, and we would rather raise it early than have it come up too late.
A course for seminoma is short. Most men have around ten to fifteen daily treatments over two to three weeks, Monday through Friday. Each visit takes about 15 minutes, with the beam on for only a couple of minutes. We usually give an anti-nausea medication before each session, because mild nausea is the most common complaint. You will feel nothing while the beam is running, you are not radioactive, and nearly everyone drives themselves and keeps working through the course.
Possible side effects
Side effects are usually temporary and typically resolve shortly after treatment ends. Tell your care team about any discomfort — managing it is part of the treatment, not an interruption to it.
- Mild nausea, usually well controlled with medication taken before treatment
- Tiredness during the course and for a few weeks afterward
- Loose stools or more frequent bowel movements
- Indigestion or a reduced appetite
- A temporary drop in sperm count, which usually recovers over months
- Mild redness or dryness of the skin over the treated area
- A small dip in blood counts
Caring for yourself during treatment
- Rest when you need to, and don't hesitate to ask for help.
- Follow your care team's advice — and ask when anything is unclear.
- Tell us about every medication, vitamin and supplement you take.
- Eat a balanced diet and drink plenty of fluids.
- Treat skin in the treatment area gently: no sun, no hot or cold packs, and only lotions your team has approved.
- Lean on support groups, family and friends. Coping is part of treatment.
Trusted resources
- Testicular Cancer Foundation — www.testicularcancer.org
- Urology Care Foundation — www.urologyhealth.org
- American Cancer Society — 1-800-227-2345
- National Cancer Institute — 1-800-422-6237
- Livestrong Fertility — 1-855-220-7777
- RT Answers, American Society for Radiation Oncology — www.rtanswers.org
Clinical background adapted from materials by the American Society for Radiation Oncology (rtanswers.org) and the American Cancer Society.
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