Testicular cancer

Testicular tumor, testicular carcinoma, germ cell tumor

Testicular cancer mainly affects younger men aged 15 to 45. In this age group, testicular cancer is the most common malignant tumor disease. According to the Swiss Cancer League, almost 500 men are diagnosed with testicular cancer every year. However, testicular carcinoma can usually be cured if detected early. For this reason, every man from puberty onwards should regularly palpate his testicles for hardening and consult a doctor immediately if they increase in size.

What is testicular cancer?

The two testicles are located in the scrotum and have the function of producing sperm as well as the male hormone testosterone. Different types of testicular cells take on certain tasks and can degenerate. In the vast majority of cases, only one testicle is affected; it is very rare for both testicles to be affected at the same time. A testicular tumor can also rarely develop outside the testicle in the abdomen or chest (so-called extragonadal tumor). This is the case in 3 to 5% of patients.

Histological subtypes of testicular tumors

In most cases, germ cells, i.e. the cells that produce sperm, form the starting point of the tumor. Accordingly, testicular tumors are also known as germ cell tumors. There are two main groups of germ cell tumors:

  • Seminoma – the most common form of testicular cancer is caused by altered sperm stem cells.
  • Non-seminoma – germinative tumors of various cell types, which are designated accordingly, such as yolk sac tumor, chorionic carcinoma, embryonal cell carcinoma, teratoma and others.

Non-germinal tumor

All other forms of testicular cancer are referred to as non-germinal as opposed to germinal. These are formed from connective tissue cells in the testicles. The very rare non-germinal tumors are usually benign.

Testicular cancer: causes and risk factors

Not everything about the development of testicular cancer has been researched so far. For example, the causes of a testicular tumor are often unknown. However, one knows:

  • The fact that undescended testicles (in around 2% of newborns) are considered the most important risk factor means that the testicles have not moved into the scrotum after birth. This increases the risk of testicular cancer by up to 20 percent.
  • There is a genetic component, so if the father already had testicular cancer, the son has an increased risk.
  • that the predisposition to develop a malignant germ cell tumor can already be determined prenatally. Increased estrogen levels in the mother can play a role here. They cause the germ cells in the embryo to change and many years later the affected person develops testicular cancer.

Symptoms: Not only the palpable hardening of the testicles

The most common symptom is a usually painless, palpable change or enlargement in one of the testicles, sometimes associated with a feeling of heaviness or pulling.

Symptoms that can occur with more advanced, already metastasized testicular tumors are

  • Back pain
  • Headache
  • Shortness of breath
  • Fatigue
  • Gynecomastia (development of breasts in men)

If the above symptoms occur, a doctor should be consulted immediately for further diagnosis.

Diagnosis of testicular cancer

First, your medical history will be taken (anamnesis interview). During the subsequent physical examination, both testicles are first palpated manually. This is usually followed by an ultrasound of the testicles.

Testicular sonography

The subsequent ultrasound examination, testicular sonography, provides more precise details. It clearly shows changes in the tissue. Ultrasound can also be used to quickly and painlessly examine the neighboring lymph nodes and the abdominal cavity to determine whether the tumor has already spread.

Determination of tumor markers

In addition, a blood test may show elevated markers in the blood

  • Beta-human chorionic gonadotropin (beta-HCG) – the normally female pregnancy hormone
  • Alpha-fetoprotein (AFP)
  • Lactate dehydrogenase (LDH)

The markers beta-HCG and AFP are often elevated. An elevated HCG value alone can prove testicular tumor disease. AFP is never elevated in a seminoma. All 3 markers can be elevated in a non-seminoma.


To assess whether a testicular tumor has already spread, cross-sectional imaging of the lungs and abdomen is always carried out using computer tomography (CT) and/or magnetic resonance imaging (MRI). A PET scan has no place in the initial diagnosis of testicular tumors. An examination of the bones or the head is not obligatory and is only carried out if there are symptoms or if the disease is very advanced (very high tumor markers, very extensive metastases).

Testicular cancer: prevention, early detection, prognosis

Early detection is important. This is because treatment for testicular cancer is extremely successful, especially if the tumor is detected early. Regular self-examination of the testicles is therefore recommended from the age of 15. Men should carefully feel their testicles about once a month, for example when showering. Warm water softens and relaxes the skin of the scrotum, making it easier to feel the testicles.

Progression and prognosis for testicular cancer

The cure rate for testicular cancer is very high at more than 95 percent, regardless of the initial tumor stage. As with other types of cancer, the prognosis is particularly favorable if the cancer is detected early, i.e. before it has metastasized. However, a cure can also be achieved in many cases if the tumor has already spread.

The diseased testicle must always be removed. Libido, potency and fertility are usually maintained even with only one testicle for the man. This is because the second testicle produces sufficient sperm and testosterone. If the testosterone level nevertheless drops, or if both testicles are affected, this can be compensated for with appropriate testosterone substitution.

If chemotherapy is required for treatment, sperm must be collected and stored by cryopreservation before starting treatment in patients who have not yet completed their family planning. All patients must be informed about this option before starting therapy.

Testicular cancer: treatment with surgery, chemotherapy and radiotherapy

An important first step in treatment is usually surgery (orchiectomy), which is often already a therapy for patients in so-called stage I (only the testicle is affected, no metastases present).

In the more advanced stages with the presence of metastases (stage II – metastases in the abdomen and stage III – metastases in the lungs or other organs), chemotherapy is the treatment of choice. In the case of stage II seminoma (lymph node metastases in the abdomen), radiotherapy may also be necessary as an alternative. In the case of non-seminomas, surgery must be performed after chemotherapy if there are tumor remnants larger than 1 cm (so-called residual tumor resection). Only then is the treatment complete and regular aftercare can begin.