Testicular Cancer

Testicular cancer is very uncommon to rare, accounting for just 1% of all cancers that occur in men. But even then, testicular cancer is the most common cancer in males between the ages of 15 and 40. The majority of testicular cancers occur within this age group.

Testicular cancer is very uncommon in the elderly age group, but we do see them, and it can still occur at any age.

Testicular cancer is treatable, and the treatment is very highly effective, achieving cure in more than 95% of the cases when diagnosed in the early stages. It is one of the best outlook among all other cancers. Even when the cancer has spread beyond the testicle, the cure rates are still very high.

Depending on the type and stage of testicular cancer, you may receive treatment, or a combination of treatment as advised by the doctor.

Types of testicular cancer

The most common type of testicular cancer is germ cell testicular cancer, which accounts for around 95% of all cases. Germ cells are a type of cell that the body uses to create sperm.

There are 2 main subtypes of germ cell testicular cancer. They are:

    • seminomas –accounts for 40 to 45% of testicular cancers
    • non-seminomas – which account for most of the rest and include teratomas, embryonal carcinomas, choriocarcinomas and yolk sac tumours

Less common types of testicular cancer include:

    • Leydig cell tumours – which account for around 1 to 3% of cases
    • Sertoli cell tumours – which account for less than 1% of cases


Testicular cancer occurs when healthy cells in a testicle become altered, grow and divide in an unorderly and uncontrolled way, growing out of control. This subsequently cause a nodule or swelling in the testicle.

Risk factors

Factors that may increase the risk of testicular cancer include:

  • An undescended testicle (cryptorchidism). Men who have a testicle that never descended since birth (meaning never went down completely into the scrotum) are at greater risk of testicular cancer. The risk remains high even if the testicle has been surgically relocated to the scrotum.

Around 3 to 5% of boys are born with undescended testicles inside their abdomen. But they usually descend into the scrotum during the first year of life. 

In most cases, testicles that do not descend by the time a boy is one year old descend at a later stage.

If the testicles do not descend naturally, an operation known as an orchidopexy must be carried out to move the testicles into the correct position inside the scrotum.

It’s important that undescended testicles move down into the scrotum during early childhood because boys with undescended testicles have a higher risk of developing testicular cancer than boys whose testicles descend normally.

  • Abnormal testicle development. Conditions that cause testicles to develop abnormally, such as Klinefelter syndrome, may increase your risk of testicular cancer.
  • Family history. If family members have had testicular cancer, you may have an increased risk.

If your father had testicular cancer, you’re around 4 times more likely to develop it than someone with no family history of the condition.

If your brother had testicular cancer, you’re about 8 times more likely to develop it.

  • Age. Testicular cancer affects teenagers and younger men, particularly those between ages 15 and 40. However, it can occur at any age.
  • History of previous testicular cancer. Men who have previously been diagnosed with testicular cancer are between 12 and 18 times more likely to develop it in the other testicle.
For this reason, if you have been diagnosed with testicular cancer, it is very important that you follow up and have a surveillance on the other testicle.


Signs and symptoms of testicular cancer include:

    • A lump or enlargement in either testicle, usually painless
    • A sensation of heaviness in the scrotum
    • A dull ache in the abdomen or groin
    • A sudden collection of fluid in the scrotum
    • Pain or discomfort in a testicle or the scrotum

Cancer usually affects only one testicle at a time.


Diagnosis is by a clinical examination of a testicular lump and ultrasound to confirm the diagnosis.

Tumor markers are done to assess if they are elevated as a prognostic marker.

Even if tumor markers are normal, it does not mean testicular cancer is absent. Many times, testicular cancer is present even with normal tumor marker readings.


The testicle should not be biopsied before the operation as ultrasound and clinical examination confirms the diagnosis with high surety, and biopsy may allow spread of the cancer outside the testicle. The doctor can advise you on the plan of treatment.

Treatment almost always includes the surgical removal of the affected testicle (orchidectomy or orchiectomy), which does not usually affect fertility or the ability to have sex. Partial excision of the testicle is rarely needed and has very specific indications.

The doctor will advise you on sperm banking and testicular prosthesis.

In some cases, chemotherapy or, less commonly, radiotherapy may be used in the treatment of testicular cancers after removal of the testicle, based on the stage of the disease.

Radical orchidectomy through a groin incision. Pics from BJUI Surgery Illustrated


There is no way to prevent testicular cancer.

The best way to prevent testicular cancer from spreading is to identify it in the early stages and obtain treatment as soon as possible.

Testicle self-examinations have been advocated by some to identify testicular cancer at its earliest stage, but this is controversial as a lot of false self-examination will lead to unnecessary investigations. For this, it is best to see the doctor to confirm if anything is wrong. 

When to see the doctor

See your doctor if you detect swelling or lumps in your testicles or groin area, or even any pain especially if these signs and symptoms last longer than two weeks.

Any suspicion of a testicular cancer needs an IMMEDIATE referral to the urologist and treatment must be started immediately to achieve cure.

Spread of the cancer may occur very fast and can even reach stage 4 advanced cancer even within 4 weeks after diagnosis if treatment was not started promptly.


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