Testicular Cancer: Symptoms, Treatment & Survival Rates

What Are the Symptoms of Testicular Cancer?

The most common symptom of testicular cancer is a painless lump or swelling in one testicle. Other signs include a feeling of heaviness in the scrotum, changes in testicle size or shape, and a dull ache in the lower abdomen or groin area.

Testicular cancer often presents with subtle symptoms that may be easy to overlook or attribute to other causes. Understanding these warning signs is crucial for early detection and successful treatment. The symptoms can vary from person to person, and some men may experience multiple symptoms while others have only one noticeable change.

Primary Symptoms

The hallmark symptom of testicular cancer is the presence of a lump within the testicle itself. This lump is typically painless and may feel like a small, hard pea or marble embedded in the testicular tissue. The texture often differs noticeably from the surrounding normal tissue. Men frequently discover these lumps during self-examination or sometimes incidentally while bathing or showering.

• Testicular lump: A firm, painless nodule within the testicle that was not present before. This is the most common presenting symptom.
• Change in size: One testicle may become noticeably larger or feel different in consistency compared to the other.
• Heaviness: A sensation of increased weight or fullness in the scrotum, even without visible swelling.
• Testicular pain: While typically painless, some men experience a dull, persistent ache in the testicle or scrotum.

Secondary Symptoms

When testicular cancer spreads beyond the testicle, additional symptoms may develop. These secondary symptoms often indicate more advanced disease and should prompt immediate medical evaluation. The retroperitoneal lymph nodes in the abdomen are typically the first site of spread, which can cause distinctive symptoms.

• Lower back pain: Persistent discomfort in the lower back may indicate spread to retroperitoneal lymph nodes.
• Abdominal pain: Dull or sharp pain in the abdomen can occur when cancer affects abdominal lymph nodes.
• Breast tenderness or growth: Some testicular cancers produce hormones that can cause breast tissue to enlarge or become tender (gynecomastia).
• Shortness of breath: If cancer has spread to the lungs, breathing difficulties may occur.

Symptoms That May Have Other Causes

It's important to note that many symptoms associated with testicular cancer can also be caused by benign (non-cancerous) conditions. Epididymitis (inflammation of the epididymis), hydrocele (fluid collection around the testicle), and varicocele (enlarged veins in the scrotum) can all cause testicular swelling or discomfort. However, any persistent change in your testicles should be evaluated by a healthcare provider to rule out cancer.

Testicular torsion, while not cancer-related, presents with sudden severe pain and requires emergency treatment. Infections such as orchitis (inflammation of the testicle) can also mimic cancer symptoms but typically present with additional signs like fever and painful urination.

When Should You See a Doctor for Testicular Concerns?

Contact your doctor if you notice any lump, swelling, or change in your testicles that persists for more than two weeks. Seek emergency care for sudden, severe testicular pain, as this may indicate testicular torsion requiring immediate treatment.

Prompt medical evaluation is essential when you notice changes in your testicles. While many testicular abnormalities turn out to be benign, early detection of cancer significantly improves treatment outcomes. Healthcare providers are experienced in evaluating these concerns and can quickly determine whether further investigation is needed.

Signs That Warrant a Doctor Visit

Any noticeable change in your testicles deserves medical attention. Men often delay seeking care due to embarrassment or the hope that symptoms will resolve on their own. However, testicular cancer grows relatively quickly, making timely evaluation important.

• A lump or nodule in either testicle, regardless of size
• Swelling or enlargement of one testicle
• A change in how the testicle feels (harder, softer, or different texture)
• A feeling of heaviness or pulling sensation in the scrotum
• A dull ache or discomfort in the testicle, groin, or lower abdomen
• Breast tenderness or enlargement

What to Expect at Your Appointment

During your medical appointment, the doctor will perform a physical examination of your testicles, scrotum, abdomen, and lymph nodes. They will ask about your symptoms, when they started, and any relevant medical history. Be prepared to discuss any family history of testicular cancer or other cancers, as well as any history of undescended testicle.

If the examination reveals any concerns, your doctor will likely order additional tests. These typically begin with a scrotal ultrasound, which is painless and provides detailed images of the testicular tissue. Blood tests to measure tumor markers may also be ordered. Based on these results, further imaging or surgical evaluation may be recommended.

