Testicular cancer starts in one or both testicles and is one of the most treatable cancers, even when found at a later stage

Testicular cancer begins when cells in the testicle grow abnormally and multiply out of control. The testicles are two small, oval-shaped glands that sit in the scrotum (the pouch of skin below the penis) and produce sperm and the hormone testosterone. Cancer can start in one testicle or, less often, in both.

Most testicular cancers are found in men between ages 15 and 40, though they can happen at any age. The good news is that testicular cancer responds well to treatment — even when it has spread beyond the testicle. Survival rates are high, especially when the cancer is caught early.

Key Takeaways

  • Testicular cancer most often appears as a painless lump or swelling in one testicle, though some men notice heaviness, aching, or a change in testicle size.
  • A doctor can usually spot testicular cancer with a physical exam and an ultrasound of the scrotum, which takes about 15 minutes.
  • If cancer is suspected, blood tests check for tumor markers — substances the cancer cells release — which help doctors understand how far the cancer has spread.
  • Most men with testicular cancer have one testicle removed surgically, and many need no further treatment if the cancer has not spread.
  • Testicular cancer has high survival rates because it responds well to chemotherapy and radiation, even at advanced stages.

The two main types of testicular cancer

Germ cell tumors account for about 95 percent of testicular cancers. These start in the cells that make sperm. Germ cell tumors come in two broad groups: seminomas and non-seminomas. Seminomas grow more slowly and tend to stay in the testicle longer before spreading. Non-seminomas grow faster and are more likely to spread to other parts of the body.

Non-germ cell tumors are much rarer and start in the supporting tissue of the testicle rather than in sperm-producing cells. These include Leydig cell tumors and Sertoli cell tumors. Because they are uncommon, less is known about their behavior and treatment.

Your doctor will identify which type you have during testing, because the type affects which treatments work best and what your outlook is likely to be.

Signs and symptoms to watch for

The most common sign is a painless lump or hard mass in one testicle, usually noticed by the man himself during bathing or by accident. Some men feel heaviness in the scrotum, a dull ache in the lower belly or groin, or notice that one testicle is larger than the other.

Less often, testicular cancer causes breast tenderness or growth (because some cancer cells produce hormones), lower back pain, or shortness of breath if the cancer has spread to the lungs. A few men have no symptoms at all and discover the cancer during a routine exam or imaging done for another reason.

Any lump, swelling, or change in a testicle that lasts more than a few weeks should be checked by a doctor. Most lumps are not cancer — many are benign cysts or other harmless growths — but only a doctor can tell the difference.

How doctors diagnose testicular cancer

The first step is a physical exam. Your doctor will feel both testicles to check for lumps, swelling, or hardness, and will ask about when you first noticed the change and whether you have pain.

If the doctor suspects cancer, the next step is an ultrasound of the scrotum. This uses sound waves to create a picture of the testicles and takes about 15 minutes. Ultrasound can show whether a lump is solid (more likely to be cancer) or filled with fluid (usually harmless), and it can check both testicles and nearby lymph nodes.

If ultrasound suggests cancer, your doctor will order blood tests to measure tumor markers — substances that cancer cells release into the bloodstream. The main markers are alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH). These tests do not diagnose cancer on their own, but they help doctors understand how much cancer is present and whether it has spread.

The only way to confirm testicular cancer is a biopsy, but this is done differently than in other cancers. Instead of taking a small sample, the surgeon removes the entire testicle through an incision in the groin (called a radical inguinal orchiectomy). This is both a diagnostic and a treatment step — the testicle is then examined under a microscope to confirm cancer and identify the exact type.

Staging: how far the cancer has spread

Once cancer is confirmed, your doctor needs to know whether it has spread beyond the testicle. This is called staging, and it determines which treatments you will need.

Staging tests may include a CT scan of the abdomen and chest to look for enlarged lymph nodes or tumors in other organs, and sometimes a PET scan (which uses a radioactive tracer to find cancer cells). Your doctor will also use the tumor marker blood tests — if markers are high before surgery and drop to normal afterward, it suggests the cancer was contained in the testicle. If markers stay high or rise, it suggests cancer cells are elsewhere in the body.

Testicular cancer is staged from Stage 1 (cancer in the testicle only) to Stage 3 (cancer in distant organs like the lungs, liver, or brain). Stage 1 cancers have the best outlook; even Stage 3 cancers respond well to treatment.

What happens after diagnosis

After the testicle is removed and staging tests are done, your doctor will discuss treatment options. For Stage 1 seminomas, many men need no further treatment — surgery alone cures the cancer in about 85 to 90 percent of cases. Your doctor will monitor you with regular exams, blood tests, and imaging over the next few years.

For cancers that have spread or for non-seminomas, chemotherapy is the main treatment. Chemotherapy drugs are given by IV (into a vein) in cycles, usually over several weeks or months. Most men receive three to four cycles. Radiation therapy is sometimes used for seminomas that have spread to lymph nodes in the abdomen.

Some men need surgery to remove lymph nodes in the abdomen if they remain enlarged after chemotherapy. Most men keep their remaining testicle and can still produce sperm, though chemotherapy can temporarily lower sperm count. Fertility often returns within a few years, but some men may want to bank sperm before treatment begins.

Life after testicular cancer treatment

Follow-up care is important because testicular cancer can recur, though recurrence is uncommon, especially if the cancer was caught early. Your doctor will schedule regular check-ups — usually every few months for the first year or two, then less often — and will order blood tests and imaging as needed.

Most men return to normal activities within a few weeks of surgery. If you receive chemotherapy, recovery takes longer, and you may experience side effects like nausea, fatigue, or hair loss during treatment. These usually fade once treatment ends.

Having had testicular cancer does not mean you cannot have children. Many men father children after treatment, though chemotherapy can affect sperm production temporarily. If you are concerned about fertility, talk to your doctor about sperm banking before treatment begins.

Frequently Asked Questions

Can testicular cancer be prevented?

There is no known way to prevent testicular cancer. Men with a family history of testicular cancer or a personal history of undescended testicles have higher risk, but most men with testicular cancer have no known risk factors. Regular self-exams can help catch it early, though there is no evidence that self-exams reduce death rates.

What is the survival rate for testicular cancer?

Testicular cancer has one of the highest survival rates of any cancer. About 95 percent of men with testicular cancer survive at least five years after diagnosis. Survival is even higher for Stage 1 cancers and for seminomas. Even men with advanced cancer have good survival rates because chemotherapy works very well against testicular cancer.

Will I lose sexual function after testicular cancer treatment?

Most men maintain normal sexual function after testicular cancer treatment. Removing one testicle does not affect the ability to have erections or orgasms. Chemotherapy can temporarily lower testosterone levels, which may affect sex drive, but this usually returns to normal within months to a year after treatment ends.

Do I need to remove the other testicle if one has cancer?

No. Doctors remove only the testicle with cancer. The other testicle is left in place and can continue to produce sperm and testosterone. The risk that cancer will develop in the remaining testicle is low — about 1 to 2 percent over a lifetime.

What should I do if I find a lump in my testicle?

Schedule an appointment with your doctor or a urologist (a doctor who specializes in the urinary and reproductive systems) as soon as you can. Bring up the lump and when you first noticed it. Your doctor will do a physical exam and may order an ultrasound. Most lumps are not cancer, but only a doctor can tell for sure.