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Common side effects of testicular cancer treatment

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Table of contents
Key points & intro text
Orchiectomy (surgery) side effects
Chemotherapy side effects
Radiation therapy side effects
RPLND side effects
  • Whether you were just diagnosed with testicular cancer or you’re being treated now, it’s helpful to know the most common side effects to surgery, chemotherapy, radiation therapy and RPLND.

  • We’ll also cover some of the lesser-known side effects and, just as importantly, emotional effects to watch for.

  • There are steps you can take to manage many of the most common side effects of testicular cancer treatment, and there are things your doctor can do to help.

If you were recently diagnosed with testicular cancer, you may be wondering what you and your nuts are in for next. The good news is most men go on to live healthy, happy, normal lives after treatment. There can be side effects, though. Here’s what you should know — and how to cope.

Orchiectomy (surgery) side effects

Testicular cancer treatment often begins with a surgical procedure called an orchiectomy to remove one or (rarely) both testicles.

Physical side effects

  • Pain. Some pain is normal after any surgery. The discomfort should last anywhere from a few weeks to a month. Talk to your care team if the pain is really bad or if it gets worse over time.

  • Bruising and swelling. This can happen if blood starts to collect inside the scrotum or wound area. There’s usually no reason to be concerned, but call your doctor if you’re worried.

Emotional side effects

A lot has been said about the physical side effects of an orchiectomy, but what about the emotional effects? They are just as real — and no less important to watch for.

It’s a bit like mourning a loss. There’s always alone time afterward. You start to wonder, Why me? What effects will this have? It affected me for a few months.

Joshua, Nuts & Bolts Guide

Common emotional side effects of surgery can include:

  • Self-consciousness. You may be acutely aware of the changes to your body after surgery. This is normal. For some men, this feeling fades with time. What’s important to remember is that you are the same person you were before your surgery.

  • Lower self-esteem. Some guys struggle with self-esteem or body image. Thankfully, it’s rare for the orchiectomy itself to affect your sex drive or ability to get an erection. But for some guys, the experience can be a blow to their confidence or body image, which can affect their sex life.

  • Depression. As many as 1 in 10 men with testicular cancer will go through some form of depression after treatment.

If you’re experiencing the emotional aftermath of surgery, you’re not alone. Whatever you’re feeling, don’t hold it in. Talk to a partner, a counselor or other guys who’ve been through testicular cancer.

Bilateral orchiectomy side effects

Bilateral testicular cancer — that is, cancer in both nuts at the same time — is pretty rare, occurring in about 2% of men with testicular cancer. In such cases, both testicles may need to be removed, or sometimes part of one testicle, which can cause a couple additional side effects afterward:

  • Difficulty getting and maintaining an erection. The testicles are involved in making testosterone. Removing one typically doesn’t affect your ability to have an erection, but if both are removed, your testosterone levels will drop. Testosterone supplementation can help you maintain your sex drive.

  • Fertility issues. Removing one testicle generally does not affect your ability to have children, as long as the other is healthy. Many doctors recommend banking sperm before removing a testicle but it can also be done after. If both testicles need to be removed, talk to your doctor beforehand to decide whether you should bank some sperm for later use. Removing both testicles will make you infertile (unable to father children), so sperm banking ahead of time is critical if you’d like to have kids later.

Remember, it’s not that common to have cancer in both testicles. Even in these cases, most men are able to maintain their sex lives after treatment.

If you feel a lowered sex drive or have trouble maintaining an erection, there are steps you can take to get your sex life back on track.

Chemotherapy side effects

Chemotherapy uses powerful anti-cancer drugs to kill cancerous cells. Most men have at least some side effects, but every guy’s experience is different. The good news: options for managing chemo side effects have come a long way in recent years.

Common chemotherapy side effects

  • Nausea (feeling sick to your stomach or like you might throw up)

  • Fatigue (feeling extremely tired or weak)

  • Weakened immune system (caused by reduced white blood cell count)

  • Hair loss

Less common chemotherapy side effects

  • Anemia (low red blood cell count)

  • Blood clotting issues

  • Dry, brittle nails and skin

  • Loss of appetite

  • Difficulties concentrating or remembering things

  • Lowered sex drive

  • Depression

The nausea really got me towards the end. The two days [after chemo] were always the hardest. I sort of knew they were coming by the end of it.

Andreas (testicular cancer survivor)

Tips for managing chemotherapy side effects

As almost anyone who’s been through testicular cancer will tell you, chemotherapy is no walk in the park but everyone has a different experience, some mild and some rougher. But there are steps you can take to help manage side effects after each treatment:

  • Eat something light before each chemo session. Don’t skip meals if you can manage it. Small portions and simple foods like yogurt, toast and cereal are best.

  • After chemo, eat what feels good to you — and be prepared for that to change over time. One testicular cancer survivor talked about craving tuna and rice early in his chemo treatment. A few weeks later, he’d gone off it.

  • Avoid strong or unpleasant smells.

  • Drink plenty of fluids.

  • If you have to run errands or do other activities, try to schedule them for the time of day when you normally feel your best.

  • Rest as much as you can. Naps are definitely encouraged!

  • Keep your hygiene up — partly to protect your immune system and partly because you’ll feel better if you do. Wash hands regularly, shower daily, and so on.

  • Avoid being around people who are sick. As an added layer of protection (literally), consider masking up when you go out.

  • Avoid sharp objects or use them with caution. If you shave with a razor, consider switching to an electric shaver while you’re on chemo.

Radiation therapy (or radiotherapy) side effects

Radiation therapy uses a specialised X-ray machine to target cancer cells, often after other treatments such as orchiectomy. It’s more commonly used for seminoma, a slow-growing type of testicular cancer.

The procedure itself is painless. Side effects are generally fewer and less severe than chemotherapy because:

  • Radiation therapy can be targeted with greater precision than chemo.

  • Testicular cancer requires a lower dose of radiation than other cancers.

However, there are some side effects you should be prepared for, in case you experience them.

Common radiation therapy side effects

  • nausea

  • fatigue

  • diarrhea

  • skin irritation

Radiation therapy’s impact on fertility

Radiation can affect your body’s sperm production — talk with your doctor if you are concerned about this and consider sperm banking.

Before each treatment, the medical team will spend time carefully measuring to determine the right spot to give the radiation. Assuming only one testicle is needs treatment, they’ll also use a protective shield to prevent the other testicle from being exposed to radiation.

When to see a doctor

If your side effects from radiation therapy don’t improve with time (typically 1 to 2 weeks after treatment), if you’re having trouble concentrating or if you’re so fatigued that it’s disrupting everyday life, talk to your doctor.

RPLND side effects

RPLND stands for retroperitoneal lymph node dissection. (Now you know why people just call it RPLND.) Simply put, it’s a surgery to remove the lymph nodes at the back of the abdomen — occasionally done at the same time as an orchiectomy, sometimes done separately. Not everyone with testicular cancer needs this procedure.

Recovery from RPLND is generally quick and long-term side effects are rare. But there are a few to be aware of:

  • short-term pain

  • difficulty passing gas or having bowel movements while you’re recovering

  • hernia at the incision (area where you were cut for surgery)

  • difficulty with ejaculation (or cumming) (everything with sex feels the same except no semen comes out)

  • fertility issues

The side effects of testicular cancer treatment can be difficult — mentally, emotionally and physically. By knowing what to expect, and when to get help, you’ll be able to face almost anything your treatment throws at you.

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