Let's start off with some quick facts:
| The Testicular Cancer Resource Center |
Let's start off with some quick facts:
What are the testicles?
For more information on this topic, click HERE
What is cancer?
Healthy cells that make up the body's tissues grow, divide, and replace themselves in an orderly way. This process keeps the body in good repair. Sometimes, however, some cells lose the ability to limit and direct their growth. They grow too rapidly and without any order. Too many cells are produced, and tumors are formed. Tumors can be either benign or malignant.
Benign tumors are not cancer. They do not spread to other parts of the body and are seldom a threat to life. Benign tumors can often be removed by surgery, and they are not likely to return. Some tumors of the testicle are benign, but most are not.
Malignant tumors are cancer. They can invade and destroy nearby healthy tissues and organs. Cancerous cells can also spread, or metastasize, to other parts of the body and form new tumors.
Cancer that develops in a testicle is called testicular cancer. When testicular cancer spreads, the cancer cells are carried by blood or by lymph, an almost colorless fluid produced by tissues all over the body. The fluid passes through lymph nodes, which filter out bacteria and other abnormal substances such as cancer cells. Doctors use CT scans of the abdomen and chest in an attempt to determine if the cancer has spread to the lymph nodes or lungs.
What is testicular cancer?
According to the American Cancer Society, about 9,810 new cases of testicular cancer are expected to be diagnosed in the United States in 2026, and about 630 men will die from the disease.
Testicular cancer is much more common in some racial and ethnic groups than others. Current U.S. data show the highest rates among non-Hispanic White and American Indian/Alaska Native men, followed closely by Hispanic men. Rates are much lower among Asian/Pacific Islander men and especially Black men. No one really knows why these differences exist.
Rates also vary widely around the world, with testicular cancer generally much more common in Europe and North America than in Africa or Asia. The incidence continues to rise, and more men are being diagnosed today than 20 years ago.
The encouraging part is that testicular cancer has also become dramatically more curable. Before cisplatin chemotherapy was introduced in the 1970s, only about 5% of men with metastatic testicular cancer were cured. Today, even many men with widely metastatic disease can be cured.
Sources: American Cancer Society, NCI SEER. For more statistics, click HERE.
Most testicular cancers are found by men themselves, by accident or while doing a testicular self-examination. The testicles are smooth, oval-shaped, and rather firm. Men who examine themselves regularly (once a month) become familiar with the way their testicles normally feel. Any changes in the way they feel from month-to-month should be checked by a doctor, preferably a Urologist.
Most testicular cancers are germ cell tumors. They are divided into two broad groups: seminoma and nonseminoma. A pure seminoma is treated as seminoma. If a tumor contains any nonseminoma component, even if seminoma is also present, it is treated as a nonseminoma.
Nonseminomas are often mixed tumors containing more than one type of germ cell cancer. These can include embryonal carcinoma, yolk sac tumor, choriocarcinoma and teratoma.
Teratoma is a little unusual. Under the microscope, a mature teratoma can look almost like normal tissue, but in an adult testicular cancer it is still treated as a malignant germ cell tumor component. Teratoma is also resistant to chemotherapy, which is one reason surgery is so important when teratoma remains after treatment.
Other tumors can also arise in or around the testicle, including Leydig cell and Sertoli cell tumors, lymphoma, sarcomas and several other rare cancers. Rare tumors can be harder to deal with either because the tumor itself is difficult to treat or because so few doctors and pathologists have experience with it. An expert pathology review and an opinion from a center experienced with unusual testicular tumors can be especially important.
Another uncommon tumor seen mostly in older men is the spermatocytic tumor, formerly called spermatocytic seminoma. It usually behaves very indolently and is generally cured by removal of the testicle.
Terminology note: Older British and Australian records sometimes use the word "teratoma" much more broadly for tumors that today would usually be called nonseminoma. Modern usage generally treats teratoma as one particular type of nonseminoma.
There are three stages of testicular cancer:
(There is no Stage IV testicular cancer.)
Cure rates for Stage I testicular cancer are about 99% or better. Stage II disease is also highly curable, with survival generally in the mid-to-high 90% range. Even when testicular cancer has spread more widely, many patients can still be cured.
For metastatic disease, doctors also use the IGCCCG prognostic classification. It uses the type of tumor, where the cancer has spread, and the AFP, hCG and LDH tumor-marker levels to divide patients into groups that give a better idea of how difficult the cancer may be to cure.
With modern treatment, about 95-96% of men in the good-risk group are alive five years later, as are about 88-89% of men in the intermediate-risk group. Nonseminoma also has a poor-risk group, where five-year survival is now about 67%. Seminoma does not have a poor-risk category.
