Testicular Cancer: Questions and Answers 

 

 

Key Points 

• Nearly all testicular cancers are one of two general types: seminoma or 

nonseminoma. Other types are rare (see Question 1). 

• This disease occurs most often in men between the ages of 20 and 39. It accounts 

for only 1 percent of all cancers in men (see Question 1).

• Risk factors include having an undescended testicle, previous testicular cancer, 

and a family history of testicular cancer (see Question 2).

• Symptoms include a lump, swelling, or enlargement in the testicle; pain or 

discomfort in a testicle or in the scrotum; and/or an ache in the lower abdomen, 

back, or groin (see Question 3).

• Diagnosis generally involves blood tests, ultrasound, and biopsy (see Question 4).

• Treatment can often cure testicular cancer (see Question 5), but regular follow-up 

exams are extremely important (see Question 6).

1. What is testicular cancer? 

Testicular cancer is a disease in which cells become malignant (cancerous) in one or both 

testicles. 

The testicles (also called testes or gonads) are a pair of male sex glands. They produce 

and store sperm and are the main source of testosterone (male hormones) in men. These 

hormones control the development of the reproductive organs and other male physical 

characteristics. The testicles are located under the penis in a sac-like pouch called the 

scrotum. 

Based on the characteristics of the cells in the tumor, testicular cancers are classified as 

seminomas or nonseminomas. Other types of cancer that arise in the testicles are rare

and are not described here. Seminomas may be one of three types: classic, anaplastic, or 

spermatocytic. Types of nonseminomas include choriocarcinoma, embryonal carcinoma, 

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teratoma, and yolk sac tumors. Testicular tumors may contain both seminoma and 

nonseminoma cells. 

Testicular cancer accounts for only 1 percent of all cancers in men in the United States. 

About 8,000 men are diagnosed with testicular cancer, and about 390 men die of this 

disease each year (1). Testicular cancer occurs most often in men between the ages of 20 

and 39, and is the most common form of cancer in men between the ages of 15 and 34. It 

is most common in white men, especially those of Scandinavian descent. The testicular 

cancer rate has more than doubled among white men in the past 40 years, but has only 

recently begun to increase among black men. The reason for the racial differences in 

incidence is not known. 

2. What are the risk factors for testicular cancer?

The exact causes of testicular cancer are not known. However, studies have shown that 

several factors increase a man’s chance of developing this disease. 

• Undescended testicle (cryptorchidism): Normally, the testicles descend from inside 

the abdomen into the scrotum before birth. The risk of testicular cancer is increased 

in males with a testicle that does not move down into the scrotum. This risk does not 

change even after surgery to move the testicle into the scrotum. The increased risk 

applies to both testicles. 

• Congenital abnormalities: Men born with abnormalities of the testicles, penis, or 

kidneys, as well as those with inguinal hernia (hernia in the groin area, where the 

thigh meets the abdomen), may be at increased risk. 

• History of testicular cancer: Men who have had testicular cancer are at increased 

risk of developing cancer in the other testicle. 

• Family history of testicular cancer: The risk for testicular cancer is greater in men 

whose brother or father has had the disease. 

3. How is testicular cancer detected? What are symptoms of testicular cancer?

Most testicular cancers are found by men themselves. Also, doctors generally examine 

the testicles during routine physical exams. Between regular checkups, if a man notices 

anything unusual about his testicles, he should talk with his doctor. Men should see a 

doctor if they notice any of the following symptoms: 

• a painless lump or swelling in a testicle 

• pain or discomfort in a testicle or in the scrotum 

• any enlargement of a testicle or change in the way it feels 

• a feeling of heaviness in the scrotum 
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• a dull ache in the lower abdomen, back, or groin 

• a sudden collection of fluid in the scrotum 

These symptoms can be caused by cancer or by other conditions. It is important to see a 

doctor to determine the cause of any of these symptoms. 

4. How is testicular cancer diagnosed?

To help find the cause of symptoms, the doctor evaluates a man’s general health. The 

doctor also performs a physical exam and may order laboratory and diagnostic tests. 

These tests include: 

• Blood tests that measure the levels of tumor markers. Tumor markers are substances 

often found in higher-than-normal amounts when cancer is present. Tumor markers 

such as alpha-fetoprotein (AFP), Beta-human chorionic gonadotropin (βHCG), and 

lactate dehydrogenase (LDH) may suggest the presence of a testicular tumor, even if 

it is too small to be detected by physical exams or imaging tests. 

