Urology & uro-oncology · KIMS Secunderabad
Testicular Cancer — Symptoms, What to Look For, and Why Early Detection Matters
Testicular cancer is the most common solid malignancy in men between the ages of 15 and 40 — and one of the most curable cancers in medicine when detected at the localised stage, with overall survival rates above 95%. Despite these exceptional outcomes, many men in India delay seeking help for months after noticing a testicular lump or swelling, typically because of embarrassment, fear, or the mistaken belief that a painless lump cannot be cancer. This delay costs lives unnecessarily, because the same cancer that is cured with a single surgical procedure at Stage 1 requires chemotherapy and potentially complex surgery at Stage 3.
This page explains what testicular cancer is, what symptoms to look for, how it is diagnosed, and what treatment and follow-up involve at KIMS Secunderabad. The central message is simple: any new, painless, firm lump on or within a testicle requires urgent assessment — within days, not weeks. Most testicular lumps are benign. But the ones that are not are rapidly curable when caught early and significantly harder to cure when caught late.
Who gets testicular cancer and why
Testicular cancer affects approximately 1 to 2 men per 100,000 per year in India — lower than Western rates (6 to 7 per 100,000 in the UK and USA) but not rare. The peak incidence is in the 20s and 30s. Key risk factors:
Cryptorchidism (undescended testicle)
The most significant risk factor. Men with a history of undescended testicle have a 3 to 5 times higher risk of testicular cancer, even if the testicle was surgically corrected in childhood. The risk applies to both the affected and the contralateral testicle.
Personal or family history of testicular cancer
Men who have had testicular cancer in one testicle have a 12-fold higher risk of developing it in the other.
Klinefelter syndrome
Associated with an increased risk, particularly of mediastinal germ cell tumours.
Infertility
Men with subfertility have a modestly higher risk of testicular cancer, suggesting shared underlying testicular dysgenesis.
Testicular atrophy or microlithiasis
Testicular microlithiasis (calcium deposits within the testis on ultrasound) is associated with germ cell tumours. Surveillance is advised for men with microlithiasis and additional risk factors.
Types of testicular cancer
Testicular cancer is broadly divided into germ cell tumours (GCTs, 95% of cases) and non-germ cell tumours (5%). The histological type drives the prognosis and the treatment plan — the cards below summarise each.
Germ cell tumours (GCTs) — 95% of all testicular cancers
Seminoma (pure) — the most common type (50%). Typically affects men in their 30s and 40s. Grows more slowly, highly radiosensitive and chemosensitive. Non-seminoma germ cell tumours (NSGCTs) — embryonal carcinoma, yolk sac tumour, choriocarcinoma, teratoma, and mixed tumours. More common in the 20s. Tend to grow faster and spread earlier than seminoma but respond excellently to cisplatin-based chemotherapy. Mixed GCT contains elements of both seminoma and non-seminoma and is managed as NSGCT.
Non-germ cell tumours — 5% of testicular tumours
Leydig cell tumours (most common sex cord-stromal tumour — often hormonally active, usually benign), Sertoli cell tumours, and lymphoma (primary testicular lymphoma — typically in men above 60). These are managed differently from GCTs and are identified on histopathology after radical orchiectomy.
Symptoms — what to look for
Any new, firm lump on or within the testicle is a testicular cancer until proven otherwise. Do not wait. Do not monitor it at home for weeks. Call KIMS on 040-4488-5000 for a same-week urology appointment.
Symptoms that warrant urgent urology assessment
The features below — alone or in combination — should trigger same-week urology review and a scrotal ultrasound within 48 to 72 hours:
Painless testicular lump or swelling — the most common presentation. The absence of pain is not reassuring. Most testicular cancers are completely painless in the early stages, which is precisely why they are missed.
Heaviness or aching in the scrotum or lower abdomen — a dull, persistent ache or sensation of heaviness, with or without a palpable lump.
Sudden fluid collection around the testicle (secondary hydrocele) — new or rapidly enlarging hydrocele in a man above 40 should always prompt an ultrasound to exclude an underlying tumour.
Breast tenderness or growth (gynaecomastia) — choriocarcinoma and some mixed GCTs produce hCG, which has LH-like activity and stimulates oestrogen production. Gynaecomastia may be the presenting symptom.
Back pain or loin pain — retroperitoneal lymph node involvement (the first site of spread for testicular GCTs via the lymphatics) can cause back pain at presentation in advanced cases.
