Testicular Cancer

Testicular cancer is a malignant tumour that develops in the testicles, most commonly a germ cell tumour classified as either a seminoma or a non-seminoma. It is the most common cancer in men aged 15–40, with one of the highest cure rates of any cancer when detected early — overall 5-year survival is around 98%. Diagnosis is typically confirmed by scrotal ultrasound and serum tumour markers (AFP, β-hCG, LDH), followed by radical inguinal orchidectomy for tissue diagnosis and treatment.

The classic sign is a painless lump or swelling in one testicle. Other symptoms include a change in the size, shape or firmness of a testicle, a dull ache or heaviness in the scrotum or lower abdomen, a sudden fluid collection (hydrocele), and — in advanced disease — back pain (from spread to retroperitoneal lymph nodes) or breast tenderness (from β-hCG production). Any new testicular lump or change should be assessed urgently, even if it is painless.

Yes. Regular self-examination — ideally after a warm shower when the scrotum is relaxed — is the best way to spot a change early. Gently roll each testicle between your thumb and fingers, feeling for any new lump, hardness or change in size or shape. Testicular cancer is the most common cancer in younger men, and early diagnosis leads to excellent outcomes, so getting to know what is normal for you makes any change easier to detect.

The precise cause is not fully understood, but the strongest risk factors are an undescended testicle (cryptorchidism), a personal history of testicular cancer in the other testicle, and a family history of testicular cancer. Other associations include age (most common in men aged 15–40), Caucasian ethnicity, HIV infection and Klinefelter's syndrome. Most men who develop testicular cancer have no identifiable risk factor.

Assessment starts with a clinical examination and a scrotal ultrasound, which is highly accurate for identifying a testicular tumour. Serum tumour markers — alpha-fetoprotein (AFP), beta human chorionic gonadotropin (β-hCG) and lactate dehydrogenase (LDH) — help characterise the tumour type and monitor response to treatment. Where testicular cancer is confirmed or strongly suspected, a CT scan of the chest, abdomen and pelvis is arranged for staging, followed by radical inguinal orchidectomy for definitive diagnosis and treatment.

Radical inguinal orchidectomy is the surgical removal of the affected testicle through a small incision in the groin. It is both diagnostic (providing tissue to confirm cancer type and grade) and therapeutic (removing the primary tumour). Because testicular cancer usually affects only one side, the other testicle is left in place and normally produces enough testosterone and sperm to maintain fertility and hormonal function. A testicular prosthesis can be inserted at the same time for cosmetic and psychological reasons if desired.

Removing one testicle usually has little or no effect on fertility because the remaining testicle continues to produce sperm normally. However, chemotherapy and radiotherapy can temporarily or permanently affect fertility. For this reason, all men diagnosed with testicular cancer are routinely offered sperm banking (cryopreservation) before starting systemic treatment, and this is arranged before any chemotherapy or radiotherapy begins. Fertility usually recovers over 1–3 years after chemotherapy, but this is not guaranteed.

The outlook is exceptionally good. Overall 5-year survival is around 98%, and for early-stage (stage I) disease survival is essentially 100%. Even in advanced disease, cure rates remain high thanks to the effectiveness of platinum-based chemotherapy (BEP regimen). Because testicular cancer is so curable and typically affects young men, long-term follow-up focuses on identifying the small proportion of relapses early and monitoring for long-term effects of treatment. Most men return to full health and normal life.