Testicular Cancer

Testicular cancer starts in the testicle or testis and is often found in men aged 15 to 44 years. It is relatively rare but treatable, and the prognosis is good if diagnosed early, when the tumors are small and have not spread. It is, in fact, one of the most treatable solid cancers in medicine — the large majority of men diagnosed, including many with more advanced disease, go on to be cured.

The first sign of testicular cancer is usually a lump on the testicle which looks swollen or larger than usual. Some variation between the two testes is normal — it is common for one testicle to be slightly different in size, and for one to hang a little lower than the other. Normal testicles contain blood vessels, supporting tissue and the tubes that carry sperm, and an enlarged or lumpy testicle can also result from other, non-cancerous causes — for instance, a build-up of fluid around the testicle (a hydrocele), or dilated veins within the scrotum. However, some testicular cancers might not cause any noticeable symptoms until they have reached a more advanced stage, which is one reason familiarity with one's own body matters.

Testicular self-examination is the easiest and most basic way for men to detect early signs of cancer. The best time to perform one is during or after a bath or shower, when the skin of the scrotum is relaxed and any changes are easier to feel.

Understanding the Testicles and How Testicular Cancer Develops

The testicles are two small, oval-shaped glands that sit within the scrotum and are responsible for producing sperm and the hormone testosterone. Sperm develop within a dense network of tiny tubules inside each testicle before travelling onward through the reproductive tract.

The great majority of testicular cancers, around 90 to 95 percent, arise from germ cells — the cells responsible for producing sperm. These are known as germ cell tumors and are broadly divided into seminomas and non-seminomas, which behave somewhat differently and are sometimes treated differently as a result. A much smaller proportion of testicular cancers arise instead from the surrounding supportive and hormone-producing tissue of the testicle.

Types of Testicular Cancer

• Seminoma: The more common of the two main germ cell tumor types, seminomas tend to grow and spread more slowly than non-seminomas. They occur across a wide age range but are most frequently diagnosed in men in their 30s to 50s, and they are generally very sensitive to radiation therapy.
• Non-Seminoma: A group of germ cell tumors — including embryonal carcinoma, yolk sac tumor, choriocarcinoma and teratoma — that tend to grow and spread somewhat more quickly than seminomas. Non-seminomas are typically diagnosed in younger men, often in their late teens to early 30s, and a single tumor may contain a mixture of these different cell types.
• Leydig Cell Tumor: A rare, non-germ cell tumor arising from the cells responsible for producing testosterone. Most are benign, though a small proportion can be cancerous, and they can sometimes cause hormonal changes such as breast tissue growth.
• Sertoli Cell Tumor: Another rare, non-germ cell tumor, arising from the cells that support sperm development. The majority are benign, and malignant cases are uncommon.

Stages of Testicular Cancer

Once testicular cancer is diagnosed, doctors determine its stage to guide treatment planning and give a clearer picture of prognosis.

1. Stage 0: Abnormal cells are confined to the small tubules within the testicle where sperm cells develop, and have not yet become invasive cancer (also called germ cell neoplasia in situ).
2. Stage I: Cancer is confined to the testicle and has not spread to lymph nodes or distant organs, though it may have grown into nearby structures within the scrotum.
3. Stage II: Cancer has spread to lymph nodes in the abdomen (the retroperitoneal lymph nodes), but has not yet spread to distant organs.
4. Stage III: Cancer has spread beyond the retroperitoneal lymph nodes to more distant lymph nodes or organs, such as the lungs, liver or brain.

Staging takes into account the size of the tumour, whether it has spread to lymph nodes, and the levels of specific tumour markers in the blood. Because testicular cancer often responds very well to treatment even at more advanced stages, a higher stage at diagnosis does not carry the same weight it might for some other cancers.