Standardized Care Pathways

When testicular cancer is suspected, healthcare systems typically follow standardized care pathways designed to expedite diagnosis and treatment. These pathways ensure that patients receive timely evaluations, with appointments and tests scheduled efficiently. The goal is to minimize the time between initial concern and definitive diagnosis, as prompt treatment leads to better outcomes.

How Is Testicular Cancer Diagnosed?

Testicular cancer is diagnosed through physical examination, scrotal ultrasound, blood tests for tumor markers (AFP, HCG, LDH), and CT scans to check for spread. The definitive diagnosis is made by surgically removing and examining the affected testicle.

The diagnostic process for testicular cancer is systematic and thorough, designed to confirm the diagnosis, determine the cancer type, and assess whether it has spread. Modern diagnostic techniques allow for accurate staging, which guides treatment decisions and helps predict outcomes.

Physical Examination

The initial diagnostic step involves a thorough physical examination. Your doctor will carefully palpate (feel) both testicles, comparing their size, shape, and consistency. They will also examine your abdomen for enlarged lymph nodes and check for signs of gynecomastia (breast enlargement). While a physical exam alone cannot confirm cancer, it can identify abnormalities that require further investigation.

Scrotal Ultrasound

Ultrasound is the primary imaging test for evaluating testicular abnormalities. This painless, non-invasive procedure uses high-frequency sound waves to create detailed images of the testicular tissue. Ultrasound can distinguish between solid masses (which may be cancer) and fluid-filled cysts (which are typically benign). It can also characterize the size and location of any abnormalities with high accuracy.

The ultrasound examination typically takes about 15-20 minutes. A trained technician or radiologist will apply a warm gel to the scrotum and use a handheld probe to capture images. The results are usually available immediately or within a few days, depending on the facility.

Blood Tests (Tumor Markers)

Blood tests play a crucial role in testicular cancer diagnosis and monitoring. Three tumor markers are commonly measured:

• Alpha-fetoprotein (AFP): Elevated in non-seminoma tumors but typically normal in pure seminoma.
• Human chorionic gonadotropin (HCG): Can be elevated in both seminoma and non-seminoma cancers.
• Lactate dehydrogenase (LDH): A less specific marker that can indicate the extent of disease and tumor burden.

These markers are measured before and after surgery to help confirm the diagnosis, determine the cancer type, assess treatment response, and detect recurrence during follow-up. Not all testicular cancers produce elevated markers, so normal levels do not rule out cancer.

Radical Inguinal Orchiectomy

The definitive diagnosis of testicular cancer requires surgical removal of the affected testicle through a procedure called radical inguinal orchiectomy. Unlike most cancers where a biopsy is performed first, testicular cancer is typically not biopsied before removal. This is because the blood and lymphatic drainage of the testicle makes biopsy potentially harmful, as it could allow cancer cells to spread.

During the procedure, the surgeon makes an incision in the groin area (not the scrotum) and removes the entire testicle along with the spermatic cord. The surgery is performed under general or spinal anesthesia, and most patients can go home the next day. The removed tissue is then examined under a microscope by a pathologist to confirm the diagnosis and determine the cancer type.

Staging Tests

If cancer is confirmed, additional tests determine whether it has spread:

• CT scan (computed tomography): Detailed imaging of the chest, abdomen, and pelvis to check for spread to lymph nodes or other organs.
• MRI (magnetic resonance imaging): Sometimes used for more detailed evaluation of specific areas.
• PET scan: May be used in certain situations, particularly for seminoma, to evaluate residual masses after treatment.

Testicular Prosthesis

If you wish to maintain the appearance of having two testicles, a prosthesis can be implanted during the orchiectomy procedure or at a later date. Testicular prostheses are made of silicone and come in different sizes to match your remaining testicle. The prosthesis is purely cosmetic and does not affect hormone production or fertility. Many men choose to have a prosthesis, while others do not—the decision is entirely personal.

What Are the Treatment Options for Testicular Cancer?