For a more detailed explanation of stages and risk groups, click HERE.
Sources: updated IGCCCG seminoma outcomes and updated IGCCCG nonseminoma outcomes.
What are the causes of testicular cancer?
Testicular cancer is not contagious, and an injury to the testicle does not appear to cause cancer. Sometimes an injury simply calls attention to a tumor that was already there.
Researchers continue to study possible environmental, developmental and genetic causes. For more detail, see the TCRC causes page.
What are the symptoms of testicular cancer?
These symptoms are not sure signs of cancer, they can also be caused by other conditions. There are numerous other causes of swelling of the testis that are harmless, including hydrocele, a collection of fluid in the scrotum; epididymitis, a swelling of the epididymis (the structure behind the testis where sperm mature) which may also cause fever and discharge from the penis; and varicocele, varicose veins in the scrotum which is described as feeling like "a bag of worms". Inflammation of the testis can also be related to bacterial infections. Torsion of the testis occurs when a testicle rotates and the spermatic cord becomes obstructed and the blood supply is cut off. This most commonly occurs around puberty and causes excruciating pain and swelling of the testis. (If this happens, it is a surgical emergency and the patient should be rushed to an emergency room.)
However, it is important to see a doctor, preferably a urologist, if any of these symptoms occur -- any illness should be diagnosed and treated as soon as possible. Early diagnosis of testicular cancer is especially important because the sooner cancer is found and treated, the better a man's chance for complete recovery and the easier the treatment protocol. We realize that it may be difficult to discuss this or let yourself be examined, but it is very important. Cancer is not going to go away on its own, and neither will your concern. If you are suspicious that something is going on down there, get it checked out. You will feel better that you did, even if it turns out to be nothing serious!
How is testicular cancer diagnosed?
If a doctor thinks the problem is an infection and prescribes antibiotics without ordering an ultrasound, it is reasonable to ask why. Testicular cancer is uncommon, and symptoms can be mistaken for infection, injury or other benign problems.
After cancer is diagnosed, CT scans are usually used to look for enlarged lymph nodes or spread elsewhere. CT technology has improved enormously, but CT still cannot see microscopic cancer. A patient can have a completely normal scan and still have small amounts of cancer in the retroperitoneal lymph nodes. That is one reason surveillance after orchiectomy requires repeated follow-up rather than a single "all clear" CT scan.
The only sure way to know whether cancer is present is for a pathologist to examine a sample of tissue under a microscope. To obtain the tissue, the affected testicle is removed through the groin. This operation is called inguinal orchiectomy. The surgeon does not cut through the scrotum and does not remove just a part of the testicle because, if the problem is cancer, cutting through the outer layer of the testicle might cause a local spread of the disease. For more information on the orchiectomy, click HERE.
How is testicular cancer treated?
Before Treatment
If a man has testicular cancer, it is important to find out the extent, or stage, of the disease (whether it has spread from the testicle to other parts of the body). Staging procedures include a thorough physical exam, tumor-marker blood tests, and imaging studies such as CT scans.
Most patients will have a CT or CAT scan of their abdomen and chest. A CT scan is a series of x-rays of various sections of the body that gives the doctors a good look to see if the cancer has spread. Special blood tests can also reveal certain substances in the blood. These substances are called tumor markers because they often are found in abnormal amounts in some patients with testicular cancer. The levels of specific tumor markers in the blood can help the doctor determine what type of testicular cancer the patient has and how advanced it is.
Treatment Methods
Testicular cancer can be treated with surgery, radiation therapy, chemotherapy, and surveillance. One method or a combination of methods may used. Often, the patient is referred to medical centers that specialize in testicular cancer treatment.
Surgery
In most cases, surgery is initially performed to remove the testicle (called an Inguinal Orchiectomy). Surgery can also be used to remove lymph nodes in the abdomen or, in some situations, tumors that remain elsewhere in the body.
RPLND is an operation to remove the lymph nodes in the back of the abdomen, where testicular cancer most commonly spreads first. The operation has always had an important role in nonseminoma, although exactly when it is used has changed considerably over the years.
For a while, RPLND became less common as doctors increasingly relied on surveillance and highly effective cisplatin chemotherapy. More recently there has been renewed interest in using expert, nerve-sparing surgery for carefully selected patients with low-volume disease. The reason is not that chemotherapy or radiation stopped working. They work extremely well. The concern is that a man cured in his 20s or 30s may live for another 50 years, and both treatments can cause important late effects.
