Testicular Cancer: Understanding Your Condition and Treatment Options

Germ cell tumours (which develop from the cells that produce sperm) are the most common type of testicular cancer. They divide into two main categories:

Seminomas grow relatively slowly. They typically occur in men between 25 and 45 years old. They are sensitive to radiation therapy and generally have a favourable prognosis. Pure seminomas do not spread as quickly as other types.

Non-seminomas tend to grow and spread more quickly than seminomas. They usually develop in younger men, from late teens to early 30s. This category includes several subtypes:

• Embryonal carcinoma
• Yolk sac tumour
• Choriocarcinoma
• Teratoma

Some tumours contain both seminoma and non-seminoma cells. Healthcare providers classify these as mixed germ cell tumours.

Stromal tumours develop from the supportive and hormone-producing tissues of the testicle. They represent a less common type of testicular cancer.

Leydig cell tumours arise from cells that produce testosterone. Most are benign (non-cancerous). Some can be malignant and spread to other parts of the body.

Sertoli cell tumours develop from cells that support and nourish sperm-producing cells. Like Leydig cell tumours, most are benign. Malignant forms exist.

Occasionally, cancer from another part of the body spreads to the testicle. Lymphoma (a cancer of the immune system) is the most common secondary testicular cancer, particularly in men over 50 years old.

Consult a urologist promptly if you notice any of the following:

• A lump or swelling in either testicle, regardless of whether it’s painful
• A change in how the testicle feels, including hardness or firmness
• Persistent heaviness in your scrotum
• A dull ache in your lower abdomen, groin, or scrotum lasting more than two weeks
• Sudden accumulation of fluid in the scrotum
• Unexplained pain or discomfort in the testicular area

Do not wait to see if symptoms resolve on their own. Testicular cancer can grow rapidly. Early intervention provides a wider range of treatment options.

During your first consultation, your urologist will:

• Take a detailed medical history, including any relevant family history
• Perform a physical examination of the testicles, abdomen, and lymph nodes
• Order appropriate diagnostic tests based on these findings

Many conditions can cause testicular symptoms, including benign cysts, infections, and hernias. A specialist evaluation can provide clarity and, if cancer is present, initiate treatment promptly.

Your urologist will carefully examine both testicles, feeling for lumps, swelling, or tenderness. They also check the abdomen and groin lymph nodes for any enlargement. This examination should not be painful and typically takes only a few minutes.

This is usually the first imaging test performed. High-frequency sound waves create detailed images of the testicles and surrounding structures. Ultrasound can distinguish between solid tumours and fluid-filled cysts, helping determine whether a lump may be cancerous. The procedure is non-invasive, should not be painful, and produces results immediately. No special preparation is required.

Certain testicular cancers produce proteins that healthcare providers can detect in the blood. These tumour markers (substances in the blood that may indicate the presence of cancer) include:

• Alpha-fetoprotein (AFP): Elevated in non-seminomatous tumours. This protein is produced by certain types of testicular cancer cells and helps your doctor monitor disease activity.
• Beta-human chorionic gonadotropin (beta-hCG): May be elevated in both seminomas and non-seminomas. This hormone is another indicator that helps with diagnosis and tracking treatment response.
• Lactate dehydrogenase (LDH): A general marker that can indicate tumour burden. Cells release this enzyme when they are damaged, which can suggest the amount of cancer present.

These blood tests help with diagnosis, staging (determining how far the cancer has spread), and monitoring treatment response. Not all testicular cancers produce elevated markers, so normal levels do not rule out cancer.

If healthcare providers confirm or strongly suspect cancer, additional imaging determines whether it has spread:

• CT scan of the chest, abdomen, and pelvis identifies enlarged lymph nodes and any spread to organs
• MRI may be used for more detailed imaging when needed
• PET scan is sometimes used to assess residual masses after treatment

Healthcare providers typically do not diagnose testicular cancer using a needle biopsy because removing a tissue sample through the scrotum could potentially spread cancer cells. Instead, if imaging and blood tests suggest malignancy, the standard approach is a radical inguinal orchiectomy to surgically remove the affected testicle through a small incision in the groin.

Following removal, specialists examine the entire testicle under a microscope to confirm the diagnosis and determine the specific tumour type, ensuring a more accurate assessment while maintaining oncological safety.

Results from the laboratory analysis are usually available within one to two weeks.

There is no known way to prevent testicular cancer. The established risk factors, such as an undescended testicle and family history, cannot be changed.

Regular testicular self-examination allows men to become familiar with their normal anatomy, making it easier to notice any changes. Whilst not all health organisations universally recommend routine self-examination, many urologists encourage it, particularly for men with known risk factors.

To perform self-examination:

• Check each testicle individually during or after a warm shower when the scrotal skin is relaxed
• Roll the testicle gently between thumb and fingers, feeling for lumps, hardness, or changes in size
• Note that the epididymis (a soft, tube-like structure behind the testicle that stores and transports sperm) is normal and should not be mistaken for an abnormality

Men with undescended testicles, whether corrected or not, should be particularly vigilant about self-examination and may benefit from regular medical check-ups.

If you have a family history of testicular cancer, discuss appropriate surveillance strategies with your doctor.