Testicular cancer is a cancer that starts in one or both testicles, the male reproductive glands that sit inside the scrotum. It’s relatively uncommon compared to other cancers, but it’s the most common cancer in young men. The average age at diagnosis is about 33, and the vast majority of cases occur between ages 15 and 55. The good news: it’s one of the most treatable cancers, with a 99% survival rate when caught early.
Types of Testicular Cancer
Nearly all testicular cancers begin in germ cells, the cells that produce sperm. From there, they split into two main categories: seminomas and non-seminomas.
Seminomas are slow-growing tumors most often found in men in their 40s and 50s. They tend to stay localized longer and respond very well to treatment. Non-seminomas are more common overall and grow more quickly. They typically appear at younger ages and include several subtypes, though the distinction matters more to your treatment team than to you. What’s worth knowing is that the type of tumor influences which treatments work best and how closely you’ll be monitored afterward.
Symptoms to Watch For
The most common first sign is a lump or swelling in one testicle. It’s usually painless, which is part of why some men ignore it or delay getting it checked. The lump often feels firm or hard compared to the surrounding tissue.
Other symptoms include:
- A feeling of heaviness in the scrotum
- A dull ache in the lower belly or groin
- Pain or discomfort in a testicle or the scrotum
- Sudden swelling in the scrotum
None of these symptoms are exclusive to cancer. Infections, fluid buildup, and benign cysts can all cause similar sensations. But a lump that doesn’t go away within a week or two, or any sudden change in the size or feel of a testicle, is worth getting examined.
Who’s Most at Risk
The single biggest risk factor is a condition called cryptorchidism, where one or both testicles don’t descend from the abdomen into the scrotum before birth. Men born with an undescended testicle are many times more likely to develop testicular cancer, even if the condition was surgically corrected in childhood.
Family history plays a role as well. Having a father or brother who had testicular cancer increases your risk, though most men diagnosed have no family history at all. If you’ve already had cancer in one testicle, there’s roughly a 3% to 4% chance of eventually developing it in the other one. Age is also a factor: while about 6% of cases occur in children and teens and 8% in men over 55, the peak risk window is the late teens through mid-30s.
How It’s Diagnosed
Diagnosis typically starts with a physical exam and an ultrasound of the scrotum, which can distinguish a solid mass from a fluid-filled cyst. If the ultrasound suggests cancer, blood tests measure three specific proteins that testicular tumors can release into the bloodstream. These markers help confirm the diagnosis, identify the tumor type, and track how well treatment is working later on.
The first marker is a protein normally produced during fetal development. It’s elevated in certain non-seminoma tumors but, by definition, never in pure seminomas. The second is a hormone normally associated with pregnancy. Both seminomas and non-seminomas can produce it, and very high levels typically point to non-seminoma and a more aggressive tumor. The third is a general enzyme found throughout the body. It’s less specific to testicular cancer, but high levels correlate with a larger tumor burden.
Together, these blood tests give doctors a biological fingerprint of the cancer before surgery even happens.
Treatment and What to Expect
The first step in nearly every case is surgical removal of the affected testicle. The incision is made in the groin rather than the scrotum, which allows the surgeon to remove the testicle along with the spermatic cord while reducing the risk of spreading cancer cells. Losing one testicle doesn’t affect your ability to have erections or, in most cases, your testosterone levels, since the remaining testicle compensates.
What comes after surgery depends on the type and stage of the cancer. Some men need no further treatment and simply enter a monitoring phase called active surveillance, with regular blood tests and imaging scans. Others may need chemotherapy, radiation, or a second surgery to remove lymph nodes in the abdomen. That lymph node surgery can be done through a traditional large incision or, in some cases, through smaller incisions using a camera-guided approach.
Fertility and Sperm Banking
This is one of the most practical concerns for young men facing treatment, and it’s worth addressing before anything starts. Surgery to remove one testicle usually doesn’t eliminate fertility on its own. But chemotherapy can have a significant long-term impact: about 40% of patients who receive chemotherapy will have permanently reduced sperm counts that impair their ability to conceive naturally.
Sperm banking before treatment begins is an effective safeguard. It preserves the option of having biological children regardless of what happens to sperm production during or after treatment. If fertility matters to you, this is a conversation to have with your care team before the first round of treatment, not after.
Survival Rates by Stage
Testicular cancer has some of the highest survival rates of any cancer. Based on data from patients diagnosed between 2015 and 2021, the five-year relative survival rates are:
- Localized (cancer confined to the testicle): 99%
- Regional (spread to nearby lymph nodes): 96%
- Distant (spread to distant organs like the lungs): 72%
Even in cases where the cancer has spread beyond the testicle and local lymph nodes, nearly three out of four men survive at least five years. That 72% figure for distant-stage disease is remarkably high compared to most other cancers at the same stage, largely because testicular cancer responds exceptionally well to chemotherapy.
Checking Yourself
A monthly self-exam is the simplest way to catch changes early. The best time is right after a warm shower or bath, when the scrotal skin is relaxed and the testicles hang lower. Roll each testicle gently between your thumb and fingers, feeling for any hard lumps, smooth bumps, or changes in size or shape. It’s normal for one testicle to be slightly larger or hang lower than the other, and the soft, rope-like structure along the back of each testicle is the epididymis, not a lump.
What you’re looking for is anything new: a pea-sized hard spot, a noticeable change in firmness, or swelling that wasn’t there before. Getting familiar with what’s normal for your body makes it much easier to recognize when something changes. Men between ages 15 and 35 benefit most from regular self-exams, though some medical organizations recommend all men check monthly after puberty.