Testicular Cancer: Symptoms and Treatment
Testicular cancer most often presents as a painless lump, enlargement or change in the feel of one testicle. It is one of the most curable solid cancers, especially when diagnosed early, and treatment is highly effective even in many metastatic cases. A suspicious intratesticular mass is evaluated urgently with scrotal ultrasound and blood tumour markers (AFP, beta-hCG and LDH). If cancer is suspected, the standard first operation is radical inguinal orchidectomy, which removes the affected testicle through the groin. Further treatment depends on whether the tumour is seminoma or non-seminoma, its stage, marker levels and other risk factors.
Common symptoms
- Painless testicular lump or hard area
- Increase in testicular size or heaviness
- Dull ache in the scrotum, groin or lower abdomen
- Testicular discomfort that does not settle
- New breast tenderness/enlargement in some hormone-producing tumours
- Back pain, cough or breathlessness in some advanced presentations
Who is at higher risk?
Important risk factors include a history of undescended testis (cryptorchidism), previous testicular cancer, certain disorders of testicular development and a family history in a first-degree relative. Most patients, however, do not have an obvious preventable cause.
How is testicular cancer diagnosed?
Scrotal ultrasound is the key first imaging test. A solid intratesticular lesion is more concerning than a fluid-filled or clearly extratesticular lesion. AFP, beta-hCG and LDH are measured before orchidectomy and repeated afterwards because their fall or persistence helps with staging.
Once cancer is diagnosed, contrast CT of the chest, abdomen and pelvis is commonly used for staging. Testicular biopsy through the scrotum is generally avoided when a germ-cell tumour is suspected.
Treatment
Radical inguinal orchidectomy provides diagnosis and local treatment. Stage I disease may then be managed with surveillance, adjuvant chemotherapy or, in selected seminoma, other strategies depending on risk and patient preference. Metastatic germ-cell tumours are usually treated with cisplatin-based chemotherapy; selected residual masses may require surgery.
What happens after orchidectomy?
The orchidectomy result is only the first part of treatment planning. The pathology report, post-operative AFP/beta-hCG/LDH trend and staging CT are reviewed together to define stage and risk. Many stage I patients need no immediate chemotherapy and can enter surveillance, while persistent markers, nodal disease or distant spread may require cisplatin-based treatment. This is why the post-surgery review should discuss the complete stage rather than the operation alone.
Fertility and long-term health
Sperm quality can already be reduced before treatment. Fertility preservation should be discussed early, ideally before chemotherapy or radiotherapy and sometimes before orchidectomy when circumstances allow. Survivorship also includes testosterone symptoms, cardiovascular health, hearing, nerve symptoms and late effects of chemotherapy.
Why the operation usually comes before a needle biopsy
When ultrasound strongly suggests a testicular germ-cell tumour, the standard diagnostic operation is radical inguinal orchidectomy. Passing a needle through the scrotum is generally avoided because it can alter lymphatic drainage and is rarely needed to establish the diagnosis. The final pathology then separates seminoma from non-seminomatous elements and directs further treatment.
A normal tumour-marker panel does not rule out cancer
AFP, beta-hCG and LDH are helpful but not universally elevated. Pure seminoma should not produce AFP, and many stage I tumours have normal markers. Ultrasound and pathology therefore remain essential even when blood tests look reassuring.
The first visit should include fertility thinking
Testicular cancer itself can be associated with reduced sperm quality before treatment. Orchidectomy, chemotherapy or radiotherapy can add further risk. When future biological children matter, sperm banking should be discussed early—without delaying necessary cancer treatment.
Why testicular cancer is treated as an urgent but highly curable disease
The sequence matters: ultrasound and tumour markers are obtained promptly, and a suspicious intratesticular mass is usually treated by inguinal orchidectomy rather than needle biopsy through the scrotum. After surgery, the pathology, post-orchidectomy marker trend and CT staging determine whether surveillance, chemotherapy, radiotherapy or selected retroperitoneal surgery is appropriate. In young men, fertility preservation and a testicular prosthesis should be discussed early rather than after treatment decisions are complete.
When to seek earlier medical review
A new testicular lump or enlargement should be assessed promptly. After orchidectomy or during treatment, report fever, wound problems, persistent vomiting, breathlessness, severe pain or rapidly worsening swelling. Fertility discussions should happen before chemotherapy or radiotherapy when feasible.
Emergency warning signs
- Sudden severe testicular pain, especially with nausea (torsion must be excluded urgently)
- Rapidly increasing scrotal swelling or severe pain
- Breathing difficulty, severe headache or neurological symptoms in a patient with known advanced cancer
- Fever or worsening wound redness after surgery
What to bring to your consultation
- Scrotal ultrasound
- AFP, beta-hCG and LDH before/after surgery if available
- CT staging reports/images
- Semen banking/fertility records if relevant
Questions to ask your doctor
- Have AFP, beta-hCG and LDH been checked before surgery?
- Should I bank sperm before any chemotherapy?
- Will the pathology be reviewed as seminoma versus non-seminoma?
FAQs
Is every painless testicular lump cancer?
No, but a new hard intratesticular lump should be assessed promptly because cancer cannot be excluded by touch alone.
Can testicular cancer occur without pain?
Yes. Painless swelling or a lump is a classic presentation.
Will removal of one testicle affect sex life?
Usually not if the remaining testicle is healthy. Testosterone and erections are often preserved.
Is testicular cancer curable after it spreads?
Many metastatic germ-cell tumours remain highly curable with modern cisplatin-based treatment, although prognosis varies by tumour type and risk group.
Related reading
- Painless Testicular Lump: When to Worry
- Tumor Markers AFP, Beta-hCG and LDH Explained
- Radical Orchidectomy Explained
- Testicular Cancer and Fertility
- Sperm Freezing Before Cancer Treatment
- Testicular Ultrasound: What Does a Testicular Mass Mean?
- Testicular Cancer Stages Explained
- Chemotherapy for Testicular Cancer
- Urologist in Latur
References
- European Association of Urology (EAU). Testicular Cancer Guidelines, 2026. Diagnostic Evaluation https://uroweb.org/guidelines/testicular-cancer/chapter/diagnostic-evaluation
- European Association of Urology (EAU). Testicular Cancer Guidelines, 2026. Disease Management https://uroweb.org/guidelines/testicular-cancer/chapter/disease-management
- European Association of Urology (EAU). Testicular Cancer Guidelines, 2026. Follow-up After Curative Therapy https://uroweb.org/guidelines/testicular-cancer/chapter/followup-after-curative-therapy
- National Cancer Institute. Testicular Cancer Treatment (PDQ) – Patient Version https://www.cancer.gov/types/testicular/patient/testicular-treatment-pdq