Treatment for testicular cancer always begins with surgical removal of the affected testicle. Additional treatment depends on the cancer type and stage, and may include active surveillance, chemotherapy, or radiation therapy. The excellent cure rates apply even for advanced disease.

Testicular cancer treatment has become highly refined over decades of research and clinical experience. The specific treatment approach depends on the type of cancer (seminoma or non-seminoma), whether it has spread, and various individual factors. Treatment decisions are made collaboratively between you and your healthcare team, taking into account the available evidence and your personal preferences.

Surgery (Radical Inguinal Orchiectomy)

Surgical removal of the affected testicle is the cornerstone of testicular cancer treatment and is performed in virtually all cases. This procedure both removes the cancer and provides tissue for accurate diagnosis and staging. The surgery typically takes about an hour and is performed through an incision in the groin rather than the scrotum.

During surgery, a sample may also be taken from the other testicle to check for precancerous changes, although cancer in both testicles is uncommon. Recovery from orchiectomy is relatively quick, with most men returning to normal activities within one to two weeks.

Sperm Banking Before Treatment

Before surgery and any additional treatment, you will be offered the opportunity to bank (freeze) sperm. This is strongly recommended because subsequent treatments, particularly chemotherapy and radiation, can affect sperm production. Some men may already have reduced sperm counts due to the cancer itself. Banking sperm preserves your options for fathering children in the future, whether through natural conception or assisted reproductive techniques.

Treatment for Stage I Cancer (No Spread)

When testicular cancer is confined to the testicle (Stage I), several treatment options are available after surgery:

Active Surveillance

For many men with Stage I disease, especially seminoma, close monitoring without additional treatment may be appropriate. This approach involves regular follow-up visits, blood tests for tumor markers, and imaging studies at specified intervals. Active surveillance avoids the side effects of additional treatment while maintaining excellent cure rates because any recurrence can be detected early and treated effectively.

Adjuvant Chemotherapy

Some men may benefit from one or two cycles of chemotherapy after surgery to reduce the risk of recurrence. This is particularly considered for non-seminoma or when certain risk factors are present. The chemotherapy regimen typically used is BEP (bleomycin, etoposide, and cisplatin) or EP (etoposide and cisplatin).

Adjuvant Radiation Therapy

For Stage I seminoma, radiation therapy to the retroperitoneal lymph nodes is an alternative to surveillance or chemotherapy. This approach has a long track record of success, though it is used less frequently now due to potential long-term side effects and the effectiveness of surveillance.

Treatment for Advanced Cancer (Spread Beyond Testicle)

When testicular cancer has spread to lymph nodes or other organs, more intensive treatment is required but remains highly effective.

Chemotherapy

Chemotherapy is the primary treatment for metastatic testicular cancer. Treatment is given in cycles, typically lasting three to four days, followed by rest periods of about three weeks. Most men require three to four cycles of chemotherapy, though additional cycles with different drugs may be needed in some cases.

The standard regimen is BEP chemotherapy, which combines bleomycin, etoposide, and cisplatin. Side effects may include nausea, fatigue, hair loss, increased infection risk, and hearing changes. Most side effects resolve after treatment ends, though some may be permanent.

Retroperitoneal Lymph Node Dissection (RPLND)

If tumor masses remain after chemotherapy, surgery to remove affected lymph nodes in the abdomen may be necessary. This major operation requires careful surgical technique to minimize complications, particularly nerve damage that can affect ejaculation.

Radiation Therapy for Metastatic Disease

Radiation may be used to treat seminoma that has spread to lymph nodes, typically delivered over about three weeks. It may also be used for the other testicle if precancerous changes are detected.

What Can You Expect During Recovery and Follow-Up?

Recovery from surgery typically takes one to two weeks. After chemotherapy or radiation, recovery may take several weeks longer. Follow-up care continues for years with regular check-ups, blood tests, and imaging to monitor for recurrence, which is most likely in the first two years.

Recovery from testicular cancer treatment varies depending on the treatments received. Understanding what to expect during recovery helps you prepare and plan appropriately. The goal is to return to your normal activities while ensuring any recurrence is detected early.

