Supportive care for testicular cancer

Supportive care helps with the physical, practical, emotional and spiritual challenges of cancer. This important part of cancer care focuses on improving the quality of life of people with cancer and their loved ones, especially after treatment has ended.

Adjusting to life after treatment is different for everyone. Your recovery will depend on many different factors, such as where the cancer was in your body, the stage of the cancer, the organs and tissues removed during surgery, the type of treatment and side effects.

If you have been treated for testicular cancer, you may have the following concerns.

Self-esteem is how you feel about yourself. Body image is how you see your own body. They are often closely linked. Testicular cancer and its treatments can affect your self-esteem and body image. Often this is because cancer or cancer treatments change your body in different ways, such as:

• loss of one or both testicles
• loss of body function such as bladder control or the ability to have an erection
• scars
• hair loss
• skin problems
• changes in body weight

Some of these changes can be temporary. Others can last for a long time or be permanent.

But treatment can affect your self-esteem or body image even if it does not affect how you look. Other people may not be able to see changes to your body, but you may still worry about how they now see you. This may affect your self-esteem, making you feel angry or upset, afraid to go out or worried that others will reject you.

After surgery to remove one or both testicles, the scrotum may look and feel empty. This change to your body may make you feel anxious, embarrassed or uncomfortable around others. You may worry that you are less masculine or less attractive than you used to be.

Talking about feelings may help you cope with your changed body image. Support from other people who have had testicular cancer and professional counsellors can help. Reconstruction with a testicular prosthesis (artificial testicle) may also help you cope with changes to body image and self-esteem.

Find out more about how to cope with problems of self-esteem and body image.

Many people continue to have strong, supportive relationships and a satisfying sex life after testicular cancer. If sexual problems occur because of testicular cancer treatment, there are ways to manage them.

Most often, testicular cancer occurs only in one testicle. Having surgery to remove one testicle should not affect your ability to have an erection and ejaculate because the remaining testicle can make enough testosterone and sperm. If you have both testicles removed or you have lower than normal testosterone levels after the removal of one testicle, you will be offered testosterone replacement therapy. This is given as a gel or patch on your skin or by an injection in a doctor’s office once a month.

Other treatments for testicular cancer, such as a retroperitoneal lymph node dissection (RPLND), chemotherapy and radiation therapy can also affect your sex life.

If you’ve had lymph nodes removed in an RPLND, side effects that can make sex challenging include:

• semen flowing backwards into the bladder instead of going out through the penis (called retrograde ejaculation)
• orgasms without ejaculating semen (called dry orgasms or dry ejaculation)
• erectile dysfunction caused by damage to nerves or blood vessels

You may also experience erectile dysfunction if chemotherapy causes lower testosterone levels or if radiation therapy damages nerves or blood vessels.

Some people may lose interest in having sex. It is common to have a decreased interest in sex around the time of diagnosis and treatment. Talk to your doctor about sexual problems that happen because of testicular cancer treatment and how to manage them. Some people and their partners may need counselling to help them cope with the effects of testicular cancer and its treatments on their sexual relationships.

Find out more about sex and intimacy and sexual problems.

Some treatments for testicular cancer can cause fertility problems, which can affect your ability to get someone pregnant. Infertility happens when the testicles don’t make enough sperm or the sperm is damaged. Depending on the treatments given, your age and other factors, infertility may be temporary or permanent.

Some surgeries for testicular cancer cause a permanent loss of fertility. If both testicles are removed (called a bilateral orchiectomy), your body can no longer make sperm. An RPLND can also cause nerve damage that may result in retrograde ejaculation, which leads to infertility because your semen moves backwards into your bladder instead of going out through the penis.

Chemotherapy and radiation therapy can lower the number of healthy sperm made by the testicles. This is usually temporary. Sperm production returns to normal after treatment is finished. Sometimes it can take up to 2 years after treatment for sperm counts and health to return to normal.

If you have testicular cancer and you want to have children in the future, you may be offered sperm storing or banking before treatments like RPLND, chemotherapy or radiation therapy. This is because it is hard to know how these treatments will affect fertility. Sperm is collected before treatment starts in case the sperm count does not return to normal after treatment. The sperm is frozen and stored for future use in fertilization procedures known as artificial insemination.

Find out more about fertility problems and how they can be managed.

To make decisions that are right for you, ask your healthcare team questions about supportive care.