What Is Testicular Cancer?

The testicles (testes) are a part of the male reproductive system. Located in the scrotum—the sac of skin that hangs behind the penis—they’re usually about the size of a golf ball in adults. These organs produce sperm and manufacture male hormones such as testosterone.

Testicular cancer is rare and arises when cancer cells develop in a testicle. Typically, the first sign of this condition is a noticeable lump on a testicle, which is often painless, though it can cause sensitivity or pain.

This article details the signs, types, and causes of testicular cancer and how it’s diagnosed and treated.

Testicular Cancer Symptoms: What Does It Feel Like?

Testicular cancer can be challenging to identify because it is sometimes asymptomatic (without symptoms or having few symptoms). Its symptoms also are nonspecific, meaning they can resemble other conditions, such as viral or bacterial infections of the testicles, orchitis, and epididymis. The symptoms of the disease can vary from case to case.

Testicular Cancer Lump

The primary symptoms of testicular cancer are typically observed in the scrotum. Generally, the early signs of the condition include:

• A lump on a testicle
• Pain in the scrotum
• Firm testicles
• Swelling of the testicles
• A feeling of heaviness or aching in the scrotum or abdomen

In rare cases, the effects of cancer on testosterone production can cause additional symptoms, such as soreness or growth in the breasts and early puberty in boys.

Advanced Testicular Cancer Symptoms

If left untreated, testicular cancer cells can spread throughout the body (metastasis), becoming dangerous or fatal. Specific symptoms depend on the part of the body that’s affected. In advanced cases, you may experience the following:

• Low-back pain due to cancer spreading to lymph nodes (clusters of white blood cells) in the back of the stomach
• Shortness of breath, coughing, and/or chest pains if cancer reaches the lungs
• Abdominal pain and gastrointestinal symptoms, such as nausea, diarrhea, vomiting, and obstruction of the throat
• Headaches and/or confusion if cancer has spread to the brain  

Types of Testicular Cancer Tumors

Testicular cancer causes various types of tumors, categorized based on the specific testicular cells affected. During diagnosis, oncologists (medical specialists who treat cancer) identify the tumor type to determine your prognosis and treatment plan. However, most people with testicular cancer have multiple types of cancer cells.

Seminomas

Most (95%) testicular cancer cases arise in the cells that manufacture sperm (germ cells). Seminoma is a germ cell tumor type that usually spreads slower than non-seminomas. The two subtypes characterized by elevated levels of the protein human chorionic gonadotropin (HCG) in the blood are:

• Classical seminoma: This type represents over 90% of seminomas and is typically seen in adults 25 to 45.
• Spermatocytic seminoma: Spermatocytic seminoma grows slower than the classical subtype and is less likely to spread to the rest of the body. It is very rare and usually affects older men, with an average age of onset of 65.

Most people with germ cell tumors have a mixture of seminoma cells and the other primary type, non-seminoma.  

Non-Seminomas

A non-seminoma is the other major germ cell tumor; notably, many people with testicular cancer have seminoma and non-seminoma cells. Most often seen in males in their late teens to early 30s, non-seminomas tend to be more aggressive. The four types are:

• Embryonal carcinoma: Though only 3 to 4% of those with testicular cancer have just this type, embryonal carcinoma cells are present in 40% of cases. This type rapidly moves and spreads to the rest of the body.
• Yolk sac carcinoma: Cells of this type resemble the yolk sac of the human embryo. This is the most common type in children and infants and is rare in adults.
• Choriocarcinoma: Fast-growing choriocarcinoma is a rare testicular cancer that affects adults and is known to spread quickly to other body parts, including the bones, lungs, and brain.
• Teratoma: Typically seen alongside other types, teratoma cells have three distinct layers.

Carcinoma in Situ

Carcinoma in situ (CIS) is typically a noninvasive testicular cancer, though it can progress to germ cell cancer. CIS testicular cancer cells usually don't spread outside the seminiferous tubules. It doesn't cause lumps or other symptoms in this state and can only be identified with a biopsy (removing sample tissue for testing in a lab).

Stromal Tumors

Stromal tumors are testicular cancers that arise in the stroma, the hormone-producing tissues of the testicles. Representing only about 5% of cases in adults—though about 20% of those in children—the two primary types are:

• Leydig cell tumor: This type of cancer arises in the Leydig cells, which produce reproductive hormones called androgens. Seen in both adults and children, Leydig cell tumors are often noncancerous (benign) and do not spread to other parts of the body. However, Leydig cell carcinoma is resistant to treatment if it invades other body parts.
• Sertoli cell tumor: The Sertoli cells support the work of germ cells. As with Leydig cell tumors, when cancer arises in these cells, the case is usually benign and can be challenging to treat if it spreads.   

What Causes Testicular Cancer?

Cancer cells develop due to DNA mutations in healthy cells. While researchers aren’t sure why this happens, it’s currently thought that genetics, physiological (the way the body functions), and environmental factors lead to testicular cancer.  

Risk Factors

Researchers have identified at least 19 specific gene mutations associated with testicular cancer. The condition is highly heritable, meaning it can be passed from parent to child. Having first-degree relatives, especially a father or brother, with a history of the condition increases your risk of developing it.

Several other factors increase the risk, including:

• Undescended testicles, a condition called cryptorchidism
• A previous history of testicular cancer
• Infertility
• Human immunodeficiency virus (HIV)
• Klinefelter's syndrome, a genetic disorder
• Taller height

Testicular Cancer Diagnosis: How to Check

Prompt detection and diagnosis of testicular cancer improve the chances of a positive outcome. Testicular cancer that is detected early is typically smaller and more localized than that which is found late.

Typical diagnostic approaches include examination of the testicles, assessment by a healthcare provider, and medical tests.  