Recovery After Surgery

Following orchiectomy, most men experience some pain and discomfort in the groin area for several days. This is typically well-controlled with prescribed pain medications. You should plan to rest for the first few days and avoid heavy lifting or strenuous activity for about two to four weeks. Most men can return to desk work within one to two weeks and to more physical activities within four to six weeks.

Recovery After Chemotherapy

Chemotherapy recovery takes longer, as the body needs time to recover from the effects of treatment. Fatigue is common and may persist for weeks to months after treatment ends. Blood counts typically recover within a few weeks, but full energy levels may take several months to return. Hair loss is temporary, with regrowth usually beginning within a few weeks after the final treatment.

Sick Leave Considerations

After surgery alone, sick leave of one to two weeks is typically sufficient. If you receive chemotherapy or radiation therapy, you may need to be off work for the entire treatment period plus several weeks afterward, depending on how you feel. Your healthcare team can provide documentation for your employer and help you plan for time off.

Long-Term Follow-Up

Follow-up care is essential after testicular cancer treatment. The schedule is more intensive in the first few years when recurrence is most likely, then gradually decreases:

• Years 1-2: Visits every two to four months with blood tests and periodic CT scans
• Years 3-5: Visits every four to six months
• After 5 years: Annual visits, often continuing for up to ten years

Follow-up visits typically include physical examination, tumor marker blood tests, and imaging studies as appropriate. The specific schedule depends on your cancer type, stage, and treatment received.

If Cancer Returns

Testicular cancer can recur, most commonly within the first two years after treatment. However, recurrent testicular cancer remains highly curable. Treatment for recurrence typically involves chemotherapy, sometimes with different drugs than initially used, and possibly surgery. The vast majority of men with recurrent disease are cured with appropriate treatment.

How Does Testicular Cancer Affect Your Life?

Most men return to normal life after treatment with good quality of life. Fertility may be affected by treatment, but many men father children afterward. Testosterone replacement may be needed if levels drop. Psychological support is available for emotional challenges.

A diagnosis of testicular cancer affects not just your physical health but many aspects of your life. Understanding potential impacts helps you prepare and take advantage of available support. The good news is that most men report good quality of life after treatment, and many impacts are temporary or manageable.

Fertility and Having Children

One of the most common concerns for men with testicular cancer is fertility. Having one testicle removed does not typically cause infertility, as the remaining testicle usually produces sufficient sperm. However, chemotherapy and radiation therapy can affect sperm production, sometimes temporarily and occasionally permanently.

Most men are advised to wait at least six months after chemotherapy before attempting to conceive, to ensure sperm quality has recovered. During this time, use contraception to prevent pregnancy with potentially damaged sperm. Many men successfully father children naturally after treatment, while others may need assisted reproductive techniques using their banked sperm.

In some cases, chemotherapy may cause retrograde ejaculation, where semen is directed into the bladder rather than out through the penis. This doesn't prevent orgasm or sexual pleasure but does require assistance to retrieve sperm for conception.

Sexual Function and Intimacy

Most men maintain normal sexual function after testicular cancer treatment. Having one testicle does not affect the ability to achieve erections or experience orgasm. However, some men experience changes in sexual desire or function related to hormonal changes, psychological factors, or treatment effects.

Body image concerns are common, particularly after losing a testicle. Many men choose to have a prosthesis, which can help with self-confidence. Open communication with your partner about your feelings and any physical changes is important for maintaining intimacy.

Testosterone and Hormones

Testosterone is primarily produced in the testicles and is essential for sexual function, energy, mood, and overall well-being. While one testicle usually produces enough testosterone, some men experience low testosterone levels after treatment. Symptoms of low testosterone include fatigue, decreased libido, mood changes, and difficulty concentrating.

If blood tests confirm low testosterone, replacement therapy is available. Options include daily gel applied to the skin or injections given every few weeks to months. Testosterone replacement can effectively restore normal hormone levels and relieve symptoms.

