Testicular cancer

MBA, MBBS

Last updated on: 23 Jun 2025 | 06:19 PM (IST)

Also known as Germ cell tumour

Overview

Testicular cancer happens when abnormal cells grow in the testicles. The testicles are two small glands in the scrotum, located below the penis. They make sperm and male hormones. Common symptoms of testicular cancer include a lump, swelling, or heaviness in the testicle or scrotum.

Testicular cancer accounts for merely 1% of malignancies found in men. It can occur in men of all ages, but is most commonly seen in men aged 15 to 44 years. It usually affects only one testicle. Risk factors for testicular cancer include undescended testicles, family history, and HIV infection.

Testicular cancer is highly treatable, especially when caught early. Based on the diagnosis and stage, your doctor may recommend surveillance, surgery, radiation, chemotherapy, or a combination of these treatments for the best outcome.

Key Facts

Usually seen in

Adults between 15 to 44 years of age

Gender affected

Body part(s) involved

Testicles

Mimicking Conditions

Testicular torsion
Epididymitis
Hydrocele
Spermatocele

Necessary health tests/imaging

Imaging tests: Ultrasound scrotal, CECT scan whole abdomen, Chest X-ray, and CECT scan chest.

Blood tests: Alpha-fetoprotein (AFP), Beta-human chorionic gonadotropin (beta-hCG), and Lactate dehydrogenase (LDH).

Surgical removal of the testicle (orchidectomy or orchiectomy)

Treatment

Surgery: Radical inguinal orchiectomy and Retroperitoneal lymph node dissection.

Chemotherapy: Bleomycin, Cisplatin, Etoposide, and Ifosfamide.

Radiation therapy

Bone marrow transplantation

Specialists to consult

General physician
General surgeon
Urologist
Oncologist

Symptoms of Testicular Cancer

Testicular cancer can cause several symptoms that affect your health. It is possible to experience more than one symptom at the same time. These include:

Feeling a lump or swelling in either testicle
Feeling of heaviness in the scrotum
Collection of fluid in the scrotum
Experiencing pain or discomfort in one testicle or the scrotum
Testicular atrophy (shrinking of the testicles)
Experiencing a dull ache in the abdomen or groin region
Enlargement or tenderness of the breasts
Lower back pain
Swelling of one or both legs or shortness of breath due to a blood clot
Shortness of breath, chest pain, and blood in sputum or phlegm (when cancer has spread to the lungs)
Headaches and confusion in case the tumour spreads to the brain.

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Types Of Testicular Cancer

The first step in distinguishing types of testicular cancer often starts with how the tumor cells appear under a microscope. These include:

1. Seminoma

These tend to grow slowly and usually remain confined to the testicles, making them less likely to spread. Seminomas are more common in older adults.

2. Nonseminoma

This type is usually seen at earlier stages of life. Later, it grows in size and spreads rapidly throughout the body. Nonseminoma tumours tend to involve the lymph nodes. There are different types of non-seminoma tumours, like:

Embryonal carcinoma
Yolk sac tumour
Choriocarcinoma
Teratoma

3. Stromal tumours

Stromal tumors are rare testicular cancers that arise from the supportive tissues around germ cells and usually have a good outcome with surgery. The two main subtypes are:

Leydig cell tumors
Sertoli cell tumors.

Causes Of Testicular Cancer

The exact cause of testicular cancer remains unclear. Typically, healthy cells grow and divide in a controlled manner to support normal body function, but in some cases, mutations (changes) cause these cells to grow uncontrollably, even when the body doesn't need them.

The cancerous cells pile up, take up space, and use nutrients meant for healthy cells. Over time, they form a lump that can be felt in the testicle.

Some testicular cancers start in cells that create immature sperm. Researchers have found that many of these cancers have an extra copy of chromosome 12. Others show abnormal numbers or structures of chromosomes.

Certain risk factors increase the probability of testicular cancer, which are discussed in detail in the next segment.

Risk Factors For Testicular Cancer

The following factors are associated with a high risk of testicular cancer.

Non-modifiable factors

Age group of 15 to 44 years

Failure of the testicle to descend from the abdomen into the scrotum (cryptorchidism)
Personal history of testicular cancer
Family history of testicular cancer
Race (Incidence is highest in the white race, most rapidly increasing in the Hispanic population, and lowest amongst African-American individuals)
Abnormal testicular development in conditions like Klinefelter syndrome
Congenital defects like hypospadias (abnormality of the penis) and inguinal hernia (a lump in the groin)

Modifiable factors

Infertility or difficulty conceiving a baby
HPV or HIV infection
Issues before birth related to the mother’s pregnancy, such as abnormal bleeding and estrogen or hormone therapy

Lifestyle factors

Smoking
Cannabis use
Diet (high consumption of dairy products, red meat, etc)
Exposure to electromagnetic fields
Occupational exposure to plastics and high temperatures.

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Home care For Testicular Cancer

It generally takes about two weeks or two months to recover from an orchiectomy that allows doctors to remove the affected testicle. It is important to follow the post-op instructions given by your doctor during your recovery time.

