Testicular Cancer

Reviewed by Mr Neil Haldar – August 2026

I am a consultant urological surgeon specialising in the diagnosis and surgical treatment of testicular cancer. I perform radical orchidectomy and provide comprehensive care from initial scrotal ultrasound through to coordination of chemotherapy and long-term surveillance, working closely with oncology colleagues at the Thames Valley Cancer Network. I see patients privately at several locations across Buckinghamshire, Oxfordshire, Berkshire, West Hertfordshire, and London.

If you have found a testicular or scrotal lump but have not yet had an ultrasound or diagnosis, see my Rapid Access Scrotal Lumps Clinic.

GMC: 3683914 | BUPA Platinum Consultant | MBBS MD FRCS (Eng) FRCS (Urol)

“Testicular cancer is one of the most treatable cancers. More than 95% of men survive for at least five years overall, and outcomes are particularly good when disease is diagnosed at an early stage. Any new lump, change in size, heaviness or discomfort in a testicle should be assessed within days, not weeks. Most lumps are not cancer, but the ones that are need immediate attention.”

Diagnosis, treatment and what to expect

Testicular cancer mainly affects younger men and is most common between the ages of 15 and 49, with incidence highest in men aged 30–34. However, it can occur at any age. It is also one of the most treatable cancers, with cure rates exceeding 95% when caught at an early stage. Despite this, many young men delay seeking help out of embarrassment or anxiety. If you have found a lump or change in a testicle, please do not wait. Early assessment is quick, straightforward, and in most cases will provide reassurance.

Any new lump, swelling, heaviness or change in a testicle should be assessed urgently. Most testicular lumps are not cancerous, but the ones that are need prompt treatment. Please do not delay seeking assessment.

How common is testicular cancer?

Approximately 2,300 men are diagnosed with testicular cancer in the UK each year. It accounts for just 1% of all cancers in men, but is significant because it predominantly affects young men at the peak of their lives. The good news is that testicular cancer is highly sensitive to treatment, and the majority of men are cured, including many with advanced disease.

Risk factors

• Undescended testis (cryptorchidism) — the most significant risk factor, even if surgically corrected in childhood

• Family history of testicular cancer in a first-degree relative

• Previous testicular cancer in the other testis

• Caucasian ethnicity — testicular cancer is more common in white men than in other ethnic groups

The majority of men who develop testicular cancer have none of these risk factors. Any man who notices a change in a testicle should seek assessment regardless of whether he considers himself at risk.

Symptoms

• A painless lump or swelling in one testicle — the most common presentation

• A feeling of heaviness or dragging in the scrotum

• A dull ache in the lower abdomen, back, or groin

• A sudden collection of fluid in the scrotum

• Tenderness or change in texture of a testicle

It is important to note that testicular cancer is often painless in its early stages. The absence of pain does not mean a lump is benign. Any new or unexplained change should be investigated.

Sudden severe testicular pain is different from a painless lump. Attend A&E immediately because testicular torsion is a surgical emergency.

If you have any new testicular lump, swelling or unexplained change, arrange prompt assessment through my Rapid Access Scrotal Lumps Clinic.

Diagnosis

Scrotal ultrasound

Ultrasound is the first-line investigation for a suspected testicular mass and can usually establish whether a lump is within the testicle or arises from a benign structure around it. Suspicious intratesticular abnormalities require specialist assessment

Blood tumour markers

Blood tests for AFP (alpha-fetoprotein), beta-hCG (human chorionic gonadotrophin), and LDH (lactate dehydrogenase) are performed before any surgery. These markers are elevated in many testicular cancers and are used for diagnosis, staging, monitoring response to treatment, and detecting recurrence. Importantly, normal markers do not exclude cancer.

CT scan

CT of the chest, abdomen and pelvis is used for staging when testicular cancer is diagnosed or strongly suspected, looking particularly for lymph-node and distant spread.

Staging

Once testicular cancer is confirmed following orchidectomy, staging determines whether the cancer has spread beyond the testis:

• Stage 1: Cancer confined to the testis. Treated by orchidectomy followed by surveillance, radiotherapy or chemotherapy depending on tumour type. Highly curable.
• Stage 2: Spread to retroperitoneal lymph nodes. Treated with chemotherapy or radiotherapy. Still highly curable.
• Stage 3: Spread to distant lymph nodes or organs. Treated with platinum-based chemotherapy. Cure rates remain excellent even at this stage.

Testicular cancer is unusual among cancers in that it remains highly curable even at advanced stages — this is why prompt diagnosis and treatment are so important.

Types of testicular cancer

Germ cell tumours

The great majority of testicular cancers — over 95% — arise from germ cells (the cells that produce sperm). They are divided into two main types:

• Seminoma: Tends to occur in men aged 25–45. Grows more slowly and is exquisitely sensitive to radiotherapy and chemotherapy. Excellent prognosis even in advanced disease.

• Non-seminoma (including teratoma, embryonal carcinoma, yolk sac tumour, and choriocarcinoma): Tends to occur in younger men aged 15–35. Grows more quickly but responds very well to platinum-based chemotherapy. Mixed tumours containing both seminoma and non-seminoma elements are treated as non-seminoma.