Potential Long-Term Effects of Treatment

Chemotherapy and radiation can have lasting effects that may appear months or years after treatment:

• Hearing changes: Some chemotherapy drugs can affect hearing, causing hearing loss or tinnitus (ringing in the ears). These effects may be permanent.
• Peripheral neuropathy: Numbness or tingling in the hands and feet can occur after certain chemotherapy drugs. Symptoms often improve over time but may persist.
• Cardiovascular effects: There may be a slightly increased long-term risk of heart disease after certain treatments.
• Second cancers: Treatment may slightly increase the risk of developing other cancers later in life, though the absolute risk remains low.
• Fatigue: Persistent tiredness is common during and after treatment but typically improves over time. Light exercise and good sleep habits can help.

Emotional and Psychological Impact

A cancer diagnosis brings emotional challenges regardless of the excellent prognosis. Common feelings include fear, anxiety, sadness, and uncertainty. Some men experience depression or struggle with body image changes. Concerns about fertility and sexuality can add additional stress.

Psychological support is available and beneficial. Many cancer centers offer counseling services, support groups, and resources specifically for young men with cancer. Speaking with others who have had similar experiences can be particularly helpful. Don't hesitate to ask your healthcare team about psychological support services.

Overall Quality of Life

Research consistently shows that most testicular cancer survivors report good to excellent quality of life after treatment. While there may be physical and emotional challenges along the way, the vast majority of men return to their normal activities, relationships, and life goals. Many survivors describe gaining a new perspective on life and what matters most to them.

What Causes Testicular Cancer and Can It Be Prevented?

The exact cause of testicular cancer is unknown, but risk factors include undescended testicle and family history. Unlike many cancers, lifestyle factors like smoking and diet play minimal roles. Prevention isn't possible, but regular self-examination aids early detection.

Understanding the causes and risk factors for testicular cancer helps put your diagnosis in context and can inform family members who may have increased risk. While the exact cause remains unknown, research has identified several factors that increase the likelihood of developing this cancer.

What Is Testicular Cancer?

Testicular cancer develops from germ cells, the cells in the testicle that produce sperm. It is primarily divided into two main types:

• Seminoma: Tends to grow more slowly and is very sensitive to radiation therapy. Usually occurs in men in their 30s and 40s.
• Non-seminoma: Includes several subtypes (embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma). Tends to grow more quickly and often affects younger men.

Both types have excellent cure rates, though treatment approaches differ. Some tumors contain both seminoma and non-seminoma elements and are treated as non-seminoma.

Risk Factors

Several factors are associated with increased risk of testicular cancer:

• Undescended testicle (cryptorchidism): This is the strongest known risk factor. Men who had an undescended testicle have 4-6 times the normal risk, even if the condition was surgically corrected in childhood. The risk applies to both testicles, not just the one that was undescended.
• Family history: Having a father or brother with testicular cancer increases your risk approximately 8-10 times for brothers and 4-6 times for sons.
• Previous testicular cancer: Men who have had cancer in one testicle have about a 2-5% chance of developing it in the other testicle.
• Age: Testicular cancer most commonly occurs between ages 15 and 44, with peak incidence between 28 and 43 years.
• Race/ethnicity: Testicular cancer is more common in white men than in men of other racial groups.
• Certain genetic conditions: Klinefelter syndrome and some other genetic conditions increase risk.

Factors That Don't Increase Risk

Unlike many cancers, testicular cancer is not strongly associated with lifestyle factors. The following do NOT significantly increase testicular cancer risk:

• Smoking or tobacco use
• Alcohol consumption
• Diet or obesity
• Physical injury to the testicles
• Vasectomy
• Sexual activity or sexually transmitted infections

Prevention

There is no known way to prevent testicular cancer. The risk factors that have been identified—such as undescended testicle and family history—cannot be changed. However, early detection through regular self-examination significantly improves outcomes by catching cancer at its most treatable stage.

Testicular Self-Examination

Monthly self-examination is the best way to detect testicular cancer early. Here's how to perform a self-exam:

1. Choose the right time: Perform the exam during or after a warm shower or bath when the scrotum is relaxed.
2. Examine one testicle at a time: Hold the testicle between your thumbs and fingers with both hands and gently roll it between your fingers.
3. Feel the entire surface: Check for lumps, swelling, or changes in size or consistency.
4. Know what's normal: The epididymis (a soft, tube-like structure behind each testicle) is normal. Learn how your testicles usually feel so you can detect changes.
5. Compare both sides: It's normal for one testicle to be slightly larger or hang lower, but significant differences may warrant evaluation.