You will be advised to avoid lifting anything over ten pounds for the first few weeks of the surgery.
You will also be asked to refrain from engaging in any kind of sexual activity until you have recovered.
Activities such as exercising, running, or playing sports should be avoided for nearly four weeks post-surgery.

You will be asked to maintain a schedule of follow-up appointments to minimise the risk of testicular cancer returning.
You will be asked to learn how to perform self-testicular examinations.

Diagnosis Of Testicular Cancer

Diagnosis of testicular cancer begins with evaluating symptoms and identifying any unusual changes through a medical assessment. It consists of:

1. Clinical examination

The doctor will examine both testicles to check for lumps or changes
Other areas like the abdomen, neck, chest, armpits, and groin are checked for swollen lymph nodes
Breasts and nipples are examined for any unusual growth
Legs are checked for swelling that could be due to blood clots.

2. Imaging tests

Ultrasound scrotal: A testicular ultrasound uses sound waves to create an image of the scrotum and testicles. It helps determine the size, nature, and location of the lump.
CECT scan whole abdomen: It is usually done to evaluate the abdominal area. The presence, size, and location of a tumour, along with associated lymph nodes, can be evaluated.
Chest X-ray: It is used to ascertain any metastasis (spread) to the lungs.
CECT chest: It should be performed in case of metastasis to the lung or if lung nodules are identified on chest x-ray.

3. Blood tests

Alpha-fetoprotein (AFP): It is a protein that may be found in higher levels in the blood if certain types of testicular cancer are present.
Beta-human chorionic gonadotropin (beta-hCG): It is a hormone that may be elevated in the blood with some types of testicular cancer, helping in diagnosis and monitoring.
Lactate dehydrogenase (LDH): It is an enzyme that may rise in testicular cancer, indicating tumor burden and helping track disease progression.

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4. Surgical removal of the testicle (orchidectomy or orchiectomy)

In testicular cancer, the affected testicle is usually removed through surgery and then examined in a lab.
This procedure helps confirm the diagnosis, and typically, only one testicle is removed since both are rarely affected at the same time.
Unlike other cancers, a biopsy isn't done directly from the testicle because it may increase the risk of cancer spreading to nearby lymph nodes.

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Prevention Of Testicular Cancer

There’s no known way to prevent testicular cancer yet. Healthy lifestyle habits like eating a balanced diet, staying active, avoiding tobacco, and limiting alcohol may help lower your risk of developing cancer.

But catching it early can stop it from spreading and improve outcomes. Doing a testicular self-exam (TSE) can help spot changes early. Learn more:

Testicular self-exam (TSE)

Start in your teens and do it once a month, ideally after a warm bath or shower when the scrotal skin is relaxed.

How to perform?

Stand upright during the exam
Look for any swelling in the scrotum
Gently feel the scrotal sac to locate each testicle
Check one testicle at a time by gently rolling it between your thumb and fingers to feel for lumps or changes.

Not sure how to do a testicular self-exam? Don’t worry, our expert’s got you covered.

Specialist To Visit

Testicular cancer requires a comprehensive approach for the best outcomes. Experts who may be involved include:

General physician
Urologist
Oncologist
Radiation oncologist
Fertility specialist

A general physician identifies early symptoms and refers you to a specialist for further evaluation.

A urologist diagnoses and performs surgery to remove the affected testicle.

An oncologist plans and manages chemotherapy or targeted cancer treatments.

A radiation oncologist delivers radiation therapy to shrink or destroy cancer cells.

A fertility specialist offers options to preserve fertility before treatment begins.

If you notice a lump, swelling, or any unusual change in the size of your testicle, it’s important to get professional help without delay.

Treatment Of Testicular Cancer

Testicular cancer can be treated based on the type and staging of the cancer. The staging of testicular cancer is based upon understanding the pattern of spread. One staging classification that is used is the TNM system:

Stage I: Tumour (T) is limited to the testis
Stage II: Tumour has spread to the lymph nodes (N) in the back of the abdomen (retroperitoneum)
Stage III: Metastasis (M) of the cancer has spread to other parts of the body, such as the lungs, liver, brain, and bone.

Note: For testicular cancer, an S is also added to the TNM system. Serum tumour marker (S) indicates any elevation of serum tumour markers like AFP, beta-hCG, and LDH.

Management consists of:

1. Surgery

Radical inguinal orchiectomy: The surgeon makes a small cut in the groin to remove the affected testicle. In early stages, this surgery alone may be enough to treat the cancer.

Retroperitoneal lymph node dissection: This surgery removes lymph nodes through a cut in the abdomen.

2. Chemotherapy

Chemotherapy treatment is a treatment modality that uses strong medicines that are effective in killing cancer cells. Commonly used chemotherapeutic agents in the treatment of testicular cancer are:

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3. Radiation therapy

Radiation therapy is a treatment modality that uses high-powered energy beams that work as an effective treatment to kill cancer cells.

