Testicular Cancer: Symptoms, Types, Causes and Treatment

Testicular cancer, while relatively rare among all male cancers, stands out as the most common malignancy in young men, particularly those between the ages of 15 and 44. Its high cure rate—exceeding 90% in many cases—makes it a remarkable success story in modern cancer care. Understanding the symptoms, types, causes, and treatment options is essential for early detection and optimal management. This article offers a comprehensive, evidence-based overview for patients, caregivers, and those seeking to learn more about this important health topic.

Symptoms of Testicular Cancer

Early recognition of testicular cancer symptoms can be lifesaving. Most cases present with subtle, often painless changes, making awareness and regular self-examination crucial. Although many symptoms are not unique to cancer and may be mistaken for benign conditions, it is vital to investigate any persistent testicular changes.

Symptom	Description	Frequency/Notes	Source(s)
Lump/Swelling	Painless lump or enlargement	Most common symptom; usually one testicle	1 2 5 8
Pain	Discomfort or pain in scrotum/testis	Less common; may indicate advanced disease or other causes	4 3 2
Heaviness	Feeling of heaviness in scrotum	Sometimes reported	8
Metastatic Symptoms	Symptoms related to spread (e.g., abdominal pain, vision loss, cough)	Rare, late-stage, variable	3 2 5
Changes in Testicle	Hardening, firmness, or shape change	May be noticed during self-exam	1 2 5

Table 1: Key Symptoms

Understanding the Symptoms

Painless Lump or Swelling

• The hallmark early sign of testicular cancer is a painless lump or swelling in one testicle. It’s often discovered incidentally, either by the patient during self-examination or by a partner or physician during a routine check-up. This lump is typically firm and may not be tender to the touch. In some cases, the swelling is the only abnormality noted 1 2 5 8.

Scrotal Pain or Discomfort

• While most testicular cancers are painless, some individuals may experience a dull ache or a sensation of heaviness in the scrotum. Acute pain is less common and, when present, may be due to bleeding within the tumor or rapid growth stretching the testicular capsule. Rarely, pain may be the first symptom, and this should never be dismissed—especially in older men or if persistent 4 2.

Symptoms from Metastasis

• If the cancer spreads (metastasizes), symptoms may appear in other parts of the body. These can be highly variable and include:
  • Abdominal or back pain (due to lymph node involvement)
  • Cough or shortness of breath (lung metastases)
  • Rarely, vision problems or neurological symptoms if the cancer spreads to the brain or eye 3 2 5.

Other Signs to Watch

• A change in the consistency or shape of the testicle, unexplained heaviness in the scrotum, or an unusual feeling of fullness may also occur 8.

The Importance of Self-Examination

• Regular self-examination can lead to earlier detection and better outcomes. Any persistent change should prompt timely medical review. Overcoming stigma and increasing public awareness are important steps in reducing delayed diagnosis 5.

Types of Testicular Cancer

Testicular cancer is not a single disease, but a group of tumor types that arise from different cells within the testicle. Understanding the main types helps guide both diagnosis and treatment.

Type	Description	Typical Age Group	Source(s)
Germ Cell Tumors (GCT)	Originate from sperm-producing cells; includes seminoma & non-seminoma	Most common, ages 15–44	6 8 10 9
Seminoma	Slow-growing subtype of GCT	Usually 30s–40s	2 8 9 10
Non-seminoma	Diverse, faster-growing GCTs (includes embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma)	Younger adults (20s–30s)	7 8 10
Sex Cord-Stromal Tumors	Arise from supportive tissue (Leydig/Sertoli cells)	Rare, all ages	10 9
Secondary Tumors	Metastases from other cancers (e.g., lymphoma)	Older men (>50), rare	9 10

Table 2: Main Types of Testicular Cancer

Classification and Features

Germ Cell Tumors (GCTs)

• Germ cell tumors account for about 95% of testicular cancers and are divided into:

  • Seminomas: Tend to grow more slowly and are more sensitive to radiation. They are the most common subtype in many populations and often present in men in their 30s–40s 2 8 9.
  • Non-seminomas: Include a variety of cell types—embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma. These tumors are generally more aggressive and occur at a younger age than seminomas 7 8 10.

• Mixed tumors can contain components of both seminomatous and non-seminomatous cells.

Sex Cord-Stromal Tumors

• These rare tumors arise from the cells that support and produce hormones in the testicle (Leydig and Sertoli cells). They account for a small percentage of testicular neoplasms and may present at any age 10 9.

Secondary (Metastatic) Tumors

• Occasionally, cancers from other organs (like lymphoma or metastatic carcinoma) can involve the testicle. This is more common in older men and should be considered if a testicular mass appears in this age group 9 10.

Age and Epidemiological Patterns

• Testicular cancer is most common among men aged 15–44, but patterns vary by histological subtype. For example, seminomas peak slightly later than non-seminomatous tumors, while sex cord-stromal tumors and lymphomas are more often seen in older adults 9.

Causes of Testicular Cancer

While the exact causes of testicular cancer remain unclear, multiple risk factors have been identified. These involve a combination of genetic, developmental, and environmental influences.

