Last updated:
12/23/2025
Years published: 2019, 2025
NORD gratefully acknowledges Liang Cheng, MD, Virgil H. Moon Professor of Pathology and Urology, Director of Molecular Diagnostics and Molecular Pathology Laboratory, Chief of Genitourinary Pathology Division, Director, Fellowship in Urologic Pathology, Indiana University School of Medicine; and Gioconda Alyea, MD (FMG), MS, National Organization for Rare Disorders, for the preparation of this report.
Testicular cancer is a relatively uncommon cancer that begins in the testicles. The testicles are two small, egg-shaped glands inside the scrotum, the loose pouch of skin beneath the penis. They make sperm and male hormones. Inside the testicles are germ cells, which develop into sperm through a process called spermatogenesis, an essential step for fertility.1, 2, 3
Most testicular tumors first appear as a firm, painless lump or swelling. Some people may notice a dull ache, a feeling of heaviness, or tenderness. Less common symptoms include sudden pain, breast changes, or back pain. In about one in ten cases, symptoms may not appear until the cancer has spread. These symptoms can include a lump in the neck, trouble breathing, bone pain, nausea, weight loss, or gastrointestinal bleeding.1, 2, 3
According to the National Cancer Institute, testicular cancer is considered a rare cancer in the United States. A cancer is considered rare when it affects fewer than 15 out of every 100,000 people each year. Testicular cancer is diagnosed at a rate of about 6.4 per 100,000, well below that mark.
Once a solid testicular tumor is identified, radical surgery to remove the testicles (called an inguinal orchiectomy) is usually performed. This surgery is done both to confirm the diagnosis and for treatment purposes. Tumor staging helps guides further treatment. Options may include active surveillance, chemotherapy, retroperitoneal lymph node dissection, and radiation therapy. 3
With effective management, the prognosis is excellent, with more than a 90% cure rate, and five-year survival rates above 95%.3
Approximately 95% of testicular cancers are germ cell tumors.4, 5, 6 Germ cells are the cells that develop into sperm in males and eggs in females.4, 6 Most germ cell tumors develop in the testes or ovaries (called the gonads), but they can also occur in the lower back.4, 6 When germ cell tumors occur outside of the gonads, they are called extragonadal tumors.6
Testicular germ cell tumors are generally split into two main subtypes: seminomas and nonseminomatous germ cell tumors (NSGCTs).7 NSGCTs are sometimes referred to as nonseminomas.7 Each type accounts for about 50% of testicular germ cell tumors. There are several different types of nonseminomas, including choriocarcinoma, yolk sac tumor, embryonal carcinoma, and teratoma. 4, 7
About 5% of people develop non-germ cell tumors, such as lymphoma involving the testicles or a sex cord-stromal tumors, which arise from the supportive tissues of the testicles.6, 7
Germ cell tumors (the most common group)
Stromal tumors (also called gonadal stromal tumors)
The first sign of a testicular tumor is often a firm, painless bump (a nodule, meaning a small abnormal lump) or swelling of one testicle. 6, 8- 10
Other possible early symptoms include: 1, 2, 6, 8-10
In about 10% of individuals, the first signs of testicular cancer appear after the cancer has spread (metastasized) beyond the testicle. Symptoms of metastasis vary depending on where the cancer spreads and may include: 6, 9, 10
The exact cause of testicular cancer is not fully understood, and researchers think that multiple factors are involved in its development. These factors can include genetic, environmental, infectious, and immunologic factors (differences in how a person’s immune system functions, including how well it can detect and respond to abnormal or damaged cells).4, 11 In most people, testicular cancer develops randomly without a family history (sporadically).4, 6, 11
Cancer involves abnormal, uncontrolled cell growth that forms a tumor. These cancer cells can invade nearby tissues and may spread (metastasize) to distant parts of the body through the bloodstream or lymphatic system. In most people with testicular cancer, the cancer arises in germ cells.4, 6, 11
Although the exact causes and genetic aspects of testicular cancer are not fully understood, researchers have identified several risk factors. A risk factor is anything that increases a person’s chance of developing a condition. However, having a risk factor does not mean a person will develop that condition, and people who do not have any risk factors can still develop a condition.4, 11
Known and suspected risk factors of testicular cancer include: 4, 6, 8, 11,12
Testicular cancer is more common in men between 15–35 years of age.4, 6, 11 It occurs more often in Caucasian individuals than in African or Asian Americans.4, 11 According to the Division of Cancer, Epidemiology & Genetics of the National Cancer Institute, rates of testicular cancer are rising fastest among Hispanic men, who are projected to have the highest incidence of testicular cancer among any ethnic group in the United States by 2026.