Breathlessness or cough — pulmonary metastases in advanced disease.
The testicular self-examination habit — feeling each testicle between the thumb and fingers for any new lump, change in consistency, or change in size — takes 30 seconds and should be done monthly from age 15. Most men who diagnose their own testicular cancer do so by noticing an incidental finding during self-examination or bathing. The testicle should feel smooth and firm with the epididymis at the back — any deviation from this warrants assessment.
Diagnosis at KIMS
Scrotal ultrasound
The first and most important diagnostic test. A high-resolution scrotal ultrasound performed at KIMS identifies intratesticular lesions with near-100% sensitivity and distinguishes intratesticular (high suspicion for malignancy) from extratesticular lesions (usually benign). The report should specifically state whether the lesion is intratesticular and whether it is hypoechoic — both features raise the index of suspicion for GCT. Ultrasound should be performed within 48 to 72 hours of the clinical concern.
Tumour markers
Alpha-fetoprotein (AFP), beta-hCG, and lactate dehydrogenase (LDH) are drawn before orchiectomy. Elevated AFP indicates non-seminomatous component. Elevated hCG may be present in both seminoma and NSGCT. LDH reflects tumour burden. Critically, pure seminoma never elevates AFP — a raised AFP in a testicular tumour mandates management as NSGCT regardless of histology.
CT chest, abdomen, and pelvis
Performed for staging after histological diagnosis — to assess retroperitoneal lymphadenopathy (Stage 2) and pulmonary/hepatic metastases (Stage 3). CT is the cornerstone of testicular cancer staging.
Radical orchiectomy — diagnosis and treatment simultaneously
The standard surgical procedure for suspected testicular cancer is radical orchiectomy — surgical removal of the testicle through an inguinal (groin) incision, with ligation of the spermatic cord at the internal inguinal ring. Importantly, the testicle is NEVER biopsied through the scrotum — this would disrupt the lymphatic drainage and potentially seed the inguinal and pelvic lymph nodes. The inguinal approach is mandatory. At KIMS, radical orchiectomy is performed by Dr. Neil Narendra Trivedi or Dr. Likhiteswer Pallagani.
Staging and treatment
Treatment is determined by the stage at diagnosis and the histological type (seminoma vs NSGCT). Even metastatic disease has excellent cure rates with cisplatin-based chemotherapy — testicular cancer is one of the success stories of modern oncology.
Stage 1 — tumour confined to the testicle (T1–T4)
CT: no retroperitoneal or distant disease. Markers: normal after orchiectomy. Seminoma: surveillance (preferred for low-risk) or adjuvant carboplatin (1 cycle) or radiotherapy (20Gy). NSGCT: surveillance (preferred for Stage 1A) or 1 cycle BEP chemotherapy. Cure rate: >99%.
Stage 2 — retroperitoneal lymph node involvement
2A (below 2cm), 2B (2–5cm), 2C (above 5cm). Seminoma: radiotherapy (Stage 2A/2B) or 3 cycles BEP (Stage 2C). NSGCT: 3–4 cycles BEP chemotherapy. RPLND (retroperitoneal lymph node dissection) for selected post-chemotherapy residual masses.
Stage 3 — distant metastases (pulmonary, hepatic, cerebral, or bone)
4 cycles BEP or 4 cycles EP chemotherapy. Good prognosis (IGCCCG classification): >90% long-term cure. Intermediate/poor prognosis: intensified chemotherapy regimens. Residual mass resection after chemotherapy where indicated.
Sperm banking before treatment. All men of reproductive age diagnosed with testicular cancer should be offered sperm banking before orchiectomy or chemotherapy. A single radical orchiectomy rarely causes infertility — the contralateral testicle continues producing sperm — but chemotherapy (particularly with alkylating agents) can cause temporary or permanent oligospermia. Sperm banking before treatment preserves the option of biological fatherhood and takes 1 to 2 days. KIMS coordinates sperm banking at the time of diagnosis.
