Testicular Cancer: Symptoms, Diagnosis, and Treatment

The American Cancer Society estimates roughly 9,800 American men will be diagnosed with testicular cancer in 2026, and although the absolute number is small compared with prostate or lung cancer, it remains the most common solid tumor in men aged 15 to 35. Testicular cancer also has one of the highest cure rates in oncology, with five-year relative survival around 95 percent across all stages combined and only about 630 deaths expected in 2026. Catching it early matters, because localized disease has survival exceeding 99 percent, while cancer that has spread is still often curable but demands more intensive treatment.

What Testicular Cancer Is

The vast majority of testicular cancers (over 90 percent) arise from germ cells, the cells that produce sperm. Germ cell tumors split into two broad categories with different biology and treatment: seminomas and non-seminomas. Seminomas tend to grow more slowly and are highly sensitive to radiation and chemotherapy. Non-seminomas (embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, and mixed tumors) often spread earlier and generally require chemotherapy. According to the National Cancer Institute, the age distribution differs slightly: seminomas tend to peak in the 30s and 40s, non-seminomas in the late teens through early 30s.

Non-germ cell tumors (Leydig and Sertoli cell tumors, and lymphoma, which is more common in older men) account for the remaining minority and have different management. Risk factors include cryptorchidism (an undescended testicle, even after surgical correction), a family history of testicular cancer (a brother with the disease raises lifetime risk several-fold), prior testicular cancer in the other testicle, HIV infection, and certain inherited conditions. Notably, most men diagnosed have none of these risk factors, and having a risk factor is not the same as developing cancer.

Symptoms

The most common presentation is a painless lump or swelling in one testicle, often noticed during a shower or while changing. Some men describe a feeling of heaviness or a dull ache in the scrotum or lower abdomen. About 1 in 10 men have acute pain, sometimes from rapid tumor growth or bleeding within the tumor. Less commonly, men present with back or abdominal pain from enlarged lymph nodes behind the abdomen, breathing difficulty from spread to the lungs, breast tenderness or enlargement (gynecomastia) from hormone-producing tumors, or swollen lymph nodes above the collarbone.

Importantly, many testicular lumps and swellings turn out to be benign conditions such as hydrocele, spermatocele, varicocele, or epididymitis. You cannot reliably tell these apart from cancer on your own — distinguishing them requires examination and imaging, not self-diagnosis. The safe move for any new lump or change is to get it checked, not to assume the worst or dismiss it.

How It Is Diagnosed

Evaluation starts with a hands-on scrotal examination, often performed in a warm room to relax the scrotum. Suspicious findings prompt a scrotal ultrasound, which distinguishes masses inside the testicle from those outside it with high accuracy. A solid mass inside the testicle is presumed to be cancer until proven otherwise.

Tumor markers (AFP, beta-hCG, and LDH) are drawn before any procedure. AFP elevation suggests non-seminomatous components (yolk sac or embryonal). Beta-hCG can rise in either seminoma or non-seminoma. LDH roughly tracks tumor burden. Markers are repeated after surgery to assess for residual disease and to help with staging.

The diagnostic and first therapeutic step is radical inguinal orchiectomy — removing the entire testicle through a groin incision rather than a scrotal one, to avoid disturbing the testicle’s lymphatic drainage. A trans-scrotal biopsy is avoided because it can spread cancer along non-standard pathways. Pathology confirms the tumor type and checks for features such as lymphovascular invasion, rete testis involvement, and tumor size.

Staging includes CT of the abdomen, pelvis, and chest. The TNM and AJCC staging system divides disease into Stage I (confined to the testicle), Stage II (nearby abdominal lymph nodes), and Stage III (distant spread or markedly elevated markers). Risk within Stage III is further classified using the IGCCCG system, which guides how intensive treatment should be.

Treatment by Stage and Histology

Stage I Seminoma

After orchiectomy, options include active surveillance (the most common approach today), a single dose of carboplatin chemotherapy, or limited radiation. Surveillance avoids treatment toxicity in the majority of men who never relapse, while keeping cure rates very high because relapses are caught and treated early. According to NCCN guidelines, surveillance is preferred for most Stage I seminomas when reliable follow-up imaging and marker testing are possible.

Stage I Non-Seminoma

Surveillance, retroperitoneal lymph node dissection (RPLND), or one to two cycles of BEP chemotherapy are options, chosen based on features like lymphovascular invasion and the patient’s preferences and ability to follow up. Surveillance is increasingly favored when reliable follow-up is possible.

Stage II

Stage II seminoma is treated with radiation or chemotherapy depending on the amount of disease. Stage II non-seminoma usually receives three to four cycles of BEP (bleomycin, etoposide, cisplatin) chemotherapy, sometimes followed by RPLND to remove any residual masses.

