Testicular cancer

Testicular cancer represents only 1 per cent of all cancers in men, but it is the single biggest cause of cancer-related deaths in men aged 15-35 years in the UK. Find out what the signs to watch out for are


Testicular cancer

Testicular cancer represents only one per cent of all cancers in men.

Unlike most cancers which are more common in older people, testicular cancer usually occurs in younger men, typically between the ages of 15 and 60 (with a peak around the early 30s).

In 2010, 2,286 men in the UK developed the disease (that means around 1 in 14,000 men each year get it).

Unfortunately, the number of UK cases has nearly trebled in the past 35 years and is still rising.


Thanks to improvements in treatments in recent years, survival rates are now very high and more than 97 per cent of men will still be alive 5 years after the diagnosis.

Signs to watch out for include:

  • a lump in one testicle
  • pain and tenderness in either testicle
  • discharge or pus from the penis
  • blood in the sperm at ejaculation
  • a build-up of fluid inside the scrotum
  • a heavy or dragging feeling in the groin or scrotum
  • an increase in size of a testicle (one testicle is normally larger than the other but the size and shape should remain more or less the same)
  • an enlargement of the breasts with or without tenderness
  • it is a good idea to know how to check your testicles and do it regularly.

What causes testicular cancer?

The causes of testicular cancer and reasons for the recent increase in frequency in some countries are unknown.

As testicular cancer is uncommon before puberty it's likely that hormones influence growth of the tumour even if they aren't the initial cause.


Exposure to female hormones in the environment, in water (possibly from the oral contraceptive pill in water supplies) has been suggested as a cause for increases in the cancer in recent years.

Undescended testicles (in which one or both testicles stay inside the body after birth and never sit in the scrotum) are a major risk factor. If a man has one or both testicles undescended, their risk of cancer is increased up to five-fold.

Your risk increases up to 4 times if your father suffered from testicular cancer, and up to 9 times if your brother did, indicating an inherited or genetic influence.

There is no link between injury to the testicles, or groin strains, and testicular cancer.

What are the types of testicular tumour?

The term 'germ cell' is applied to cells that are capable of developing into sperm (in the male) or eggs (in the female). Thus the general term 'germ cell tumours' basically means tumours of either the testicle or the ovary.

There are two main types of testicular tumour – seminomas and non-seminoma germ cell tumours (NSGCT).

The two types are about equally common.

Pure seminomas account for up to 45 per cent of testicular cancers and are fairly smooth tumours.

Non-seminoma testicular cancers include teratomas, embryonal carcinomas, choriocarcinoma and yolk sac tumours, although often non-seminomas are complex and formed from a bit of a mixture of cells.

Both types of tumour are capable of producing hormones (or proteins) that are detectable in the blood.

Human chorionic gonadotrophin (hCG) is produced by both teratomas and seminomas (hCG is the hormone also produced by a woman during pregnancy, and is what is detected in a pregnancy test).

Teratomas can produce alpha-fetoprotein (AFP). Often the level of these proteins in the blood is useful in making the diagnosis, and monitoring treatment and follow-up of men who have had testicular cancer.

However, in other regards the treatments of these types of testicular cancer is much the same, and so the exact cell types involved may not make much difference.


One other type of cancer sometimes starts in the testicles. This is a lymphoma and is more likely to be a problem in men over 50. It requires different sorts of treatment.

How is testicular cancer treated?

Early detection

Testicular cancer can be cured in more than 96 per cent of cases if caught at an early stage.

Late diagnosis increases the risk of a poorer response to treatment.

More than 97 per cent of men with testicular cancer now survive more than 5 years and more than 96 per cent will survive at least 10 years (which effectively means they area cured).

If the cancer is caught at an early stage then survival may be even higher. If the cancer has spread, the prognosis depends on which type of tumour it is and how far it has spread but results are still generally quite good.

Five-year survival for a man with a seminoma that has spread to the lymph nodes or lungs is 86 per cent for example, while it is still as high as 72 per cent if spread includes the brain or liver.

Similarly, a non-seminoma which has spread only locally has a 92 per cent five-year survival.

Late diagnosis increases the risk of a poorer response to treatment.

Treatments include surgery, chemotherapy and radiotherapy which may be given alone or in combination, depending on the situation.

In most cases the man has initial surgery to remove the affected testicle (an operation known as orchidectomy) in order to make the diagnosis. Although the affected testicle is removed, an artificial testicle (prosthesis) can be inserted to disguise the fact almost completely.

Chemotherapy (anticancer drugs) may be given to reduce the chance of an early stage cancer returning.

This is known as adjuvant chemotherapy and usually consists of one treatment with a drug called carboplatin for an early seminoma or two treatment cycles with bleomycin, etoposide and cisplatin (BEP) for a non-seminoma tumour.

If the tumour has spread beyond the testicle then other treatments may be needed. Seminomas are usually diagnosed before they have spread to other parts of the body (metastasised) but radiotherapy (X-ray treatment) may be recommended if there is a chance that the lymph nodes in the abdomen are affected.

If the seminoma has spread further, then either radiotherapy or radiotherapy plus chemotherapy (anticancer drugs) is used.

With teratomas, provided there is no evidence of spread on examination and scans, and blood tests show none of the protein markers produced by the cancer cells, then a closely observed 'wait and see' policy (also known as surveillance) can be taken following tumour removal.

If there is any sign of recurrence of a testicular cancer then chemotherapy may be started.

The treatment of germ cell tumours has been one of the great successes of modern chemotherapy. Usually three or four courses are given, at three-weekly intervals, of bleomycin, etoposide and cisplatin (BEP).

Where there are remaining tumours following chemotherapy (for example within the lymph nodes – the commonest site for the tumour to spread first) these are removed surgically.

Radiotherapy may be used to treat the recurrence of a seminoma, and sometimes for recurrence of a non-seminoma after surgery.

Treatment with radiotherapy or chemotherapy can affect the ability to father children but in many cases fertility is not affected.

Sperm can be stored before treatment for later use.

Other people also read:

Checking yourself for testicular cancer: why self-examine?

Impotence (erectile dysfunction): why does ED occur?

Testicular lumps and bumps: common conditions that can affect the testicles.

Testicular cancer: what causes it?

Based on a text by Dr Ian Banks, GP and men's health expert

Last updated

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