Book a Testicular Lump Assessment at KIMS — Same-Week Appointments Available
Frequently Asked Questions — Testicular Cancer
No — most testicular lumps are benign. The most common extratesticular causes of scrotal lumps are epididymal cysts, spermatoceles (fluid-filled cysts of the epididymis), hydroceles (fluid around the testicle), and epididymitis (inflammation). These are all benign and feel different from the firm, hard, smooth intratesticular lump typical of testicular cancer. However, the distinction requires a scrotal ultrasound — clinical examination alone cannot reliably exclude malignancy. Any new intratesticular lump must be investigated with ultrasound within 48 to 72 hours. Benign lumps are reassuringly common; the question is which category any specific lump falls into.
Testicular cancer growth rate varies by type. Non-seminomatous germ cell tumours, particularly embryonal carcinoma and choriocarcinoma, can double in size within weeks to a month. Seminoma grows more slowly — weeks to months per stage. Retroperitoneal lymph node spread (Stage 2) and pulmonary spread (Stage 3) can occur within weeks to months of the primary tumour developing in rapidly growing NSGCTs. This is why urgent assessment — ultrasound within 48 to 72 hours, surgery within 1 to 2 weeks of diagnosis — is clinically important rather than an overreaction.
Yes — testicular cancer has one of the highest cure rates of any cancer. Overall 5-year survival is above 95%. Stage 1 disease (confined to the testicle) has a cure rate above 99% with radical orchiectomy and appropriate adjuvant therapy or surveillance. Even metastatic Stage 3 disease with a good prognosis classification (IGCCCG) has a 5-year survival above 90% with cisplatin-based chemotherapy. Testicular cancer is one of the success stories of oncology — driven by the exceptional chemosensitivity of germ cell tumours and the discipline of the international surveillance and chemotherapy protocols developed from the 1970s onward.
Radical orchiectomy removes one testicle. The remaining testicle continues producing testosterone and, in most cases, sperm. Testosterone levels are maintained by the contralateral testicle in the vast majority of men after unilateral orchiectomy. Sexual function — libido, erections, ejaculation — is not directly affected by orchiectomy. A testicular prosthesis (a saline-filled silicone implant of appropriate size) can be placed at the time of orchiectomy if the patient wishes, for cosmetic purposes. If the remaining testicle also requires removal or is already absent, testosterone replacement therapy is prescribed.
Surveillance is the monitoring strategy chosen for Stage 1 disease in preference to adjuvant chemotherapy or radiotherapy. The patient undergoes regular CT scans, tumour marker measurements, and clinical examinations at defined intervals — typically 3-monthly in year 1, 4-monthly in year 2, 6-monthly in year 3, and annually thereafter for 5 to 10 years. The relapse rate for Stage 1 seminoma on surveillance is approximately 15 to 20% (most relapses are Stage 2 and highly curable at that point). For Stage 1 NSGCT, the relapse rate is 30% without adjuvant treatment. Surveillance avoids the side effects of adjuvant therapy in the 80% who would not relapse, at the cost of more intensive monitoring and the psychological burden of uncertainty.
Not necessarily. Most Stage 1 testicular cancer patients do not require chemotherapy — they are managed with surveillance (monitoring) or a single dose of adjuvant carboplatin (for low-risk Stage 1 seminoma). Chemotherapy (BEP — bleomycin, etoposide, cisplatin) is the treatment for Stage 2 and Stage 3 disease, and for Stage 1 high-risk NSGCT (lymphovascular invasion present). BEP is highly effective — even Stage 3 good-prognosis disease has cure rates above 90%. The oncology team (with KIMS providing surgical management and coordinating with the oncology team for chemotherapy) defines the correct treatment for each stage and risk group.
Yes — in two directions. Men who have had testicular cancer have a higher baseline rate of fertility problems due to shared underlying testicular dysgenesis (the same developmental abnormality that predisposes to both). Chemotherapy, particularly with alkylating agents, can impair spermatogenesis in the remaining testicle for months to years — in some cases permanently. This is why sperm banking before any treatment is essential for men who wish to preserve fertility options. Many men do successfully father children after testicular cancer treatment — but sperm banking before treatment removes the uncertainty.
KIMS Secunderabad — Dr. Neil Narendra Trivedi (MCh Urology KEM Hospital Mumbai, Member SIU), Dr. Likhiteswer Pallagani (Vattikuti Foundation uro-oncology fellowship, 400+ robotic and laparoscopic cases), same-week urgent ultrasound, radical orchiectomy, sperm banking coordination, tumour marker monitoring, and coordination with oncology for chemotherapy and radiotherapy protocols. Multidisciplinary tumour board review of every case. NABH and NABL accredited.