Testicular Cancer at a Glance
Young men
Most common between the ages of 15 and 40.
Highly curable
Overall cure rates exceed 95% with modern treatment.
Blood markers
AFP, β-hCG and LDH help diagnosis and follow-up.
Fertility can be protected
Sperm banking is discussed before treatment begins.
Symptoms and Risk Factors
- A painless lump or swelling in one testicle
- A dragging or heavy feeling in the scrotum
- Less commonly, back pain, breathlessness or breast tenderness from hormone effects or spread
An undescended testis in childhood, a previous Testicular Cancer and a family history increase the risk. Most lumps turn out not to be cancer, but a lump within the testis itself needs an ultrasound without delay. Regular self-examination helps with early detection.
Diagnosis and Staging
A scrotal ultrasound shows whether a lump lies within the testis. Blood tumour markers (AFP, β-hCG and LDH) are measured before surgery and again afterwards to confirm that they fall as expected. A CT scan of the abdomen, pelvis and chest checks the lymph nodes at the back of the abdomen and the lungs, the usual sites of spread.
A needle biopsy through the scrotum is avoided because it can spread cancer cells; the diagnosis is confirmed by removing the testis through the groin.
Seminoma and Non-Seminoma
Seminoma
Usually slower growing and very sensitive to chemotherapy and radiation. AFP is not raised in pure seminoma.
Non-seminoma
Includes embryonal carcinoma, yolk sac tumour, choriocarcinoma and teratoma, often mixed. Teratoma does not respond to chemotherapy and may need surgery.
Treatment by Stage
Radical inguinal orchiectomy
The affected testis is removed through a small groin incision. This is the first step in every case, and a testicular prosthesis can be placed at the same operation if desired.
Stage I
Most men are managed with surveillance, regular markers and scans, avoiding further treatment. One or two cycles of chemotherapy may be offered when risk features are present.
Spread disease
Chemotherapy is planned with medical oncology according to the IGCCCG prognostic group. Residual masses after chemotherapy, particularly in non-seminoma, are removed by retroperitoneal lymph node dissection (RPLND).
Fertility and Hormones
Sperm banking is offered before orchiectomy and before any chemotherapy or radiation. Most men with one healthy testis keep normal testosterone levels and fertility, and hormone levels are checked during follow-up.
Follow-Up
Markers and imaging follow a fixed schedule, most intensive in the first two years when recurrences are most likely. Because most patients are young, the schedule is designed to limit radiation exposure from CT scans wherever it is safe to do so.
Frequently Asked Questions
Is every testicular lump cancer?
No. Cysts, fluid collections and infection of the epididymis are common causes. An ultrasound quickly tells them apart; a lump within the testis itself needs prompt attention.
Will removing one testis affect sexual function?
Usually not. The remaining testis normally produces enough testosterone for normal sexual function and fertility.
Why is a biopsy not done first?
A needle biopsy through the scrotum risks spreading cancer cells. Removing the testis through the groin is both the diagnosis and the first treatment.
Do all patients need chemotherapy?
No. Many men with stage I disease are managed with surveillance alone after orchiectomy.
How often should I examine myself?
Once a month, after a warm bath or shower, so that you know what is normal for you and notice changes early.
Can Testicular Cancer come back?
It can, most often within the first two years, which is why follow-up is structured. Even recurrences are usually curable.