Symptoms of Testicular Cancer

• Feeling of heaviness in the scrotum: A dull, persistent sense of weight or fullness in the scrotum, which may develop gradually and is sometimes the first thing a man notices, even before a distinct lump is felt.
• Pain or a dull ache in the testicle, scrotum, or groin: A dull ache or more distinct pain localised to the testicle, scrotum, or lower groin area, which may come and go or persist steadily.
• Painless lump in the testicle: Often the very first noticeable sign, this is typically felt as a firm, pea-sized or larger mass within the testicle itself, and is frequently, though not always, free of pain.
• Swelling of the testicle: A noticeable increase in the size of one testicle compared with the other, sometimes accompanied by a change in its usual firmness or texture.
• Tenderness or changes in the male breast tissue: Some testicular tumours produce hormones that can cause breast tissue to become tender, enlarged, or otherwise different from usual.

In advanced testicular cancer, some of the symptoms are lower back pain, from cancer that has spread to the lymph nodes in the abdomen, and respiratory difficulty, if it has spread to the lungs.

How to Perform a Testicular Self-Examination

A testicular self-examination can be done in a minute and from the comfort of your home. It is recommended to perform one once every month. The aim of a testicular self-examination is to familiarise yourself with the look, feel and shape of your testicles, which will help you notice abnormalities should there be any.

1. The testicular self-examination is best performed after showering and in front of a mirror, when the muscles of the scrotum are relaxed and the testicles hang more freely, making changes easier to detect.
2. Gently roll one testicle between the fingers and thumb of both hands, applying light pressure to feel the entire surface for any lumps, hardened areas, or changes in size.
3. Feel along the underside of your scrotum to find the epididymis, a soft, tube-like structure that sits at the back of the testicle and stores and transports sperm. It should feel like a small, tightly curled bunch of tubes, distinct from the firmer, smoother surface of the testicle itself, and should not be mistaken for an abnormal lump.
4. Perform the self-examination on one testicle before moving on to the other, so that you build a clear, separate sense of what is normal for each side.

Causes of Testicular Cancer

The exact cause of testicular cancer is not fully understood, but it is thought to begin when something goes wrong in the process by which germ cells develop into mature sperm-producing cells, causing them to grow and divide abnormally instead. Certain inherited and developmental factors are known to increase the likelihood of this happening, which is reflected in the recognised risk factors below.

Risk Factors for Testicular Cancer

• Having an undescended testicle (cryptorchidism): The testes are formed during fetal development and typically descend into the scrotum before birth. If you have an undescended testicle, your risk of testicular cancer increases, as the testicle may develop abnormally when it remains higher in the body at a warmer temperature than the scrotum. Importantly, the risk remains elevated even if you have had corrective surgery to move the testicle into the scrotum, so ongoing awareness and self-examination remain worthwhile.
• Family history: You may have an increased risk if there is a history of testicular cancer in your family, particularly in a father or brother, which suggests that inherited genetic factors play a role in some cases alongside developmental and environmental influences.
• Age: While testicular cancer can happen at any age, it is more common among those aged between 15 and 45, making it one of the more common cancers affecting younger and middle-aged men, in contrast to many other cancers that are more strongly associated with older age.
• Ethnicity: Testicular cancer is more prominent among Caucasians compared with men of other ethnic backgrounds, for reasons that are not entirely understood but are thought to involve a combination of genetic and possibly environmental factors.
• Personal history of testicular cancer: A personal history of cancer in one testicle modestly raises the risk of a new, separate cancer later developing in the other testicle, which is part of why long-term follow-up continues even after successful treatment.

Testicular Cancer, Spread and Fertility

Because the testicles connect closely with both the lymphatic system and the body's hormonal function, testicular cancer and its treatment can have effects that extend beyond the testicle itself.