Genetic factors may also play a role in the development of cancer. When certain genetic changes (called variants) are found more often in people with a specific type of cancer, this is known as a genetic predisposition.4, 5 A genetic predisposition means that a person has genetic changes that increase risk, but the disease usually develops only if other genetic or environmental factors are also involved.
Many germ cell tumors are characterized by extra copies of part of chromosome 12, called chromosome 12p (also known as isochromosome 12p). 4, 12
Chromosomes are structures inside cells that carry genetic information. Humans normally have 46 chromosomes. Pairs of human chromosomes are numbered from 1 through 22, and the sex chromosomes are designated X and Y. Males have one X and one Y chromosome, and females have two X chromosomes.
Each chromosome has a short arm designated “p” and a long arm designated “q” and a narrowed region at which the two arms are joined (centromere). An isochromosome is an abnormal chromosome in which both arms on either side of the centromere are the same.
In certain cases of testicular cancer, there is duplication of the short arm (p) of chromosome 12.4, 12 Some researchers believe this duplication may disrupt normal gene activity and cause germ cells to remain in an immature state, known as gonocytes. This may allow genes that are normally active only during early development to remain switched on when they should not be, which can promote abnormal cell growth and tumor development.4, 12
Changes (variants) in single genes are uncommon in testicular cancer, but they have been reported.²
The genes that are most commonly altered in germ cell tumors are KIT, TP53, KRAS/NRAS, and BRAF. KIT, KRAS/NRAS, and BRAF are oncogenes, meaning genes that normally help control cell growth but can drive cancer when altered.² TP53 is a tumor suppressor gene, which normally helps control cell division and prevents damaged cells from surviving.5
The underlying genetic factors associated with testicular cancer are very complex, and more research is necessary for doctors to figure out all the genetic interactions that contribute to the development of these tumors.4, 5, 7, 12
Testicular cancer is an uncommon form of cancer and accounts for only 1% of all cancers in men.4, 6, 9 However, it is the most common form of cancer in men between the ages of 15 and 35. Approximately 9,720 men are diagnosed with testicular cancer each year in the United States.8, 13 The National Cancer Institute’s Surveillance, Epidemiology and Ends Results (SEER) Program provides updated information on testicular cancer rates.
Testicular cancer is diagnosed based on identification of characteristic symptoms, a detailed patient and family history, a physical exam, and specialized tests. 6, 9, 10, 14
It may first be suspected because of a small bump or swelling in or on one of the testicles. Prompt diagnosis and early treatment is essential in treating testicular cancer.6, 7, 9, 10
CLINICAL TESTING AND WORKUP
If testicular cancer is suspected, the first diagnostic step is usually a scrotal ultrasound. An ultrasound uses reflected sound waves to create images of internal organs and surrounding structures, and it is especially effective at detecting small or superficial areas of cancer. A scrotal ultrasound can identify a small bump or mass in the testicle and can also detect microlithiasis, a common finding in which tiny calcium deposits build up inside the testicles. Although some studies have found a link between microlithiasis and testicular cancer, no direct causal relationship has been established.7, 10, 14
Routine blood tests are also performed to measure serum tumor markers. A tumor marker is a chemical substance that becomes elevated in the blood, urine, or tissues when certain types of cancer are present. The tumor markers commonly used in evaluating testicular cancer include alpha-fetoprotein (AFP), the beta subunit of human chorionic gonadotropin (beta-hCG), and lactate dehydrogenase (LDH). Abnormal levels of these markers can support the diagnosis, but they are not definitive on their own.7, 10, 14
A confirmed diagnosis requires the surgical removal of the affected testicle, a procedure known as a radical orchiectomy. This surgery also serves as the first step in treatment for testicular cancer. In certain cases, a partial orchiectomy may be performed to spare part of the testicle.7, 10, 14
Additional imaging tests may be used to assess whether the cancer has spread. A chest x-ray may be ordered to look for spread to the lungs. Computerized tomography (CT) scanning, which uses x-rays and computer processing to create cross-sectional images of internal structures, can reveal cancer in the abdomen or pelvic regions.7, 10, 14
STAGING
After making a diagnosis of testicular cancer, assessment is also required to determine the extent or “stage” of the disease. Staging helps doctors understand how far the cancer has spread and choose the appropriate treatment. A variety of diagnostic tests may be used in staging testicular cancer (e.g., blood tests, CT scanning).7, 10, 14, 15
Testicular cancer can be staged by the American Joint Committee on Cancer (AJCC)/the Union for International Cancer Control (UICC) system, which is based on the tumor, node, and metastasis (TNM) classification system. 7, 10, 14, 15
As the stage number goes up, the cancer is more advanced and may involve larger lymph nodes, more lymph nodes, or other organs.