Radiation therapy is often recommended for patients who have the seminoma type of testicular cancer and can also be recommended after surgery to remove a testicle.

4. Bone marrow transplantation

In this procedure, the bone marrow is taken from the patient and treated with drugs to do away with the cancer cells. The marrow is then frozen.

The patient is given high-dose chemotherapy with or without radiation therapy to destroy the remaining marrow.

The marrow earlier removed from the patient is thawed or warmed and injected into a vein of the patient to replace the marrow that was destroyed.

Did You Know?

Curcumin, found in turmeric, may help fight testicular cancer by reducing inflammation and slowing the growth of cancer cells. It is important to note that it should not replace the conventional treatment.

Complications Of Testicular Cancer

Testicular cancer can lead to certain complications such as:

1. Excessive female hormones: Some types of testicular cancer make extra hormones like hCG or estrogen. This can cause men to develop enlarged breast tissue, a condition called gynecomastia.

2. Metastasis (cancer spread): If testicular cancer is not treated, it can spread to other body parts. This may cause symptoms like back pain, swollen lymph nodes, or breathing problems if the lungs are involved.

3. Long-term chemotherapy effects: Certain chemo medicines can increase the risk of heart problems, hypertension (high blood pressure), and cholesterol. In rare cases, another type of cancer, like leukemia, can appear years after treatment.

Alternative Therapies For Testicular Cancer

Testicular cancer needs standard medical treatment, but some alternative therapies can ease side effects. These include:

1. Acupuncture

Acupuncture has proven to be a successful alternative therapy for individuals with testicular pain. It involves the insertion of needles through the skin at specific points on the body. Acupuncture can also provide relief for people who have epididymitis (inflammation of the epididymis present at the back of the testicle).

2. Aromatherapy

Aromatherapy uses a mix of essential oils for massages that can make a person feel relaxed. Often, people feel that alternative therapies such as aromatherapy help them cope with the treatment of cancer and allow them to feel relaxed.

Living With Testicular Cancer

Living with testicular cancer can be overwhelming, both physically and emotionally. But with timely diagnosis and the right support, it’s possible to maintain a good quality of life. Tips that could help include:

1. Learn about testicular cancer

Learning about testicular cancer can help you make comfortable decisions regarding your treatment choice
It is better to empower yourself with the knowledge of what’s about to happen than to fear the unknown

2. Take care of yourself

Eat a healthy, well-balanced diet
Increase the number of fruits and vegetables you intake and get plenty of rest every night
Try to practice meditation and eliminate sources of stress from your life before the treatment.
Talk to your doctor about strategies that can help your body prepare for the treatment

3. Prioritize mental and emotional well-being

Talk openly about your diagnosis and feelings
Lean on close friends and family for support
Gather information to understand your treatment better
Acknowledge physical changes and limitations
Communicate with your partner about intimacy
Addressing practical issues like finances, work, etc.

4. Manage the cost of cancer care

Cancer treatment can be costly and sometimes overwhelming
Besides medical bills, unexpected expenses may arise
Financial stress can interrupt treatment if not addressed early
Reach out to a hospital social worker—they can guide you on grants, insurance claims, and available aid.

Tips for Caregivers

Offer emotional support and encouragement
Learn about the treatment plan
Help manage symptoms and side effects
Keep track of doctor visits and medications
Support with hygiene and daily tasks
Speak with empathy and maintain a positive outlook
Pitch in with chores and daily routines
Assist with insurance and financial paperwork.

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Frequently Asked Questions

How will testicular cancer affect my sex life?

Removal of one testicle generally doesn't result in infertility or change in libido levels. Most patients who undergo testicular surgery experience normal erections after the surgery. In some cases, men can have an increased risk of infertility and low testosterone levels. Surgery involving the removal of lymph nodes can make it harder for some men to ejaculate. There can also be a temporary decline in the levels of sperm count. Talk to your doctor about medicines that can help with ejaculation and consider the option of preserving your sperm before undergoing an operation.

What is the prognosis for testicular cancer?

The general prognosis for low stage or early-stage cancers is good. If detected early, the combination of chemotherapy and radiation can treat almost 100% of tumours.

What are the chances that testicular cancer will occur in the second testicle?

Around 2 to 3% of adults face the risk of developing cancer in the other testicle of the opposite side. However, most often there is no growth of tumours after the treatment. To avoid the same, it is important for patients to practise self-examination regularly.

How long does it take for an adult to heal from orchiectomy?

After the surgery, the scrotum may remain swollen for about two to four weeks. It is important to follow the post-op instructions given by your doctor and avoid engaging in strenuous activities until the surgical site has healed.

Can testicular cancer come back after treatment?

Yes, testicular cancer can recur, especially within the first few years after treatment. Regular follow-ups and monitoring help detect any recurrence early for timely management.

References

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Overview

Key Facts

Symptoms

Types

Causes

Risk factors

Home-care

Diagnosis

Prevention

Specialist to visit

Treatment

Complications

Alternatives therapies

Living with

FAQs

References