Testicular cancer usually starts with a painless lump or swelling on one testicle. From there, the process moves quickly: diagnosis typically involves an ultrasound and blood tests, treatment almost always starts with surgery to remove the affected testicle, and the overall outlook is excellent. The five-year survival rate is 99% when the cancer is caught before it spreads beyond the testicle.
Here’s what the full experience looks like, from the first signs through treatment and recovery.
The First Signs You’d Notice
The most common first sign is a lump or hard area on one testicle. It usually affects only one side. Some people notice it themselves; others have it found during a routine physical. Beyond the lump itself, other signs include a feeling of heaviness in the scrotum, a dull ache in the lower belly or groin, sudden scrotal swelling, or general discomfort in the testicle. Less commonly, breast tissue can become enlarged or tender, and some people develop back pain.
Not all of these signs mean cancer. Infections, fluid buildup, and benign cysts can cause similar symptoms. But a new lump or noticeable change in size, shape, or firmness of a testicle is worth getting checked promptly. Testicular cancer is most common between the ages of 20 and 40, an age range when many people aren’t thinking about cancer at all.
How It Gets Diagnosed
If you go in with a suspicious lump, the first step is usually an ultrasound. You lie on your back, gel is applied to the scrotum, and a handheld probe creates images of the testicle. It’s painless and takes only a few minutes. The ultrasound helps distinguish solid masses (which are more concerning) from fluid-filled cysts (which are usually harmless).
Blood tests are drawn to check for specific proteins that testicular cancers often produce. These tumor markers include AFP, hCG, and LDH. Elevated levels don’t confirm cancer on their own, but they give doctors important clues about whether a tumor is present and, later, how well treatment is working. If the ultrasound and blood work point toward cancer, a CT scan of the chest, abdomen, and pelvis checks whether the cancer has spread to lymph nodes or other organs.
Unlike most other cancers, testicular cancer is not diagnosed with a biopsy taken before surgery. Because of how the testicle is structured and how the cancer spreads, the standard approach is to remove the entire affected testicle and then examine it in a lab. That surgery is both the definitive diagnostic step and the first line of treatment.
Surgery: What to Expect
The primary treatment is an operation called an orchiectomy, where the affected testicle is removed through a small incision in the groin (not the scrotum). For many people, this is the only treatment needed. The surgery is typically done as an outpatient procedure or with a short hospital stay, and most people return to normal activities within a few weeks.
Losing one testicle does not mean losing the ability to function sexually or have children. The remaining testicle usually produces enough testosterone to maintain normal hormone levels and enough sperm for fertility. A prosthetic testicle can be placed during or after surgery if you want one for cosmetic reasons.
If imaging or blood work suggests the cancer has reached nearby lymph nodes, a second surgery to remove those nodes in the abdomen may be recommended.
Chemotherapy and Radiation
What happens after surgery depends on the type and stage of cancer. Testicular cancers fall into two main categories: seminomas, which tend to grow slowly, and nonseminomas, which grow more quickly. This distinction matters because it shapes the treatment plan.
Chemotherapy may be used after surgery to reduce the chance of the cancer returning, or to treat cancer that has already spread. It can be highly effective for testicular cancer, even in advanced cases. Radiation therapy is sometimes used for seminomas that have spread to lymph nodes in the abdomen, but it’s less commonly part of the treatment plan for nonseminomas.
Some people with early-stage cancer skip additional treatment entirely and instead enter active surveillance, a structured monitoring program where blood tests and imaging are done on a regular schedule to catch any recurrence early.
Stages and Survival Rates
Staging tells you how far the cancer has spread and shapes the treatment approach. In practical terms:
- Stage I: The cancer is confined to the testicle. No signs of spread on imaging, and tumor markers return to normal after surgery. This is the most common stage at diagnosis.
- Stage II: The cancer has spread to lymph nodes in the abdomen but not to distant organs.
- Stage III: The cancer has spread beyond the abdominal lymph nodes, potentially reaching the lungs or other organs, or tumor marker levels are significantly elevated.
The survival numbers are among the best of any cancer. Based on data from people diagnosed between 2015 and 2021, the five-year relative survival rate is 99% for localized disease, 96% when it has spread to regional lymph nodes, and 72% when it has spread to distant sites. Even stage III testicular cancer responds well to treatment compared to most other advanced cancers.
Effects on Fertility and Hormones
With one healthy testicle remaining, most people maintain normal testosterone levels and sexual function. However, some treatments carry real risks to fertility. Chemotherapy can slow or stop sperm production, sometimes temporarily and sometimes permanently. If the cells responsible for generating new sperm are damaged, production may take years to recover or may never fully return to pre-treatment levels. Cancer treatment can also reduce the hormones needed for both sperm production and sexual function.
Because of these risks, sperm banking before starting chemotherapy or radiation is worth discussing with your care team. Collecting and freezing sperm samples beforehand preserves the option of biological children later, regardless of what treatment does to fertility.
The Follow-Up Schedule
After treatment, you enter a structured monitoring period that lasts at least five years. The schedule is more intensive in the first two years, when recurrence is most likely, then gradually tapers off.
For early-stage seminomas on surveillance, the typical schedule involves blood tests and a doctor visit twice a year for the first three years, then annually in years four and five. Imaging of the abdomen and pelvis (CT or MRI) is done twice in the first year, twice in the second year, then once at the three-year and five-year marks.
Nonseminomas require slightly more frequent monitoring. Blood work is checked four times a year for the first two years, twice in the third year, then once or twice annually after that. Imaging follows a similar pattern, with scans concentrated in the first two years.
For people treated for advanced disease, the schedule includes chest imaging in addition to abdominal scans, particularly if the cancer originally involved the lungs. Tumor marker blood tests are the simplest and most accessible monitoring tool, though slightly elevated levels sometimes turn out to be false positives, so results are always interpreted alongside imaging and repeat measurements over time.
Checking Yourself
There’s no universal recommendation on how often to do a testicular self-exam, and medical organizations differ on whether routine self-exams reduce the risk of dying from the disease. That said, the technique is simple and takes less than a minute. After a warm shower, when the scrotal skin is relaxed, hold each testicle between your thumbs and fingers and gently roll it, feeling for hard lumps, smooth bumps, or any change in size, shape, or firmness. It helps to stand in front of a mirror so you can also look for visible swelling. Knowing what your normal baseline feels like makes it easier to notice something new.