ConditionCancer
Testicular Cancer
Testicular cancer is a cancer that starts in the testicles, most often in young men aged 15 to 45. The usual first sign is a painless lump or swelling in one testicle, or a feeling of heaviness in the scrotum. The main risk factor is an undescended testicle. Almost all testicular cancers are germ cell tumors (seminomas or non-seminomas), and they are among the most curable cancers: more than 95% of men are cured, even when it has spread. Treatment starts with removing the affected testicle.
Also called: Testicular germ cell tumor, seminoma, non-seminoma, testis cancer
At a glance
- What it is
- Cancer arising in the testicle, almost always a germ cell tumor.
- Who
- Most common cancer in men aged 15 to 35 in the US, though overall rare.
- Main sign
- A painless lump, swelling or hardness in one testicle.
- Diagnosis
- Scrotal ultrasound, tumor marker blood tests (AFP, hCG, LDH), then removal of the testicle.
- Outlook
- Over 95% of men are cured with surgery and, if needed, surveillance, chemotherapy or radiation.
When to get help
Call 911 or go to the ER
- Sudden, severe testicular pain, especially with nausea or vomiting (rule out testicular torsion)
See a doctor within a day or two
- A rapidly enlarging testicle or lump
- A testicular lump with back pain, coughing, breathlessness or chest pain (possible spread)
- New breast swelling or tenderness in a young man, with a testicular change
Book a routine appointment
- Any new lump, hardness or change in size or shape of a testicle, even if painless
- A dull ache or heaviness in the scrotum or lower belly lasting more than 2 weeks
- A history of undescended testicle, for awareness and regular self-checks
Types of testicular cancer
| Type | Typical age | Features |
|---|---|---|
| Seminoma | 25 to 45 | Grows slowly; very sensitive to radiation and chemotherapy |
| Non-seminoma (embryonal, yolk sac, choriocarcinoma, teratoma, or mixed) | 15 to 35 | Grows faster; often raises AFP and/or hCG |
| Stromal tumors (Leydig, Sertoli) | Any | Uncommon; often benign; may produce hormones |
| Lymphoma of the testicle | Over 60 | Most common testicular tumor in older men |
Symptoms
- a painless lump or swelling in one testicle, the most common sign
- a feeling of heaviness in the scrotum
- a dull ache in the lower belly or groin
- a change in how a testicle feels: firmer or harder
- sudden collection of fluid in the scrotum
- breast tenderness or growth (gynecomastia), from hormones made by some tumors
- symptoms of spread (less common): lower back pain from enlarged lymph nodes, cough, breathlessness, a lump in the neck
Many men delay seeing a doctor because a lump is painless or embarrassing. Early assessment makes treatment simpler.
Risk factors
- undescended testicle (cryptorchidism), even if corrected surgically
- previous testicular cancer in the other testicle
- family history: a father or brother with testicular cancer
- age 15 to 45
- White men have higher rates than Black or Asian American men in the US
- HIV infection
- Klinefelter syndrome and some disorders of testicular development
Injuries, vasectomy and cycling do not cause testicular cancer.
Testicular self-exam
Many doctors encourage men to know what is normal for them. A simple check:
- Examine after a warm bath or shower, when the scrotum is relaxed.
- Hold each testicle between thumb and fingers and roll it gently.
- Feel for lumps, hard areas or changes in size or texture.
- The soft, tube-like structure at the back is the epididymis, which is normal.
It is normal for one testicle to be slightly larger or hang lower. See a doctor about any new change. The USPSTF does not recommend routine screening for men without symptoms, but men with a history of undescended testicle or previous testicular cancer may benefit from regular checks.
Lumps that are not cancer
Most scrotal lumps are benign: hydrocele (fluid around the testicle), varicocele (enlarged veins), spermatocele (a cyst in the epididymis), epididymitis and hernias. A lump within the testicle itself is more concerning than one beside it. An ultrasound distinguishes them.
Diagnosis
- physical exam of the testicles, abdomen, lymph nodes and breasts
- scrotal ultrasound: quickly shows whether a lump is solid and inside the testicle
- tumor markers: AFP, beta-hCG and LDH blood tests, which help diagnose, stage and monitor
- radical inguinal orchiectomy: removal of the testicle through a groin incision. A biopsy through the scrotum is avoided because it can spread cancer. The removed testicle is examined to confirm the type
- staging: CT scan of the abdomen and pelvis, chest imaging, and repeat tumor markers after surgery
Stages range from I (confined to the testicle) to III (spread beyond nearby lymph nodes).
Treatment
- orchiectomy is the first treatment for nearly everyone
- stage I: often active surveillance (regular scans and blood tests), or a short course of chemotherapy, or radiation for some seminomas
- stage II and III: chemotherapy (commonly BEP: bleomycin, etoposide and cisplatin), radiation for some seminomas, and surgery to remove remaining lymph nodes (retroperitoneal lymph node dissection) for some non-seminomas
- relapse: further chemotherapy, high-dose chemotherapy with stem cell rescue
Fertility and hormones
Most men have normal testosterone and fertility with one healthy testicle. Chemotherapy and radiation can reduce sperm production, so sperm banking before treatment is recommended. A testicular prosthesis can be placed for appearance. Testosterone replacement is needed only if both testicles are removed or the remaining one does not produce enough.
Outlook
Testicular cancer has one of the highest cure rates of any cancer. The 5-year survival rate is about 99% for localized disease and remains high even with spread. Survivors need follow-up for recurrence and long-term effects of chemotherapy such as hearing loss, nerve damage, and higher risk of heart disease.
Frequently asked questions
What are the first signs of testicular cancer?
The most common first sign is a painless lump or swelling in one testicle. Others include a feeling of heaviness in the scrotum, a dull ache in the lower belly or groin, and a change in the firmness of a testicle.
Is testicular cancer curable?
Yes. Testicular cancer is one of the most curable cancers, with cure rates above 95% overall. Even when it has spread to other parts of the body, most men are cured with chemotherapy.
Can testicular cancer affect fertility?
It can. Treatment may reduce sperm production, and some men have low sperm counts at diagnosis. Sperm banking before treatment is recommended. Most men keep normal fertility and hormone levels with one remaining testicle.
How do I check my testicles for cancer?
After a warm shower, gently roll each testicle between your thumb and fingers, feeling for lumps, hardness or changes in size. Know what is normal for you, and see a doctor promptly about any new change.
Sources
This guide was written from current patient and clinical guidance, including:
- American Cancer Society: Testicular cancer
- National Cancer Institute: Testicular cancer treatment (PDQ)
- American Urological Association: Diagnosis and Treatment of Early Stage Testicular Cancer guideline
- National Comprehensive Cancer Network (NCCN): Guidelines for Patients: Testicular Cancer
- NHS: Testicular cancer