Testicular cancer — young men’s cancer that yields to treatment
Testicular cancer — germ cell tumours — ~2,400 UK cases yearly — peak 15–49 — one of most curable solid cancers when found early.
Embarrassment delays diagnosis — 2-week GP referral is standard, not overreaction.
See testicular lump symptom guide.
Presentation
Classic:
- painless hard lump within testis parenchyma
- increasing size, heaviness
Less common:
- pain — do not reassure as infection without scan
- acute hydrocele — ultrasound sees through
Advanced (rare if aware):
- retroperitoneal mass — back ache
- respiratory symptoms
- gynaecomastia
Types
Germ cell (95%):
- seminoma — 40s peak, radiosensitive, slow spread
- non-seminoma — embryonal, teratoma, yolk sac, choriocarcinoma — mixed common, AFP/HCG may rise
Non-germ cell rare — ** Leydig/Sertoli**
Diagnosis
- GP examination — intratesticular mass
- Scrotal ultrasound — hypoechoic lesion — do not biopsy testicle
- Tumour markers — AFP, β-hCG, LDH
- Staging CT — abdomen/pelvis/chest
- Radical inguinal orchidectomy — diagnostic and therapeutic — NOT transcrotal
Staging and treatment
Stage I — orchidectomy:
- seminoma — surveillance or carboplatin 1–2 cycles or radiotherapy
- non-seminoma — surveillance or adjuvant BEP 1 cycle if high-risk features
Stage II–III:
- BEP chemotherapy — 3–4 cycles — cures most metastatic
- RPLND (retroperitoneal lymph node dissection) — selected residual mass post-chemo
- salvage chemo — high-dose — refractory
Fertility and hormones
Sperm banking before chemo — cisplatin toxic to sperm
One testicle — usually adequate testosterone — monitor
Prosthesis — cosmetic option
Testicular torsion vs cancer
| Torsion | Cancer | |
|---|---|---|
| Onset | Sudden severe pain | Gradual lump |
| Age | Adolescent common | 15–49 peak |
| Action | Emergency surgery <6h | 2-week referral |
Sudden pain — A&E first — torsion excluded.
Self-awareness
No national screening — know normal, report change.
Movember, Cancer Research UK campaigns raise awareness.
Painless lump — GP this week — orchidectomy + brief chemo if needed beats metastatic disease months later.
Common questions about testicular cancer
- How do I check my testicles for cancer?
- After warm bath or shower, roll each testicle between thumb and fingers — feel for hard lump or change from normal. Know what epididymis (soft tube behind) feels like — do not confuse. Any new lump — GP not watchful waiting. Monthly check not formally recommended but awareness helps.
- What does testicular cancer feel like?
- Usually firm painless lump on testicle itself — not usually on epididymis. Testicle may feel heavier or swollen. Some present with pain — less common. Advanced — back pain (retroperitoneal nodes), cough (lung mets), gynaecomastia (HCG-secreting tumour).
- Is testicular cancer curable?
- Yes — among highest cure rates of all cancers — over 95% 10-year survival overall. Even metastatic germ cell tumours often curable with BEP chemotherapy (bleomycin, etoposide, cisplatin). Early stage may need orchidectomy alone or plus surveillance.
- Will I lose both testicles?
- Usually only affected testicle removed (radical inguinal orchidectomy). Prosthetic testicle can be inserted. Remaining testicle often maintains testosterone and fertility. Chemotherapy may temporarily reduce fertility — sperm banking offered before treatment if wish children.
- What are tumour markers in testicular cancer?
- Blood tests AFP, beta-HCG, LDH — help diagnosis and monitor treatment — not screening tests for asymptomatic men. Seminoma may have normal markers — ultrasound and histology key.
Sources
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