Patient education › Testicular cancer
Testicular cancer
Testicular cancer mostly affects young men, and it is one of the great successes in oncology: even when it has spread, most people are cured. That fact should shape how you read everything else here.
Walk in prepared
This diagnosis usually arrives fast, in your twenties or thirties, with decisions needed within days. Getting organized early is worth a lot.
Dr. Weiner uses WellPrept to help patients gather their records and write down their questions ahead of time. It is free, takes about ten minutes, and you do not need to be his patient to use it. If you are seeing another urologist, or preparing for a second opinion anywhere, it works just as well.
Organize your records and questions before you sit down. Free, and yours to keep whichever doctor you see.
A lump, an ultrasound, and blood tests
The usual presentation is a painless lump or swelling in a testicle that has been getting bigger. Pain happens but is less common. Any solid mass in the testis is treated as cancer until proven otherwise, and the test that sorts it out is a scrotal ultrasound.
Tumour markers, drawn before anything is done
Three blood tests matter: AFP, hCG and LDH. They should be drawn before any treatment, including before surgery, because the baseline is what makes the post-operative values interpretable. They are then repeated afterwards, timed to how quickly each one clears from the blood. Your stage and your risk category are based on the values after surgery, not before.
One useful detail: pure seminoma does not produce AFP. If a tumour looks like seminoma but AFP is rising, it is treated as a non-seminoma. Mildly raised markers can also be false positives, so a borderline value is usually confirmed as a trend before anyone acts on it.
Why the surgery goes through the groin
The operation is a radical inguinal orchiectomy: the testis and cord are removed through an incision in the groin, with the cord tied off high up. It is not done through the scrotum, and a needle or scrotal biopsy of a suspicious testis mass is avoided. Cutting through the scrotum disturbs different lymphatic drainage and is associated with local recurrence that essentially does not happen with the inguinal approach.
Testis-sparing surgery exists but is reserved for narrow situations: a small mass with negative markers, a solitary testicle, or tumours on both sides at once. Many small non-palpable masses turn out to be benign, which is why it is considered at all.
Two families, and a strong argument for watching
Testicular cancers divide into seminoma and non-seminoma, in roughly equal numbers. Seminomas tend to occur slightly later, behave more slowly, and are extremely sensitive to both chemotherapy and radiation. Non-seminomas may contain teratoma, which does not respond to chemotherapy and can only be removed surgically. That single fact drives many of the decisions that follow.
Stage I: surveillance is the recommended path
If the cancer appears confined to the testis after surgery and staging, surveillance is the recommended option for both seminoma and stage IA non-seminoma. The great majority of men are already cured by the orchiectomy alone. A minority relapse, and the crucial point is that relapse on surveillance is still highly curable, so survival is essentially the same as it would have been with immediate extra treatment. Surveillance simply avoids giving chemotherapy or radiation to the many people who never needed it.
Alternatives exist and are reasonable in the right circumstances: a single cycle of chemotherapy, retroperitoneal lymph node surgery, or for seminoma, radiation or single-dose carboplatin. If your non-seminoma shows lymphovascular invasion, the relapse risk is considerably higher and the balance shifts, which is a shared decision rather than an automatic one.
Surveillance means actually turning up
This is the catch. Surveillance only works if you attend. For non-seminoma it means markers and examination every two to three months in the first year, easing off through years two to five, with scans at defined points. Seminoma follows a less frequent schedule built around imaging. The great majority of relapses happen in the first two years, and late relapse beyond five years is rare. If you know you will struggle to keep appointments, say so, because that genuinely affects which option is right for you.
Being cured young brings its own agenda
Because most men are cured and are cured young, what happens over the following decades matters as much as the cancer did. After chemotherapy or radiation there is an increased risk of cardiovascular disease and of second cancers later in life. Hearing loss, nerve damage in the hands and feet, kidney effects, fatigue and low mood are all recognized. A proportion of men end up needing testosterone replacement, and the risk of that is higher after chemotherapy or radiation than after surgery alone.
Two practical things. First, the other testicle carries a small lifetime risk of developing cancer too, typically some years later, so monthly self-examination is worth the habit. Second, ask to be referred to a survivorship clinic rather than simply being discharged, and ask for your testosterone to be checked if you feel persistently flat, tired or low in libido.
Worth asking out loud
Decisions here come quickly. These are the ones worth slowing down for.
Before surgery
- Have my tumour markers been drawn before treatment?
- Where and how quickly can I bank sperm?
- Do I want a prosthesis, and can it be placed at the same time?
- Why the groin approach rather than the scrotum?
After pathology
- Is this seminoma or non-seminoma?
- Is there lymphovascular invasion?
- What stage am I, based on my post-surgery markers?
- Would a specialist pathology review be worthwhile?
About the plan
- Is surveillance recommended for me?
- What exactly does the schedule involve, and for how long?
- If I relapse on surveillance, is it still curable?
- If node surgery is proposed, will it be nerve-sparing, and how many do you do?
About the long term
- What are the late effects I should watch for?
- Should my testosterone be monitored?
- Will I be referred to a survivorship clinic?
- What should I be checking myself, and how often?
Sources and further reading
This page was written for patients and reviewed by Dr. Weiner. It reflects current professional guidelines, which are written for clinicians. The patient-facing versions below are free and often easier to read.
- Early Stage Testicular Cancer: AUA Guideline, American Urological Association.
- Testicular cancer, Urology Care Foundation.
- Urology Care Foundation, the AUA's patient education arm.
- NCCN Guidelines for Patients, free plain-language versions of the treatment guidelines.
This is general education, not medical advice. It cannot account for your imaging, your pathology, your other health conditions or what matters to you. Take it to your own doctor and work through it together. If anything here conflicts with what your urologist has told you, raise it with them directly rather than assuming either of us is wrong.
Last reviewed September 2026 by Adam B. Weiner, MD.