Supportive care helps people meet the physical, practical, emotional and spiritual challenges of cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.
Recovering from testicular cancer and adjusting to life after treatment is different for each man, depending on the extent of the disease, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A man who has been treated for testicular cancer may have the following concerns.
Follow-up care and risk of recurrence
The risk of recurrence is highest in the first 2 years after treatment is completed. After cancer treatment is over, regular follow-up is done to monitor the man’s response to treatment and to identify and provide care for any long-term or late side effects of treatment. During follow-up visits, the doctor checks for signs that the cancer has come back (recurrence). Early detection of a recurrence increases the chances of successful treatment.
Body image and self-esteem
How a person feels about or sees themselves is called self-esteem. Body image is a person's perception of their own body.
Surgical removal of one or both testicles may alter a man’s body image. The scrotum looks and feels empty. This may cause concern and feelings of embarrassment. Men with testicular cancer may feel uncomfortable with themselves and around others because of these changes.
Altered body image may affect self-esteem and the perception of what others think. It may also cause feelings of loss of masculinity. It is important to reassure the man that his altered body image does not affect his masculinity. Treatments don’t affect sex drive (libido) or erections.
Men who have had both testicles removed will be given male hormone replacement therapy. Referral for counselling may be needed if a man's concerns about his altered body image affect his sexuality and intimate relationships. Talking about feelings and reconstruction with testicular implants may help some men cope well with their altered body image.
Fertility problems
Some forms of testicular cancer treatment can affect a man's ability to father children. Infertility can occur when the testicles stop producing sperm cells. Infertility may be temporary or permanent.
Some surgeries for testicular cancer can cause a permanent loss of fertility:
- orchiectomy – If both testicles are removed, the man no longer produces sperm.
- retroperitoneal lymph node dissection – This can cause nerve damage that may result in retrograde ejaculation. This means that the semen goes into the bladder rather than outside of the body during ejaculation.
Radiation to the testicles can reduce the number of sperm and affect the sperm’s ability to function. The more radiation the testicles are exposed to, the greater the chance they may fail to function.
Chemotherapy drugs kill rapidly dividing cells throughout the body. Cancer cells divide rapidly, but so do some normal cells, such as sperm cells. The type of drug, dose and whether one drug or combinations of drugs are used influence whether fertility will be affected. The effects of chemotherapy vary from person to person. Although chemotherapy can affect the sperm count, sometimes it recovers after treatment. Fertility usually returns approximately 2 years after treatment with chemotherapy.
Sperm banking is usually offered to all men before undergoing retroperitoneal lymph node dissection, chemotherapy or radiation therapy for testicular cancer. This is because it is difficult to predict who will develop infertility. The semen is collected (a few semen collections are recommended), frozen and stored for future use in artificial fertilization procedures.
Cancer cannot be spread through sexual contact with the man’s partner. There is no evidence of increased risk of abnormalities in children who have been fathered by men who have been treated for testicular cancer.
See a list of questions to ask your doctor about supportive care after treatment.