Testicular cancer is a cancer of the testicle that mainly affects young men between about 15 and 45. Almost all cases are germ cell tumours, divided into seminomas and non-seminomas, which differ in how they are treated.
It is one of the most treatable cancers, even when it has spread, thanks to its sensitivity to cisplatin-based chemotherapy. Treatment begins with removal of the affected testicle. Afterwards, many men with early disease need only surveillance. Fertility and hormone levels deserve attention before treatment starts.
Symptoms
- A painless lump or swelling in one testicle
- A testicle that feels harder, heavier or different from the other
- A dull ache or dragging feeling in the scrotum or groin
- A sudden collection of fluid around the testicle
- Breast tenderness or enlargement
- Back pain, a lump in the neck or breathlessness if the cancer has spread
Causes and risk factors
The strongest risk factor is an undescended testicle in childhood, even after corrective surgery. Others include a brother or father with the disease, a previous cancer in the other testicle, subfertility, and certain conditions such as Klinefelter syndrome. It is more frequent in men of Northern European descent. Most tumours arise from abnormal germ cells that formed before birth and became active after puberty. Injury, tight clothing, cycling and vasectomy do not cause it.
How it is diagnosed
- Scrotal ultrasound: Distinguishes a solid lump within the testicle, which is treated as cancer until proven otherwise, from cysts and fluid collections.
- Tumour marker blood tests: AFP, beta-hCG and LDH are measured before and after surgery. Their rate of fall helps with staging and planning.
- Radical inguinal orchidectomy: The testicle is removed through a groin incision, which is both diagnosis and first treatment. A needle biopsy through the scrotum is not done.
- CT of chest, abdomen and pelvis: Checks the lymph nodes at the back of the abdomen and the lungs.
- Semen analysis and hormone tests: Carried out before treatment, along with an offer of sperm banking.
Treatment options
- Orchidectomy: A day-case or overnight operation. A silicone prosthesis can be placed at the same time if wished.
- Surveillance: For most stage 1 disease, scheduled blood tests and scans for at least 5 years, with treatment only on relapse. It depends on reliable attendance.
- Adjuvant chemotherapy: One dose of carboplatin for seminoma, or one cycle of BEP for higher-risk non-seminoma, as an alternative to surveillance.
- BEP chemotherapy: 3 or 4 cycles of bleomycin, etoposide and cisplatin at 3-week intervals for disease that has spread.
- Retroperitoneal lymph node dissection: Removal of abdominal lymph nodes, mainly for masses remaining after chemotherapy in non-seminoma, in experienced centres using nerve-sparing techniques.
- Radiotherapy: An option for seminoma involving a limited number of abdominal nodes.
When it is urgent
Sudden severe pain in a testicle, often with nausea, may be testicular torsion and needs emergency surgery within hours at the nearest hospital; this is a different condition but must never be ignored. During chemotherapy, fever, shivering or breathlessness require immediate hospital assessment. A new lump in the testicle should be examined by a doctor within days.
Travelling to Türkiye for treatment
A suspected testicular tumour should be scanned and operated on promptly near home; orchidectomy is a short operation that does not justify the delay of a journey. Travel can be useful for a specialist opinion after surgery, for pathology review, and particularly for retroperitoneal lymph node dissection, which is best performed by surgeons who do it often and needs about 2 weeks' stay. BEP chemotherapy lasts 9 to 12 weeks with frequent blood tests, and surveillance follows a strict schedule, so both should take place where you live. Bank sperm before chemotherapy wherever you are treated.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
الأسئلة المتكررة
Will I still be able to have children?
Usually. One healthy testicle is often enough, but sperm counts may be low even before treatment, and chemotherapy lowers them temporarily or sometimes permanently. Sperm banking beforehand is strongly advised.
Will removing a testicle affect my sex life or hormones?
The remaining testicle normally produces enough testosterone. Levels are checked during follow-up, and replacement is given if they are low.
Why not just take a biopsy?
Cutting through the scrotum can spread tumour cells along a different drainage route. Removing the testicle through the groin avoids this.
How strict is surveillance?
Very. Missing visits is the main risk of this approach. If you cannot commit to the schedule, a single course of adjuvant treatment may be the safer choice.