Testicular Cancer

Testicular cancer is diagnosed and treated by the Urology Division of Premier Medical Group.

What is testicular cancer?

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Testicular cancer affects the male sex glands that produce testosterone and sperm. Testicles contain what is called “germ cells”. These germ cells produce immature sperm, which eventually mature and are stored in a coil near the testicles. Almost all testicular cancers start in the germ cells. Testicular cancer is one of the most curable forms of cancer. An early diagnosis followed by an appropriate treatment program can greatly increase your chance for a cure. Testicular cancer is most common in men between the ages of 20 and 34.

What are the symptoms of testicular cancer?

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The most common symptoms of testicular cancer include:

  • A painless change in the size or shape of one or both testes
  • A feeling of heaviness in the scrotum
  • A dull pain in the lower back, abdomen, or groin
  • Swelling or lump in one or both testes
  • Pain in the testes

You should contact your doctor if you experience any of the above symptoms.

Other conditions that have symptoms similar to testicular cancer include:

  • Hydrocele: A painless buildup of fluid around one or both testicles. This causes the scrotum or groin area to swell.
  • Varicocele: An enlarged, twisted varicose vein in the scrotum. This can feel like a “bag of worms” and may sometimes cause discomfort.
  • Spermatocele: A sperm-filled cyst in the epididymis, which feels like a smooth, firm lump in the scrotum.
  • Orchitis: An inflammation or infection of the testicle caused by a virus, bacteria, trauma or exertion.
  • Epididymitis: An inflammation and infection of the epididymis, most often caused by a bacterial infection, UTI (in older men), or STDs

Symptoms of advanced testicular cancer

  • Dull pain in the lower back and abdomen
  • Lack of energy and generalized weakness
  • Shortness of breath, coughing, or chest pain
  • Headache, confusion, or dementia

What are the types of testicular cancer?

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This examination and sonography is usually able to determine the type of testicular cancer. About 95 percent of testicular cancer starts in the germ cells. Among these cancers, there are two main types: seminomas and nonseminomas. Seminomas are less aggressive and have two subtypes: typical and spermatocytic. Spermatocytic seminomas are less common overall but continue to pose a threat to men even in older age. Typical seminomas are especially common in men between 30-50 years of age. Nonseminoma tumors are more aggressive, more common in men from young adulthood to their early 40s. There are four subtypes: embryonal carcinoma, yolk sac carcinoma, choriocarcinoma and teratoma. Some cases of testicular cancer may involve both types of tumors.

The other 5 percent of cases are stromal testicular cancer. These are cancers that start in the hormone-producing part of the testicles. There are two subtypes, based on the which cells the tumors target first: Leydig cell tumors and Sertoli cell tumors. Finally, it’s also possible for other types of cancer to metastasize and travel to the testicles. This is sometimes called secondary testicular cancer.

What are the risk factors for testicular cancer?

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  • Undescended testicle (occurs in infancy when the testicle has not descended to its proper location within the scrotum)
  • Abnormal development of the testicles.
  • HIV
  • Caucasian race

How is testicular cancer diagnosed?

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Your doctor will begin with a complete physical exam and history. The testicles will be examined for lumps, swelling, or pain.

A testicular cancer diagnosis is confirmed with scrotal sonography, but your doctor will begin with a complete physical exam and history. The testicles will be examined for lumps, swelling, or pain. Tumor markers help to confirm and stage testicular cancer. Alpha-fetoprotein (AFP), Beta-human chorionic gonadotropin (β-hCG), and Lactate dehydrogenase (LDH) are specific tumor markers for testicular cancer. These levels are measured before surgery to remove the testicle.

How is testicular cancer treated?

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Testicular cancer is considered a highly curable disease. Your treatment will depend on what type of testicular cancer you have been diagnosed with and whether the cancer has spread (metastasized) beyond the testicle. Between 65%-85% of seminomas present as localized cancers, whereas 60-70% of nonseminomas present with recognized metastatic disease. In addition to tumor markers, CT scans of the chest, abdomen and pelvis help to determine the extent of disease and guide treatment.


Treatment for testicular cancer begins with a radical inguinal orchiectomy, which is surgery to remove the affected testicle(s). If tumor is present in both testicles or if a patient only has one testicle, removal of the tumor with preservation of the testicle can be performed.

Removal of lymph nodes in the abdomen and lower back may be required (Retroperitoneal Lymph Node Dissection, or RPLND). This is especially common for nonseminomas.


Radiation to lymph nodes in the abdomen is used for seminomas, as these tumors are very radiosensitive.


Used when there is bulky tumor in the lymph nodes or spread to other organs such as the lungs or liver. The most common chemotherapy is cisplatin combination therapy, which uses more than one medicine together. The dose ranges in intensity depending on how far the cancer has advanced.


With serial drawing of tumor markers, CT’s of chest, abdomen, and pelvis, can be offered to patients who have no signs of metastatic disease and whose cancers are deemed low risk. This approach requires patients to be diligent and compliant with their blood work, X-rays and appointments.

What is the prognosis for testicular cancer?

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The patient’s prognosis depends on several factors, such as the stage of the cancer, whether it has metastasized, the type of cancer, size of tumor and number and size of the surrounding lymph nodes affected. In general, testicular cancer (either seminoma or nonseminoma) has cure rates above 90%.

The prognosis for fertility is questionable at best. If the cancer is isolated to one testicle, fertility may return in the remaining testicle. However, radiation and chemotherapy treatment often cause at least temporary infertility in the remaining testicle and may permanently affect a man’s fertility. For this reason, a sperm bank is typically recommended before treatment begins for any man who still wants to have children.