In selected patients, a high-quality RPLND may cure the disease while avoiding chemotherapy or radiation altogether. This is well established for certain nonseminomas and is now also being studied and used at expert centers for carefully selected men with low-volume Stage II seminoma. Surgery is not automatically the better choice, and it is especially important that RPLND be done by a surgeon and center with substantial experience in testicular cancer.
For more information on RPLND surgery, click HERE.
Radiation Therapy
Radiation therapy uses high-energy radiation to kill cancer cells in a specific part of the body. Testicular seminoma is extremely sensitive to radiation, which made radiation an important part of testicular cancer treatment for many years.
Its use has fallen dramatically. Radiation is now rarely used after orchiectomy for Stage I seminoma because most of those men are already cured by surgery and can safely be followed with surveillance. Avoiding unnecessary radiation also avoids the long-term risk of second cancers and the inconvenience of repeated treatment visits.
Radiation still has a role in selected patients with Stage II seminoma, particularly when the disease is limited to relatively small retroperitoneal lymph nodes. Depending on the individual situation, alternatives can include chemotherapy, RPLND at experienced centers, or other treatment approaches.
Nonseminomas are much less sensitive to radiation. Patients with nonseminoma are normally treated with surgery and/or chemotherapy instead. Nonseminomas were treated with radiation in Europe until the late 1980's. The only time radiation is used on nonseminomas now is as a last ditch effort to kill chemo resistant cancer.
For more information on radiation therapy for testicular cancer, click HERE.
Chemotherapy
Cisplatin is the drug that transformed testicular cancer from a frequently fatal disease into one of the most curable solid cancers. It remains the backbone of treatment today.
Testicular cancer is usually treated with a combination of chemotherapy drugs that work together in different ways to kill cancer cells. The most familiar combination is BEP: bleomycin, etoposide and cisplatin. Depending on the situation, doctors may instead use EP (etoposide and cisplatin), VIP (etoposide, ifosfamide and cisplatin), or other combinations. The exact regimen and number of cycles depend on the type of tumor, the stage and the patient's risk group.
BEP is commonly given as outpatient treatment in otherwise healthy patients, although age, kidney function, lung function, hydration needs, complications and local practice can change that. VIP is usually given in the hospital because it requires more intensive hydration, mesna, blood-count monitoring and supportive care.
Cisplatin is remarkably effective, but it is not harmless. Hearing loss, nerve damage, kidney injury and other late effects matter especially in a cancer whose patients are often young and expected to live for decades after treatment.
For more information on chemotherapy for testicular cancer, click HERE.
Surveillance
For many men with Stage I testicular cancer, active surveillance is the preferred approach. Most Stage I patients have already been cured by the orchiectomy, so surveillance avoids giving chemotherapy, radiation or major surgery to men who do not need it.
Surveillance does not mean doing nothing. It means following a planned schedule of examinations, tumor-marker blood tests and imaging so that a recurrence can be found and treated promptly.
It cannot be stressed enough that men under surveillance must follow the schedule given by their medical team. Surveillance works extremely well, but only if you actually show up.
For more information on surveillance for testicular cancer, click HERE.
What are the side effects of treatment for testicular cancer?
Losing one testicle should not interfere with a man's sex life. A healthy remaining testicle normally makes enough testosterone to maintain normal sex drive, erections and orgasm. If testosterone does become low, it can be measured with a simple blood test and treated.
A testicular prosthesis is also a viable option. It can often be placed at the time of the orchiectomy or later, and men who care about appearance or symmetry should discuss it with their urologist before surgery. See the TCRC implants page for more information.
Testicular cancer itself can lower sperm counts even before treatment, and removing one testicle reduces the amount of sperm-producing tissue. Men who may want biological children in the future should discuss sperm banking as soon as testicular cancer is suspected, ideally before the orchiectomy. In most cases this can be arranged without creating a meaningful delay in treatment.
If sperm was not banked before the orchiectomy, it should be considered before any additional treatment. Chemotherapy and radiation can reduce fertility, while RPLND can affect ejaculation. Even if you are not sure that you will ever want children, banking sperm can preserve an option that may be difficult or impossible to recreate later.
Think of sperm banking as insurance. You hope you will never need to use it, but once treatment has affected fertility it may be too late to go back and buy the insurance.
The side effects of cancer therapy vary from person to person and may even be different from one treatment to the next in the same patient. Attempts are made to plan treatment to minimize problems. Fortunately, most side effects are temporary. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and suggest ways to deal with them.
What happens after patients are treated for testicular cancer?