• Ultrasound, a test in which high-frequency sound waves are bounced off internal 

organs and tissues. Their echoes produce a picture called a sonogram. Ultrasound of 

the scrotum can show the presence and size of a mass in the testicle. It is also helpful 

in ruling out other conditions, such as swelling due to infection or a collection of fluid 

unrelated to cancer. 

• Biopsy (microscopic examination of testicular tissue by a pathologist) to determine 

whether cancer is present. In nearly all cases of suspected cancer, the entire affected 

testicle is removed through an incision in the groin. This procedure is called radical 

inguinal orchiectomy. In rare cases (for example, when a man has only one testicle), 

the surgeon performs an inguinal biopsy, removing a sample of tissue from the 

testicle through an incision in the groin and proceeding with orchiectomy only if the 

pathologist finds cancer cells. (The surgeon does not cut through the scrotum to 

remove tissue. If the problem is cancer, this procedure could cause the disease to 

spread.) 

If testicular cancer is found, more tests are needed to find out if the cancer has spread 

from the testicle to other parts of the body. Determining the stage (extent) of the disease 

helps the doctor to plan appropriate treatment. 

5. How is testicular cancer treated? What are the side effects of treatment? 

Although the incidence of testicular cancer has risen in recent years, more than 95 

percent of cases can be cured. Treatment is more likely to be successful when testicular 

cancer is found early. In addition, treatment can often be less aggressive and may cause 

fewer side effects. 
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Most men with testicular cancer can be cured with surgery, radiation therapy, and/or 

chemotherapy. The side effects depend on the type of treatment and may be different for 

each person. 

Seminomas and nonseminomas grow and spread differently and are treated differently. 

Nonseminomas tend to grow and spread more quickly; seminomas are more sensitive to 

radiation. If the tumor contains both seminoma and nonseminoma cells, it is treated as a 

nonseminoma. Treatment also depends on the stage of the cancer, the patient’s age and 

general health, and other factors. Treatment is often provided by a team of specialists, 

which may include a surgeon, a medical oncologist, and a radiation oncologist. 

The three types of standard treatment are described below. 

• Surgery to remove the testicle through an incision in the groin is called a radical 

inguinal orchiectomy. Men may be concerned that losing a testicle will affect their 

ability to have sexual intercourse or make them sterile (unable to produce children). 

However, a man with one healthy testicle can still have a normal erection and 

produce sperm. Therefore, an operation to remove one testicle does not make a man 

impotent (unable to have an erection) and seldom interferes with fertility (the ability 

to produce children). For cosmetic purposes, men can have a prosthesis (an artificial 

testicle) placed in the scrotum at the time of their orchiectomy or at any time 

afterward. 

Some of the lymph nodes located deep in the abdomen may also be removed (lymph 

node dissection). This type of surgery does not usually change a man’s ability to 

have an erection or an orgasm, but it can cause problems with fertility if it interferes 

with ejaculation. Patients may wish to talk with their doctor about the possibility of 

removing the lymph nodes using a special nerve-sparing surgical technique that may 

preserve the ability to ejaculate normally. 

• Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer 

cells and shrink tumors. It is a local therapy, meaning that it affects cancer cells only 

in the treated areas. External radiation (from a machine outside the body), aimed at 

the lymph nodes in the abdomen, is used to treat seminomas. It is usually given after 

surgery. Because nonseminomas are less sensitive to radiation, men with this type of 

cancer usually do not undergo radiation therapy. 

Radiation therapy affects normal as well as cancerous cells. The side effects of 

radiation therapy depend mainly on the treatment dose. Common side effects include 

fatigue, skin changes at the site where the treatment is given, loss of appetite, nausea, 

and diarrhea. Radiation therapy interferes with sperm production, but many patients 

regain their fertility over a period of 1 to 2 years. 

• Chemotherapy is the use of anticancer drugs to kill cancer cells. When 

chemotherapy is given to testicular cancer patients, it is usually given as adjuvant 
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therapy (after surgery) to destroy cancerous cells that may remain in the body. 

Chemotherapy may also be the initial treatment if the cancer is advanced; that is, if it 

has spread outside the testicle at the time of the diagnosis. Most anticancer drugs are 

given by injection into a vein. 

Chemotherapy is a systemic therapy, meaning drugs travel through the bloodstream 

and affect normal as well as cancerous cells throughout the body. The side effects 

depend largely on the specific drugs and the doses. Common side effects include 

nausea, hair loss, fatigue, diarrhea, vomiting, fever, chills, coughing/shortness of 

breath, mouth sores, or skin rash. Other side effects include dizziness, numbness, loss 

of reflexes, or difficulty hearing. Some anticancer drugs also interfere with sperm 

production. Although the reduction in sperm count is permanent for some patients, 

many others recover their fertility. 