Stage III

Three to four cycles of BEP chemotherapy is standard, with intensified regimens for higher-risk disease. Salvage chemotherapy and high-dose chemotherapy with stem cell rescue are options for relapse. Even testicular cancer that has spread is curable in a large share of cases — a fact that sets it apart from most metastatic solid tumors.

Fertility and Long-Term Issues

Sperm banking before orchiectomy or chemotherapy is offered routinely, and it is worth doing before treatment even if fertility feels like a distant concern. Many men have below-normal pre-treatment semen parameters even without an obvious fertility problem. Chemotherapy, especially platinum-based regimens, can cause temporary or, less often, permanent decreases in sperm production. Our male infertility guide and semen analysis guide cover related fertility planning.

Long-term survivors can face elevated risks of cardiovascular disease, second cancers, low testosterone (hypogonadism), nerve damage (neuropathy), hearing changes, and kidney effects, depending on the treatment received. The medical conditions library covers related survivorship topics. Follow-up surveillance typically continues for 5 to 10 years after treatment, which is one reason care at an experienced center matters.

Awareness, Self-Checks, and Screening

There is an important distinction between screening healthy men and simply knowing your own body. The U.S. Preventive Services Task Force recommends against routine screening for testicular cancer in men without symptoms, concluding there is not enough evidence that a formal screening program improves outcomes for the general population — largely because the disease is uncommon and already highly curable. That is not a reason to ignore your body. Most testicular cancers are found by men themselves or their partners. Being familiar with how your testicles normally feel — so you notice a new lump, firmness, size change, or heaviness — and getting any change checked promptly is reasonable and low-risk. Our testicular self-exam guide walks through what to feel for. If you are unsure whether regular self-checks make sense for you, ask your clinician.

When to See a Doctor

Any new testicular mass, persistent scrotal swelling, or unexplained scrotal heaviness warrants prompt evaluation — don’t wait months hoping it resolves. New back or abdominal pain in a young man, particularly with weight loss or breathing changes, should also prompt a visit. When something is caught early, treatment is both more effective and less intensive.

When to seek emergency care: Call 911 or go to the nearest emergency room right away if you experience sudden, severe testicular pain (this can signal testicular torsion — a twisting of the testicle that is a surgical emergency, with the best chance of saving the testicle within about 6 hours), along with severe shortness of breath, coughing up blood, severe back pain with leg weakness, or signs of heavy bleeding. Sudden severe scrotal pain is an ER visit now, not a wait-and-see.

Frequently Asked Questions

What does testicular cancer feel like?

Most often it presents as a painless, firm lump on or within the testicle, ranging from pea-sized to larger. The mass usually feels part of the testicle rather than separate from it. Some men describe a feeling of heaviness or a dull ache on the affected side. Because benign conditions can feel similar, any change should be examined by a clinician rather than judged at home.

Can I have children after testicular cancer?

Many men father children after treatment, especially after orchiectomy alone. Chemotherapy and radiation can impair fertility temporarily or, less often, permanently. Sperm banking before treatment preserves options and is strongly encouraged.

Is testicular cancer always treated by removing the testicle?

For confirmed cancers, removal of the affected testicle (radical inguinal orchiectomy) is the standard initial treatment. A partial orchiectomy is occasionally considered for very small lesions in carefully selected patients but is not the routine approach.

Will I need testosterone replacement after treatment?

Removing one testicle leaves the other to produce testosterone, and most men maintain normal levels. Men with disease in both testicles, prior shrinkage of the remaining testicle, or chemotherapy-related damage may develop low testosterone that needs replacement — something your care team will monitor.

Is testicular cancer curable if it has spread?

Often, yes. Testicular cancer is unusual among solid tumors in that even metastatic disease is frequently cured with chemotherapy. Outcomes are best at centers experienced in treating it, which is worth seeking out.

The Bottom Line

Testicular cancer is one of the most curable solid tumors in oncology, but the best outcomes depend on prompt evaluation of any testicular abnormality. Knowing what is normal for your body, keeping a low threshold to see a clinician for a new lump or change, treating sudden severe pain as an emergency, and getting care at an experienced center all matter. The roughly 95 percent five-year survival rate reflects how much modern chemotherapy and surveillance protocols have transformed what was once a routinely fatal disease. If you notice something, get it checked — that single step is where most of the benefit lies.

Sources

• American Cancer Society (ACS) — Key Statistics for Testicular Cancer (2026 estimates); Survival Rates for Testicular Cancer
• National Cancer Institute (NCI) — Testicular Cancer Treatment (PDQ); germ cell tumor biology and staging
• National Comprehensive Cancer Network (NCCN) — Clinical Practice Guidelines in Oncology, Testicular Cancer
• U.S. Preventive Services Task Force (USPSTF) — Screening for Testicular Cancer recommendation
• American Urological Association (AUA) / Urology Care Foundation — testicular cancer evaluation and management