If you notice any changes, don't panic—many abnormalities are benign—but do contact your doctor promptly for evaluation.

How Do You Cope with a Testicular Cancer Diagnosis?

Receiving a cancer diagnosis is difficult, even with excellent prognosis. Take time to process your emotions, gather information, and build a support network. Bring someone to appointments, write down questions, and don't hesitate to seek psychological support.

Learning you have cancer is one of life's most challenging experiences, regardless of how treatable the cancer may be. The emotional impact can be significant, and it's important to acknowledge and address these feelings while also taking practical steps toward treatment.

Common Reactions

There is no "right" way to react to a cancer diagnosis. Common responses include:

• Shock and disbelief ("This can't be happening to me")
• Fear and anxiety about treatment and the future
• Anger ("Why me?")
• Sadness and grief
• Numbness or feeling overwhelmed
• Difficulty concentrating or remembering information

These reactions are normal and often fluctuate over time. Many men find that the initial shock gives way to a more pragmatic focus on treatment as they learn more about their condition and its excellent prognosis.

Getting the Information You Need

Understanding your diagnosis and treatment options helps you feel more in control. Consider these strategies:

• Bring someone with you: A family member or friend can provide emotional support and help remember what the doctor says.
• Write down questions: Prepare questions before appointments so you don't forget to ask important things.
• Take notes or record: With permission, record conversations with your healthcare team to review later.
• Ask for explanations: Don't hesitate to ask healthcare providers to explain things in simpler terms if needed.
• Request written information: Many centers provide written materials about your diagnosis and treatment.

Building Your Support Network

You don't have to face cancer alone. Support can come from many sources:

• Family and friends: Let people know how they can help, whether that's practical assistance, emotional support, or simply distraction.
• Healthcare team: Your doctors, nurses, and support staff are there to help you through treatment.
• Contact nurse/coordinator: Many cancer centers assign a dedicated contact person to help coordinate your care and answer questions.
• Support groups: Connecting with other testicular cancer survivors can be valuable. Ask your healthcare team about local groups or online communities.
• Professional counseling: Psychologists and counselors experienced in cancer care can help you process emotions and develop coping strategies.

For Partners and Family Members

Cancer affects the whole family. Partners and family members often experience their own fear, anxiety, and grief. Support is available for them too—ask your healthcare team about resources for families. Open communication about feelings and needs helps everyone cope better.

How Can You Participate in Your Healthcare Decisions?

You have the right to be actively involved in decisions about your care. Ask questions, seek second opinions if desired, and ensure you understand your options before consenting to treatment. Healthcare providers should explain things in terms you can understand.

Being an active participant in your healthcare leads to better outcomes and greater satisfaction with care. Modern healthcare emphasizes shared decision-making, where you and your healthcare team work together to determine the best treatment approach for your individual situation.

Your Rights as a Patient

As a patient, you have the right to:

• Receive clear information about your diagnosis, treatment options, and prognosis
• Ask questions and receive understandable answers
• Participate in decisions about your care
• Seek a second opinion
• Refuse treatment after being informed of consequences
• Have an interpreter if needed
• Have your privacy and dignity respected

Questions to Ask Your Healthcare Team

Consider asking:

• What type and stage of testicular cancer do I have?
• What are my treatment options?
• What are the benefits and risks of each option?
• What would you recommend and why?
• How will treatment affect my fertility?
• What side effects should I expect?
• How will my life be affected during and after treatment?
• What is my prognosis?
• Are there clinical trials I should consider?
• Who should I contact if I have questions or concerns?

Seeking a Second Opinion

Seeking a second opinion is your right and is not a sign of distrust. It can provide reassurance that you're on the right track or present alternative perspectives. If you want a second opinion, ask your doctor for a referral to another specialist. Most testicular cancer cases are straightforward, but for complex situations, a second opinion at a specialized center can be valuable.

Care Coordination

Testicular cancer treatment involves multiple healthcare providers. Your care is typically coordinated by your primary oncologist, but you may also see urologists, radiation oncologists, and other specialists. A care coordinator or contact nurse can help navigate the system and ensure good communication between all providers.