Testicular cancer is the most common cancer in men aged 15-35. It's also one of the most curable cancers, with 5-year survival rates above 90% overall and often approaching 95-100% for early-stage disease. Most testicular cancers are germ cell tumors.

What Is Testicular Cancer?

Testicular cancer develops in the testicles, which produce sperm. Most cases are germ cell tumors, which develop from cells that produce sperm. Unlike most cancers, testicular cancer is highly chemotherapy-responsive and curable even at advanced stages.

Key fact: Self-examination monthly can catch cancer early, when it's most treatable. Most men with testicular cancer find a lump themselves.

Types

  • Seminoma: Arises from mature germ cells. Most common (40% of germ cell tumors). Very radiosensitive and chemosensitive. Excellent prognosis.
  • Non-seminomatous germ cell tumors (NSGCT): Include embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma. Often mixed types. Require chemotherapy.

Risk Factors

  • Cryptorchidism: Undescended testicle significantly increases risk, even if it was corrected surgically.
  • Family history: Family members have higher risk.
  • Prior testicular cancer: Opposite testicle has 10-15% lifetime risk.
  • Infertility: Infertile men have higher risk.
  • Klinefelter syndrome: Genetic condition increasing risk.

Symptoms & Self-Examination

  • Painless lump in testicle (most common)
  • Testicle enlargement or swelling
  • Heaviness in scrotum
  • Breast tenderness or enlargement (if secreting hCG)
  • Back pain (if metastatic to lymph nodes)

Self-examination: Monthly after warm bath/shower. Roll testicle gently between fingers. Feel for lumps, hardness, or size change. Any abnormality warrants urgent evaluation.

Diagnosis

Diagnostic tools:

  • Scrotal ultrasound: First imaging test, very sensitive.
  • Tumor markers: Blood tests for alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), lactate dehydrogenase (LDH). Critical for diagnosis and monitoring.
  • Inguinal orchectomy: Surgical removal through groin (NOT scrotal biopsy). Required for diagnosis and staging.
  • Pathology: Determines type and guides treatment.
  • CT chest/abdomen/pelvis: Staging to identify metastases.

Staging

AJCC system uses tumor type, tumor markers, and metastatic spread:

  • Stage I: Confined to testicle, normal markers.
  • Stage II: Metastases to abdominal lymph nodes.
  • Stage III: Metastases to other organs (lungs, liver, brain).

Prognostic groups (low, intermediate, high) based on markers and metastatic sites guide chemotherapy intensity.

Treatment Options

Inguinal Orchectomy

Removal of the testicle through the inguinal canal (not through scrotum). Required for all testicular cancers for diagnosis and staging. Does not affect sexual function if other testicle is healthy.

Seminoma Stage I

Options: Radiation to abdominal lymph nodes, single-agent chemotherapy (carboplatin), or surveillance with regular CT scans.

NSGCT and Higher-Stage Disease

Chemotherapy is standard. BEP (bleomycin, etoposide, cisplatin) for good-risk disease, with 3-5 cycles depending on stage. Excellent cure rates even with advanced disease.

Retroperitoneal Lymph Node Dissection (RPLND)

For some non-seminomas with residual masses after chemotherapy. Removes lymph nodes that may still contain cancer.

Salvage Therapy

For relapsed disease, high-dose chemotherapy with stem cell rescue is highly effective.

Fertility & Fertility Preservation

Important issue for younger men: Chemotherapy and surgery can affect fertility and testosterone production. Before treatment, consider:

  • Sperm banking: Sperm preservation before any treatment.
  • Testosterone monitoring: Baseline testosterone levels; may need hormone replacement.
  • Recovery: Sperm counts recover in 2-3 years after treatment in most men, but banking provides insurance.

Side Effects & Survivorship

Chemotherapy side effects: Nausea, hair loss, peripheral neuropathy (especially from cisplatin), hearing loss, tinnitus, fatigue.

Long-term concerns: Secondary malignancies (very low risk), cardiovascular effects (from cisplatin), infertility in minority of men, Raynaud's phenomenon.

Psychological: Fertility concerns, body image (loss of testicle), long-term surveillance anxiety.

Prognosis

Excellent prognosis overall:

  • Good-risk disease: 95%+ 5-year survival with chemotherapy.
  • Intermediate-risk: 90-95% 5-year survival.
  • High-risk (metastatic with poor markers): 70-80% 5-year survival, still highly curable.

Even men with pulmonary or other metastases have high cure rates with appropriate chemotherapy.

Seek Immediate Care If You Experience:

  • Any testicular lump or swelling
  • Severe testicular pain not from trauma
  • Sudden onset of testicular symptoms

Key Questions for Your Doctor

  • What type and stage is my testicular cancer?
  • What is my prognostic group?
  • What is my recommended treatment plan?
  • What are my fertility risks, and should I bank sperm?
  • What are the specific chemotherapy side effects I should expect?
  • What is my expected cure rate?
  • What long-term follow-up will I need?