What is testicular cancer?
Testicular cancer is a cancer arising from the testes, which produce sperm and the male hormone testosterone. Although it is rare among all cancers, it is one of the most common solid tumours in young men aged 15–40. The vast majority of testicular cancers are germ cell tumours, which develop from sperm-producing cells.
Germ cell tumours are divided into two main groups:
- Seminoma: These tumours usually grow more slowly and are sensitive to radiotherapy and chemotherapy. They mostly occur in men in their 30s and 40s.
- Non-seminomatous germ cell tumours: These include subtypes such as embryonal carcinoma, yolk sac tumour, choriocarcinoma and teratoma. They tend to occur at a younger age and may spread at a different rate.
The group to which the tumour belongs directly determines the treatment and follow-up plan after surgery.
Risk factors
Although the exact cause of testicular cancer is not known, some conditions increase the risk:
- A history of undescended testis in childhood (even if it was brought down surgically)
- Previous testicular cancer in the other testis
- Testicular cancer in a father or brother
- Male infertility and shrinkage of the testis (atrophy)
Men with any of these risk factors are advised to check their testes themselves regularly and to seek advice without delay if they notice anything suspicious.
Symptoms
- A painless hard area, lump or swelling in the testis
- Enlargement or a change in the shape of the testis
- A feeling of heaviness in the scrotum, or a mild ache in the groin or lower abdomen
- Less commonly, enlargement or tenderness of the breast tissue
- At advanced stages, lower back or back pain, cough or shortness of breath
Because testicular cancer usually does not cause pain, it may be noticed late. Any newly noticed hard area in the testis should be assessed by examination rather than assumed to be inflammation or a simple swelling.
Testicular self-examination
A short self-examination once a month helps to detect changes in the testes early. After a warm shower, gently roll each testis in turn between the thumb and fingers. The surface of the testis should be smooth and its consistency even. The soft, coiled structure felt at the upper back of the testis is the epididymis and is normal. A slight difference in size between the two testes is also usual. If you notice a new lump or change, see a urologist.
How is it diagnosed?
- Physical examination: Both testes, the groins, the abdomen and the breast tissue are examined.
- Scrotal Doppler ultrasound: Shows a mass within the testis with high accuracy, reveals whether it is inside or outside the testis and shows the condition of the other testis. It distinguishes cancer from benign conditions such as a fluid collection in the scrotum (hydrocele).
- Tumour markers: Blood levels of AFP (alpha-fetoprotein), β-hCG and LDH are measured. These values help with diagnosis and are also used for staging and follow-up. Normal markers do not rule out cancer.
- Staging imaging: Once the diagnosis is confirmed, CT scans of the abdomen, pelvis and chest are usually performed to find out whether the disease has spread.
The definitive diagnosis is made by pathological examination of the surgically removed testis.
Treatment options
Inguinal radical orchiectomy
The first and fundamental step in treating testicular cancer is removal of the affected testis together with its cord (spermatic cord) through an incision in the groin. The operation is not performed through the scrotal skin and no needle biopsy is taken; this approach aims to prevent the tumour from spreading through different lymphatic pathways. The operation is performed under general or spinal anaesthesia, and patients are usually discharged the same day or the next day.
In selected patients with only one testis or with tumours in both testes, and with a very small mass, testis-sparing surgery may be considered.
Testicular prosthesis
If the patient wishes, a silicone testicular prosthesis can be placed where the removed testis was. The prosthesis helps to preserve the appearance of the scrotum and can usually be inserted during the same operation as the orchiectomy.
Sperm freezing
Chemotherapy, radiotherapy and lymph node surgery can affect sperm production or ejaculation. For this reason, patients who may want children in the future are advised to have sperm frozen before treatment, preferably before the orchiectomy. This is arranged quickly so that treatment is not delayed. For more information, see the male infertility page.
Treatment after surgery
The stage of the disease is determined on the basis of the pathology result, the course of tumour markers after surgery and the imaging findings. The treatment plan is made individually, together with medical oncology and radiation oncology where needed:
- Close surveillance (active monitoring): In early stages where the disease is confined to the testis, monitoring with regular blood tests and imaging is a suitable option for many patients.
- Chemotherapy: Given as a short preventive course in early-stage patients at high risk of spread, or as treatment for disease that has spread.
- Radiotherapy: May be given to the lymph nodes at the back of the abdomen in selected seminoma patients.
- RPLND (retroperitoneal lymph node dissection): Surgical removal of the lymph nodes at the back of the abdomen. It is used particularly for masses remaining after chemotherapy and in selected non-seminomatous tumours.
Recovery
After orchiectomy, most patients return to their daily routine within a few days and to work within 1–2 weeks. Heavy lifting and strenuous sport should be avoided for a few weeks. Mild pain, swelling and bruising in the groin and scrotum may occur in the first days. As long as the other testis is healthy, hormone production and sexual function are generally not affected.
Risks
Possible risks of orchiectomy include wound infection, a blood collection in the scrotum (haematoma) and numbness in the groin. In patients who receive a testicular prosthesis, infection or displacement of the prosthesis may rarely occur. The specific side effects of additional treatments (chemotherapy, radiotherapy, RPLND) are discussed separately when treatment is planned.
Life and fertility after treatment
Most men treated for testicular cancer return to work, sport and family life after treatment. Hormone production with one testis is usually sufficient; however, in some patients, particularly after chemotherapy or radiotherapy, testosterone levels may fall. This can cause tiredness, reduced sexual desire and mood changes, so hormone levels are checked during follow-up and treatment is planned if necessary.
Sperm production may decrease temporarily after chemotherapy; although many patients recover over time, this varies from person to person. Sperm frozen before treatment can be used in assisted reproduction techniques if natural conception is not achieved later. Patients who want to have children after chemotherapy are advised to wait for a certain period; this period is decided together with the treating doctor.
A diagnosis of testicular cancer at a young age can be emotionally challenging. Talking to your partner and family, and getting psychological support if needed, makes the process easier.
Follow-up
In testicular cancer, follow-up is at least as important a part of treatment as surgery. Examinations, tumour markers and imaging are carried out at set intervals; the frequency of follow-up decreases over time but continues for years. During follow-up, continuing self-examination of the other testis, checking hormone levels and monitoring cardiovascular health in the long term are also recommended.
Testicular cancer care in Bursa, Turkey
Op. Dr. Mücahit Kabar graduated from Uludağ University Faculty of Medicine and completed his urology residency at the Urology Clinic of Ankara Training and Research Hospital. He has scientific studies in uro-oncology published in international and national peer-reviewed journals, including a case report on a metastatic tumour in the testis. In Bursa (Nilüfer), he sees patients with a testicular lump or swelling at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00) and Özel Jimer Hastanesi (weekdays 13:00–17:00).
Consultations are held in English or Turkish. The hospitals’ international patient departments can arrange interpreters for other languages and help with airport transfers and accommodation. If you are travelling from abroad, you can book the examination in advance through the online booking page or appointment line of Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) or Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). You can share any ultrasound or blood test results you already have via WhatsApp (+90 541 622 54 82) beforehand. More information is available on the international patients page and the contact page.