The American Cancer Society has updated information about the staging system for testicular cancer.15, 16
Treating testicular cancer often involves a team of healthcare providers, including physicians who specialize in the diagnosis and treatment of diseases of the urinary system (urologists), physicians who specialize in the diagnosis and treatment of cancer (medical oncologists), physicians who specialize in the diagnosis and treatment of cancer with surgery (surgical oncologists), physicians who specialize in the use of radiation therapy for treatment of cancer (radiation oncologists), oncology nurses, psychiatrists, nutritionists, and other healthcare specialists. Psychosocial support for the entire family is essential as well. 7, 10, 14
Specific therapeutic procedures and interventions may vary, depending on numerous factors such as disease stage, tumor size, specific testicular cancer subtype (e.g., seminoma versus nonseminomatous germ cell tumor), degree of elevation of tumor serum markers, whether the cancer has spread to other areas of the body, an individual’s age and general health, or other elements. 7, 10, 14
Treatment decisions are made by the healthcare team in close discussion with patient, taking into account the potential benefits and risks, including possible side effects and long-term effects, and patient preferences. 7, 10, 14
Treatment options include surgery to remove the testicle, radiation therapy, chemotherapy, careful monitoring without immediate treatment (surveillance), and in some cases high-dose chemotherapy followed by a stem cell transplant.
New treatments are also being studied in clinical trials, which patients may join before, during, or after their standard treatment. All treatments can cause side effects, so patients are monitored closely throughout care. Follow-up tests are important because they help doctors assess how well treatment works, detect whether the cancer has come back, and monitor the remaining testicle, which carries a slightly higher risk for future cancer. 17
Treatment recommendations vary by stage: 7, 10, 17
Throughout care, affected people are encouraged to ask about clinical trials (see below), which help advance treatment and may offer additional options.
Whenever possible, a baseline sperm count and sperm banking should be offered before treatment begins, since therapy can affect fertility. A baseline is a starting measurement used for comparison over time. This means sperm levels are measured before therapy, and this baseline value is compared to levels during and after treatment. Sperm banking, also known as cryopreservation, is when the sperm is collected, frozen, and stored in case affected individuals want to use the sperm in the future. 7,10
Testicular cancers are among the most curable solid tumors. Germ cell tumors (GCTs) account for 95% of testicular cancers. For treatment purposes, testicular GCTs are divided into two groups: pure seminoma and nonseminomatous germ cell tumors (NSGCTs). 7, 10, 17
For metastatic disease, seminomas are classified into good- and intermediate-prognosis groups; only nonseminomas are placed into poor-prognosis groups when disease is very advanced or tumor markers are very high.
Treatment options for recurrent testicular cancer may include: 17
The National Cancer Institute has updated and detailed information about the testicular cancer treatment in two versions:
Information on current clinical trials is posted on the Internet at https://clinicaltrials.gov/. All studies receiving U.S. Government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Toll-free: (800) 411-1222
TTY: (866) 411-1010
Email: [email protected]
Some current clinical trials also are posted on the following page on the NORD website:
https://rarediseases.org/living-with-a-rare-disease/find-clinical-trials/
For information about clinical trials sponsored by private sources, contact:
https://www.centerwatch.com/
For information about clinical trials conducted in Europe, contact:
https://www.clinicaltrialsregister.eu/
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