• Pattern of spread: Testicular cancer most commonly spreads first to nearby lymph nodes in the back of the abdomen (the retroperitoneal lymph nodes), before potentially spreading further to distant lymph nodes or organs such as the lungs, liver or, less commonly, the brain.
• Effect on fertility and hormones: Because sperm and testosterone can generally still be produced adequately by a single healthy testicle, most men who lose one testicle to cancer are able to father children and maintain normal testosterone levels afterward, though individual circumstances vary.
• Sperm banking: For men who wish to preserve the option of having children in the future, banking sperm before treatment begins is often recommended, since certain treatments — particularly chemotherapy and radiation — can temporarily or, less commonly, permanently affect fertility.
• Testicular prosthesis: Men who undergo removal of a testicle may choose to have a testicular prosthesis (implant) placed at the time of surgery or later, for those who wish to restore the usual appearance of the scrotum.

How Testicular Cancer is Diagnosed

• Physical Examination: The doctor will feel the testicles for swelling, tenderness, as well as the size and location of any lumps. If there is a lump or other sign of testicular cancer detected, further testing will be needed to look for the cause.
• Ultrasound: From the images produced by the sound waves, the doctor can see if the change is due to a benign condition or a solid tumour that could be cancer. If the lump is solid, it is more likely to be cancer, and the doctor will then recommend additional tests or surgery to remove the testicle.
• Blood Test (Tumour Markers): Cancers produce proteins known as tumour markers; if they are present in the blood, it is positive for cancer. The tumour might also increase the levels of an enzyme called lactate dehydrogenase (LDH), which often — but not always — indicates widespread disease. However, some non-cancerous conditions may also increase LDH levels, in which case other detailed examination by your doctor will be necessary.
• CT Scan of the Abdomen and Pelvis: Used after a cancer diagnosis is confirmed to check whether the cancer has spread to nearby lymph nodes in the abdomen, which is important for determining the stage of the disease and planning treatment.
• Chest X-ray or CT Scan: Checks whether the cancer has spread to the lungs, a relatively common site for testicular cancer to spread to if it progresses beyond the testicle and nearby lymph nodes.

Life After Testicular Cancer Treatment

Because testicular cancer can recur, sometimes years after initial treatment, structured long-term follow-up is an important part of care even after successful treatment.

• Ongoing surveillance: Regular blood tests to check tumour marker levels, along with periodic imaging and physical examination, are used to monitor for any signs of recurrence, typically at closer intervals in the first few years and gradually spacing out over time.
• Continued self-examination: Since a personal history of testicular cancer modestly increases the risk of a new cancer in the remaining testicle, continuing monthly self-examination after treatment remains a valuable habit.
• Hormone monitoring: For men who have had one testicle removed, periodic monitoring of testosterone levels can help identify and address any hormonal changes, though most men maintain normal hormone function with a single healthy testicle.

With appropriate treatment and follow-up, testicular cancer has one of the highest cure rates of any cancer, and the great majority of men go on to lead full, healthy lives, including maintaining fertility and normal hormonal function in most cases.

Prevention and Early Detection

There is currently no proven way to prevent testicular cancer, since its main risk factors — such as an undescended testicle, family history, age and ethnicity — are not things a person can change. This makes early detection, rather than prevention, the most valuable tool available.

• Regular self-examination: Performing a testicular self-examination once a month helps build familiarity with what is normal, making it easier to notice any new lump, swelling or change early, when treatment tends to be simplest and most effective.
• Prompt assessment of any changes: Because pain is not always present, and some testicular cancers cause no symptoms until they are more advanced, any new lump, swelling or change in size or firmness — however minor — is worth having assessed by a doctor promptly.
• Awareness of personal risk factors: Men who were born with an undescended testicle, or who have a family history of testicular cancer, may benefit from being particularly attentive to regular self-examination, given their comparatively higher baseline risk.

A diagnosis of testicular cancer, particularly in a young man, can feel overwhelming, but the outlook for this condition is genuinely one of the most favourable in oncology. The combination of highly effective surgery, radiation and chemotherapy means that the great majority of men, including many with cancer that has already spread beyond the testicle, are successfully cured.

Understanding the type and stage of the cancer, the reasoning behind the recommended treatment approach, and the importance of ongoing follow-up helps men move through diagnosis and treatment with clarity, and supports a full return to normal life, fertility and long-term health afterward.