Testicular Self-Examination

Though testicular cancer can be asymptomatic in its early stages, lump development, swelling, and inflammation of the testicle are generally the first signs. Many people with testicles can check for the signs at home with a testicular self-examination using the following steps:

• Perform the exam during a shower or bath.
• Assess each testicle separately, keeping your penis out of the way.
• Use both hands and hold each testicle between your thumb and fingers and roll it gently.
• Feel for any hard lumps or smooth, rounded masses.
• Look and feel for any changes in size, shape, or consistency.
• If anything feels or looks awry, contact a healthcare provider.

Physical Assessment

When you see a healthcare provider, their first steps in diagnosing testicular cancer involve an assessment of medical history, medical status, and physical examination. You’ll be asked about any previous personal or family history of testicular cancer and any symptoms you have. Afterward, the healthcare provider will feel for any lumps or abnormalities in the testicles and check the lymph nodes, breasts, and abdomen.

Imaging

You'll undergo imaging if the healthcare provider finds any lumps or inflammation. They may use an ultrasound to assess tumors or computed tomography (CT) scan to confirm the diagnosis or to see if cancer has spread.

Blood Tests

Blood tests are used alongside other methods to stage the condition. Oncologists look for abnormally high levels of tumor markers in the blood. Tumor markers indicate more advanced cancer and can help a provider determine your type of cancer. These markers are:

• Human chorionic gonadotropin (HCG)
• Lactate dehydrogenase, which indicates seminoma
• Alpha-fetoprotein (AFP), a sign of non-seminoma

Surgery

If a testicular cancer tumor is detected, a surgery called radical inguinal orchiectomy is often indicated. This surgery involves removing the tumor and the affected testicle, which is then sent to a laboratory for clinical evaluation.

Testicular Cancer Treatment

The specific approach to the treatment of testicular cancer depends on the type and stage, and may include surgery, radiation therapy, and chemotherapy.

Surgery

Also used to assist in diagnosis, radical inguinal orchiectomy—the removal of a tumor and affected testicle—is the frontline treatment for testicular cancer. This treatment alone may be sufficient for earlier stages, though some require additional therapy.

You may require additional surgeries if the cancer has spread to other body parts. Following surgery, you’ll continue to undergo monitoring to ensure that the cancer isn’t returning.

Radiation Therapy

Directed radiation can kill cancer cells and is a standard treatment. Following orchiectomy, an oncologist may use radiation therapy to target the retroperitoneal lymph nodes, especially in stage 2 testicular cancer. This approach may also be attempted if it has spread to distant body parts, such as the brain.

Chemotherapy

Typically reserved for stage 3 testicular cancer, chemotherapy involves regular, repeated intravenous (IV) administration of certain drugs over several months, with breaks in between. Chemotherapy drugs include combinations of etoposide and cisplatin (EP) and bleomycin, etoposide, and cisplatin (BEP).

Complementary and Alternative Medicine (CAM)

Alongside standard therapy, complementary and alternative medicine (CAM) can help take on side effects, ease stress, and cope with testicular cancer. Though more research is needed, some researchers believe these approaches may help treat the condition. CAM approaches can include:

• Mind-body therapies: Meditation, mindfulness exercises, yoga, and tai chi are all modalities that may help promote relaxation, ease stress, and provide calm during treatment.
• Acupuncture: This treatment modality is from ancient Chinese medicine and involves placing needles into the skin surface of specific body parts. Some evidence suggests acupuncture can help with nausea and vomiting associated with chemotherapy.
• Vitamins and other supplements: Vitamins and supplements, such as vitamin C and coenzyme Q10 (CoQ10), may also improve the quality of life in people with cancer. These may have side effects, so consult a healthcare provider before attempting this approach.
• Herbal supplements: Supplementation with certain herbal extracts, such as curcumin and essiac and flor essence, among others, may help treat cancer, ease side effects, and improve quality of life.
• Cannabis: An approach that’s grown in popularity with the legalization of medical marijuana in certain states, using cannabis (marijuana) may help promote appetite and ease nausea associated with cancer treatment. Before considering this option, know your state’s laws; cannabis is not approved by the Food and Drug Administration (FDA) and is federally illegal.

Side Effects of Testicular Cancer Treatment

Cancer therapies cause significant and sometimes debilitating side effects. Short-term side effects associated with surgery, radiation therapy, and chemotherapy include:

• Hair loss
• Loss of appetite
• Mouth sores
• Loss of the ability to ejaculate
• Nausea and vomiting
• Fatigue
• Diarrhea
• Infertility
• Kidney damage
• Loss of or reduction in hearing ability

Prognosis and Life After Testicular Cancer

The prognosis (outlook) following treatment for testicular cancer is excellent. The cure rate for seminomas is 90%, which climbs close to 100% for early-stage non-seminomas. While much depends on the stage and type of cancer you have, overall, 95% of those with the condition are alive five years after diagnosis.

Each case is different, and the above figures represent broad statistics. Talk to your healthcare provider about your prognosis and outcomes as you undergo treatment.

Testicular Cancer Support and Resources

Testicular cancer—and its treatments—can significantly impact your quality of life and mental health. Males who’ve had an orchiectomy or have undergone chemotherapy and radiation therapy may feel self-conscious about losing a testicle or the loss of sexual function and desire. Researchers have found higher rates of anxiety and depression in males following treatment.

However, there are many resources available to support cancer survivors. Means of coping include:

• Individual or group mental health counseling
• Online or in-person support groups
• Seeking support from family or friends
• Learning strategies to cope with stress, such as meditation and mindfulness techniques
• Finding resources and support from social media groups
• Seeking out advocacy organizations, such as the Testicular Cancer Society and the Testicular Cancer Awareness Foundation