Risk Factor	Details/Examples	Strength of Evidence	Source(s)
Cryptorchidism	Undescended testis	Strong	8 11 12
Family History	First-degree relative with testicular cancer	Moderate-Strong	12
Previous Testicular Cancer	Personal history increases risk	Strong	12
Genetic Factors	Specific gene variants, syndromes	Moderate	8 10
In Utero/Childhood Factors	Maternal estrogen exposure, perinatal events	Moderate	11 13
Environmental Exposures	Pesticides, firefighting, aircraft maintenance	Possible, mixed	13
Lifestyle/Occupational	Marijuana use, heat, heavy metals (unproven)	Unclear, under study	13
Socioeconomic Factors	Some associations, not well established	Weak	11

Table 3: Established and Suspected Causes

What Leads to Testicular Cancer?

Strongest Risk Factors

• Cryptorchidism (undescended testicle): This is the most consistent and well-established risk factor. Men born with a testicle that does not descend into the scrotum have a dramatically increased risk, even after surgical correction 8 11 12.

• Personal or Family History: Having had testicular cancer in one testicle, or a close relative with the disease, increases the likelihood of developing it, suggesting a genetic predisposition 12.

Genetic and Developmental Influences

• Some gene mutations and chromosomal abnormalities are linked to higher risk, and certain syndromes (e.g., Klinefelter syndrome) may play a role. Maternal estrogen exposure during pregnancy and other events affecting testicular development in utero have been implicated 8 10 11 13.

Environmental and Occupational Factors

• Occupations such as firefighting and aircraft maintenance, as well as exposure to certain chemicals (e.g., organochlorine pesticides), have been associated with increased risk in some studies. However, the evidence is inconsistent, and causation has not been firmly established 13.

• Other possible but unproven links include chronic heat exposure, heavy metals, marijuana use, and certain lifestyle factors. More research is needed to clarify these associations 13 11.

Other Considerations

• Socioeconomic factors and geographic variation suggest environmental influences, but these are not well understood. The incidence is highest in Nordic countries and lowest in Asia and the Middle East, hinting at a complex interplay of genetic and environmental factors 12 11.

Treatment of Testicular Cancer

Testicular cancer is highly curable, especially when detected early. Advances in surgery, chemotherapy, and radiotherapy have transformed outcomes—even in advanced cases. Treatment is tailored to the type and stage of cancer, as well as patient preferences.

Treatment	Indication	Cure Rate/Outcome	Source(s)
Surgery	All localized cases (orchidectomy)	>90% cure in early-stage	1 2 8 15 18
Chemotherapy	Advanced/metastatic disease; adjuvant in some early-stage	High cure rates; up to 90–95%	1 2 14 16 17
Radiotherapy	Historically for seminoma; now limited use	Used selectively; less common	8 16
Surveillance	Select early-stage cases	Close monitoring, avoids overtreatment	16 18
Fertility Preservation	Pre-treatment sperm banking	Important consideration	16

Table 4: Standard Treatments and Outcomes

The Modern Approach to Treatment

Surgery: The Foundation of Care

• Radical inguinal orchidectomy (removal of the affected testicle) is the first step in almost all cases. It serves both for diagnosis and cure in early-stage disease 1 2 8 15 18.
• Lymph node removal or additional surgery may be required if there is evidence of spread.

Chemotherapy: Revolutionizing Cure Rates

• The introduction of cisplatin-based chemotherapy dramatically improved survival for advanced disease. The most common regimens include BEP (bleomycin, etoposide, cisplatin) and EP (etoposide, cisplatin). Cure rates exceed 90% for good-prognosis patients, with salvage regimens available for refractory cases 14 16 17.
• Chemotherapy is also used as adjuvant therapy in some early-stage nonseminomatous tumors and in cases with high-risk features 1 2 17.

Radiotherapy: Decreasing Role

• Previously a mainstay for seminoma, adjuvant radiotherapy is now used less frequently due to concerns over long-term toxicity. Its use is reserved for select seminoma cases where chemotherapy is contraindicated 8 16.

Active Surveillance

• For certain low-risk, early-stage tumors (especially seminomas), patients may be closely monitored after surgery without immediate further treatment. This avoids overtreatment and its side effects but requires strict adherence to follow-up schedules 16 18.

Fertility and Long-Term Considerations

• As most patients are young men, fertility preservation is a key concern. Sperm banking prior to treatment is advised, as chemotherapy and radiotherapy can impair fertility 16.
• Long-term survivors may be at increased risk for cardiovascular disease, secondary malignancies, and chronic complications from treatment, highlighting the need for lifelong follow-up 17.

Multidisciplinary and Individualized Care

• Treatment should be individualized, taking into account tumor type, stage, patient age, fertility concerns, and personal preferences 16.
• Management in specialized cancer centers with access to multidisciplinary teams and clinical trials offers the best outcomes, especially for complex or advanced cases 16 15.

Conclusion

Testicular cancer, though rare, is highly curable when detected early. Awareness of symptoms, understanding of risk factors, and knowledge of treatment options empower patients and clinicians to achieve the best outcomes.

Key Takeaways:

• Most common symptom: painless lump or swelling in one testicle—early reporting is vital.
• Main types: Germ cell tumors (seminoma and non-seminoma) make up the majority; rare types include sex cord-stromal and secondary tumors.
• Risk factors: Cryptorchidism, family/personal history, some genetic and environmental factors.
• Treatment: Surgery is standard for all; chemotherapy and radiotherapy are used based on type and stage, with excellent cure rates (>90%).
• Fertility: Discuss sperm banking before treatment; long-term monitoring is essential for survivorship.
• Outcome: With modern care, most men with testicular cancer can expect a full cure and return to normal life.

Early detection and prompt, tailored treatment remain the keys to conquering testicular cancer. Regular self-examination, education, and reducing stigma around testicular health are foundational steps toward saving lives.