Other types

Rarer testicular tumours include Leydig cell tumours and Sertoli cell tumours. These are usually benign and may be managed with testis-sparing surgery in selected cases.

Treatment

Radical orchidectomy

The standard initial treatment for suspected testicular cancer is surgical removal of the affected testicle — a radical orchidectomy. This is performed through a small groin incision (not the scrotum) under general anaesthesia and takes approximately 30–45 minutes. Most patients go home the same day or after one night.

The removed testicle is sent for histological analysis to confirm the diagnosis, determine the tumour type and grade, and assess whether the tumour has invaded local blood or lymphatic vessels — a key factor in staging and subsequent treatment decisions.

A testicular prosthesis — a silicone implant matching the size of the natural testicle — can be inserted at the time of orchidectomy or at a later date if desired. I discuss this option with every patient before surgery.

Removing one testicle does not affect masculinity, libido, or the ability to father children in the vast majority of cases. The remaining testicle produces sufficient testosterone and sperm. I discuss fertility preservation, including sperm banking, with all patients of reproductive age before treatment begins.

Treatment options after surgery

Surveillance

For Stage 1 seminoma and Stage 1 non-seminoma (cancer confined to the testicle with no spread detected), active surveillance after orchidectomy is an evidence-based option. This involves regular clinical review, tumour marker tests, CT scanning, and chest X-rays at defined intervals. The majority of Stage 1 patients are cured by orchidectomy alone, and surveillance avoids unnecessary additional treatment in those who are not destined to relapse.

Radiotherapy

Radiotherapy now has a more limited role in testicular cancer than historically. It may be used in selected seminoma cases, particularly some Stage II disease, but routine adjuvant radiotherapy after orchidectomy for Stage I seminoma is generally avoided because of long-term treatment risks.

Chemotherapy

For Stage I non-seminoma, many men can be managed with surveillance after orchidectomy. In men at higher risk of relapse, particularly where lymphovascular invasion is present, one cycle of Platinum-based chemotherapy (BEP — bleomycin, etoposide, cisplatin) may be discussed as an alternative. Testicular cancer is one of the most chemotherapy-sensitive solid tumours known, and a cure is achievable even in patients with extensive metastatic disease. I work closely with oncology colleagues at the Thames Valley Cancer Network to coordinate chemotherapy planning for all my patients.

Retroperitoneal lymph node dissection (RPLND)

Surgical removal of the retroperitoneal lymph nodes. Used in selected patients with residual lymph node masses after chemotherapy, or as an alternative to chemotherapy in certain Stage 2 non-seminoma presentations. Where RPLND is indicated, I coordinate referral to an appropriate specialist germ-cell tumour centre.

Fertility and sperm banking

I discuss sperm banking with all men before treatment for testicular cancer, particularly those who may wish to have children in the future. This is a straightforward process that provides insurance against any impact of treatment on fertility. Even men with a single testicle and normal fertility should consider banking, as subsequent treatment if relapse occurs may affect the remaining testicle.

Follow-up

Testicular cancer requires structured long-term follow-up regardless of the treatment received. This involves regular clinical review, blood tumour markers, and CT or MRI scanning at intervals determined by tumour type, stage, and treatment. The intensity of follow-up is greatest in the first two years after treatment, when the risk of relapse is highest, and gradually reduces over time. Most relapses, if they occur, are detected during follow-up and remain highly treatable.

Self-examination

Men should be familiar with what is normal for their own testicles and seek assessment promptly if they notice a new lump, enlargement or change in texture. Regular self-examination is particularly worthwhile for men at increased risk, including those with a history of undescended testis or a personal or family history of testicular cancer.

Self-examination can be performed after a warm bath or shower — when the scrotal skin is relaxed — and is a simple habit that can lead to earlier diagnosis.

• Gently hold the scrotum in both hands and examine each testicle separately

• Feel for any hard lumps, changes in size, shape or texture, or areas of tenderness

• The epididymis — a soft, rope-like structure at the back of each testicle — is normal and should not be confused with a lump

• If you notice any change, seek assessment promptly — do not wait to see if it resolves

Frequently asked questions

Useful resources

• The Pelvic Specialists: Please read my patient information articles on testicular cancer:
• Testicular Cancer – commonly asked questions
• Testicular Cancer and Fertility: What You Need to Know

• Testicular Cancer UK

• Cancer Research

• Macmillan Cancer Support

Why choose Mr Neil Haldar

• Specialist consultant urological surgeon with over 20 years of experience
• Urgent appointments available for testicular lumps
• Scrotal ultrasound arranged promptly
• Radical orchidectomy performed as a day case
• Testicular prosthesis offered at the time of surgery or later
• Sperm banking discussed with all patients before treatment
• Coordinated MDT care with oncology for chemotherapy planning
• Private clinics in several locations

Experience and qualifications

Patient reviews

Private hospital and clinic locations

I am recognised by all major private health insurers, including Bupa, AXA Health, Aviva, Cigna, Vitality Health, WPA and Standard Life. I also welcome self-funding patients. For urgent assessments, please call 07841 048975 directly