Follow-up care depends on the type and stage of the original cancer and on whether the patient had surveillance, surgery, chemotherapy or radiation. There is no single schedule that makes sense for everybody.
Follow-up usually includes some combination of office visits, tumor-marker blood tests and imaging. Modern schedules also try to avoid unnecessary scans and radiation exposure while still catching relapses early.
The most important thing is to leave treatment with a written follow-up plan and actually follow it. See the TCRC Surveillance page for men being followed after orchiectomy without additional treatment, and the After Treatment page for follow-up after chemotherapy, radiation or other treatment.
Patients who have been treated for cancer in one testicle have about a 3 to 4 percent chance of developing cancer in the remaining testicle. If cancer does arise in the second testicle, it is nearly always a new disease rather than a metastasis from the first tumor.
Testicular cancer survivors are also at increased risk of some additional medical problems later in life, depending on the treatment they received. Survivors should continue regular medical care and should report unusual symptoms without delay.
How can patients and their families cope with testicular cancer?
Concerns about the future--as well as about medical tests and treatments, hospital stays, medical bills, and sexuality--are common. Talking with doctors, nurses, or other members of the health care team may help ease fear and confusion. Patients should ask questions about their disease and its treatment and take an active part in decisions about their medical care. Patients and family members often find it helpful to write down questions as they think of them to prepare for the next visit to the doctor. Taking notes during talks with the doctor can be a useful aid to memory. Patients should ask the doctor to repeat or explain anything that is not clear.
Most people want to know what kind of cancer they have, how it can be treated, and how successful the treatment is likely to be. The patient's doctor is the best person to answer questions and give advice about working or other activities. If it is difficult to talk with the doctor about feelings and other very personal matters, patients may find it helpful to talk with others facing similar problems. This kind of help is available through support groups, such as those described below. If the patient or his family finds that emotional problems become too hard to handle, a mental health counselor may be able to help.
The TCRC offers two email support groups. TC-NET has roughly 500 subscribers, including patients, survivors, family members and others interested in testicular cancer. TC-SUPPORTERS has roughly 180 subscribers and is intended especially for family members, partners and other people supporting someone with testicular cancer.
There are also many testicular cancer groups on Facebook and other social-media platforms. Some are large and active and can provide valuable peer support. The quality of medical advice varies enormously, however, so use these groups for support, shared experience and questions rather than treating every confident answer as a medical fact.
There is another difference worth remembering: information posted to Facebook and many other social-media sites may be public, searchable and findable years later by employers, family members or anyone else. Before posting detailed medical information, think about how much of your health history you want permanently associated with your name.
Adapting to the changes that are brought about by having cancer is easier for patients and those who care about them when they have helpful information and support services. Often, the social service office at the hospital or clinic can suggest local and national agencies that will help with emotional support, financial aid, transportation, home care or rehabilitation.
What does the future hold for testicular cancer?
The future of testicular cancer is about detecting disease more accurately, reducing treatment when it is not needed, and finding better treatments for the relatively small group of patients whose cancers remain difficult to cure.
One of the most promising developments is a blood marker called microRNA-371a-3p, usually shortened to miR-371. In many studies it has detected active germ cell cancer much more sensitively than the traditional tumor markers AFP and hCG. Researchers are studying how well it can detect relapse during surveillance and whether it can help distinguish men who really need treatment from those who do not. One major goal is to make surveillance safer with fewer CT scans and less lifetime radiation exposure.
That could also make surveillance easier for men who do not live near major cancer centers or easy access to CT or MRI scanners. A blood test that can be drawn locally and sent to a specialized laboratory could reduce some of the travel and imaging burden, although miR-371 is not yet a complete replacement for scans. One important limitation is that it does not reliably detect teratoma.
Another developing approach is circulating tumor DNA, or ctDNA. This looks for tiny amounts of tumor-related DNA in the bloodstream. Early germ-cell-tumor studies are encouraging, but ctDNA is much less established than miR-371 and still needs larger prospective studies.
Research is also focused on treatment de-escalation: using surveillance when treatment can safely be avoided, using fewer or less toxic treatments when treatment is necessary, and using high-quality surgery in selected patients when it can avoid chemotherapy or radiation. At the other end of the spectrum, better treatments are still badly needed for the small group of patients with platinum-resistant or otherwise poor-risk disease.
The goal is to detect relapse more easily, cure difficult cancers more successfully, and let everyone else pay as little long-term price for that cure as possible.
Sources: prospective miR-371 surveillance study, EAU diagnostic guideline, and 2025 germ-cell-tumor ctDNA study.
Further Internet links for testicular and other cancer / medical information can be found HERE