Some men with advanced or recurrent testicular cancer may undergo treatment with 

very high doses of chemotherapy. These high doses of chemotherapy kill cancer 

cells, but they also destroy the bone marrow, which makes and stores blood cells. 

Such treatment can be given only if patients undergo a bone marrow transplant. In a 

transplant, bone marrow stem cells are removed from the patient before 

chemotherapy is administered. These cells are frozen temporarily and then thawed 

and returned to the patient through a needle (like a blood transfusion) after the highdose chemotherapy has been administered. 

Men with testicular cancer should discuss their concerns about sexual function and 

fertility with their doctor. It is important to know that men with testicular cancer often 

have fertility problems even before their cancer is treated. If a man has pre-existing 

fertility problems, or if he is to have treatment that might lead to infertility, he may want 

to ask the doctor about sperm banking (freezing sperm before treatment for use in the 

future). This procedure allows some men to have children even if the treatment causes 

loss of fertility. 

6. Is follow-up treatment necessary? What does it involve? 

Regular follow-up exams are extremely important for men who have been treated for 

testicular cancer. Like all cancers, testicular cancer can recur (come back). Men who 

have had testicular cancer should see their doctor regularly and should report any unusual 

symptoms right away. Follow-up varies for different types and stages of testicular 

cancer. Generally, patients are checked frequently by their doctor and have regular blood 

tests to measure tumor marker levels. They also have regular x-rays and computed 

tomography, also called CT scans or CAT scans (detailed pictures of areas inside the 

body created by a computer linked to an x-ray machine). Men who have had testicular 

cancer have an increased likelihood of developing cancer in the remaining testicle. 

Patients treated with chemotherapy may have an increased risk of certain types of 

leukemia, as well as other types of cancer. Regular follow-up care ensures that changes 

in health are discussed and that problems are treated as soon as possible. 
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7. Are clinical trials (research studies) available for men with testicular cancer?

Yes. Participation in clinical trials is an important treatment option for many men with 

testicular cancer. To develop new treatments, and better ways to use current treatments, 

the National Cancer Institute (NCI) is sponsoring clinical trials (research studies with 

people) in many hospitals and cancer centers around the country. Clinical trials are a 

critical step in the development of new methods of treatment. Before any new treatment 

can be recommended for general use, doctors conduct clinical trials to find out whether 

the treatment is safe for patients and effective against the disease. 

People interested in taking part in a clinical trial should talk with their doctor. 

Information about clinical trials is available from the NCI’s Cancer Information Service 

(CIS) (see below) at 1–800–4–CANCER and in the NCI booklet Taking Part in Cancer 

Treatment Research Studies, which can be found at http://www.cancer.gov/publications 

on the Internet. This booklet describes how research studies are carried out and explains 

their possible benefits and risks. Further information about clinical trials is available at 

http://www.cancer.gov/clinicaltrials on the NCI’s Web site. The Web site offers detailed 

information about specific ongoing studies by linking to PDQ®, the NCI’s 

comprehensive cancer information database. The CIS also provides information from 

PDQ. 

Selected Reference 

1. American Cancer Society, Inc. Cancer Facts and Figures 2005. Atlanta: American 

Cancer Society, Inc., 2005. Also available at 

http://www.cancer.org/downloads/STT/CAFF2005f4PWSecured.pdf on the Internet. 

# # # 

Related NCI materials and Web pages: 

• National Cancer Institute Fact Sheet 5.18, Tumor Markers 

(http://www.cancer.gov/cancertopics/factsheet/Detection/tumor-markers) 

• National Cancer Institute Fact Sheet 7.48, Follow-up Care After Cancer Treatment: 

Questions and Answers

(http://www.cancer.gov/cancertopics/factsheet/Therapy/followup) 

• What You Need To Know AboutTM Cancer 

(http://www.cancer.gov/cancertopics/wyntk/overview)

For more help, contact: 

NCI’s Cancer Information Service 

Telephone (toll-free): 1–800–4–CANCER (1–800–422–6237) 
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TTY (toll-free): 1–800–332–8615

LiveHelp® online chat: https://cissecure.nci.nih.gov/livehelp/welcome.asp

 

This fact sheet was reviewed on 5/24/05