Testicular Carcinoma

Testicular carcinoma refers to cancer that occurs in the male reproductive gonads or testicles (or testes) located in the scrotum. Testicles perform the function of producing and storing sperm and is the source of the male reproductive hormone, testosterone. There are different types of cells in the testes and the type of cancer depends on the kind of cells that become cancerous.  

Types of testicular cancer 

Testicular cancers can be broadly classified as:

Germ cell tumors and Stromal tumors

  • Germ cell tumors: This type of testicular cancer involves the germ cells of the testicles, which produce sperms. It accounts for 90-95 % of all forms of testicular cancer.
  • Stromal tumors: This type of testicular cancer involves the stroma of testicles. The stroma is the supportive and hormone-producing tissues in the testicles.

Classification of germ cell tumors:

Seminomas: It originates in the sperm producing germ cells. There can be several types of seminomas. These are the following:

i) Classical: It is the most frequent type of seminoma (95 % of seminomas). Mostly occurs in the men in their 40s.

ii) Spermatocytic: It is a rare type occurring in men over 50 years old.

iii) Anaplastic: It is a very aggressive form of seminoma.

Non-seminoma carcinomas: This type of testicular cancer originates in cells, which are more mature than the seminomas. It mostly occurs in men in mid-30s. These are of the following types:

i) Embryonal carcinoma: In most cases, it is found with different types of germ cell tumors. Rarely a pure form of embryonal carcinoma may be detected. It has the tendency to grow fast and spread to nearby tissues and organs.

ii) Choriocarcinoma: This rare form of testicular cancer is very aggressive and occurs in young men. They spread fast to distant organs in the body. They are mostly detected in a mixed type of carcinoma. A pure form of this type rarely occurs.

iii) Yolk sac carcinoma: This cancer originates in cells, which resemble the yolk sac of early embryo. It is named according to its appearance. It frequently occurs in children.

iv) Teratoma: These tumors may have only one kind of cell (pure form) or mixed with different types of germ cells. They are of various types: mature teratoma, immature teratoma, and teratoma with malignant transformation. 


Testicular cancer accounts for only 1-2% of all tumors in men. Young men between the ages of 20 and 39 are mostly affected by this disease. Incidence of testicular cancer is increasing in most countries over the past four decades. Testicular cancer is most frequent among men in Nordic countries while least frequent among men in the Middle East and Asia.

Causes or Risk factors

The exact causes of testicular cancer are not known. Several factors increase a man’s risk of developing the disease and these include the following:

Undescended testicle (cryptorchidism): is the condition in which the testicles fail to descend from the abdomen to the scrotum during birth. Failure of the testicles descending into the scrotum increases the risk of the disease.

Congenital abnormalities involve men who developed abnormal testicles or penis that may also increase the risk factor.

History of cancers Men who developed testicular cancer in the past may experience higher risk of recurrence.

Family history: The risk also increases in men if his father or brother had the disease in the past.

Symptoms of testicular cancer

  • Painless lump
  • Pain in the scrotum
  • Enlarged testicle
  • Collection of fluid in the scrotum
  • Other symptoms may also include fever, tender breasts and nipples, and swelling in the scrotum. Most men can detect any unusual changes by performing testicular cancer self-exam on their own. 


  • Physical exam: Lumps can be felt by examining the testicles. Swelling of the testicles and tenderness can also be detected physically.
  • Ultrasound imaging: This procedure with sound waves gives an image of the internal parts on a computer screen. This technique is most often used to detect lumps and swellings in testicles.
  • Blood tests: Certain tumor marks like alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) when present in abnormal levels in the blood can give an indication of testicular cancer. If both these markers are high in the blood then it most often indicates non-seminomas, whereas if only HCG levels increase then it indicates seminomas.
  • Chest X ray: The chest x-ray remains probably the most valuable tool in diagnosing whether       cancer has spread to other organs.
  • CT scan: The CT scan is a procedure by which images of the internal organs of the body can be obtained with a help of x-rays. A contrasting dye is injected in the veins so that the images are clearly understood. The images can be viewed with the help of a computer.
  • MRI scan: This imaging procedure is based on the use of radiowaves in the presence of a magnet. The images produced can be viewed with the help of a computer attached to the machine.
  • Lymphangiogram: This imaging technique is based on injection of a radioactive dye in blood and imaging of the lymph nodes and lymph vessels.
  • PET scan: The PET scanner is an imaging technique, which helps to find out the spread of the disease.
  • Biopsy: Cells or tissues removed from the affected tissue are examined under a microscope in the laboratory to check for signs of cancer.


Surgery: The affected testicle can be removed through an incision made in the groin. This kind of surgery is called radical inguinal orchiectomy. Surgery is mainly done to remove seminomas when detected at an initial stage (Stage I).  Removal of a single testicle does not make a man impotent or interferes with fertility. Cosmetic surgeries can be done in which an artificial testicle can be placed in the scrotum after removal of the affected testicle. Further Retroperitoneal lymph node dissection is also done to remove lymph nodes located in the abdomen.

Radiation therapy: High-energy rays are used to kill cancer cells and reduce the size of testicular tumors. This can be done in two ways:

External radiation therapy: Radiation is given by a machine from outside the body at the affected region.

Internal radiation therapy: Radioactive substance sealed in a needle or wire is placed near the larynx. Radiation emitted from this radioactive substance kills the cancer cells.

It is usually given after surgery to treat seminomas. Because nonseminomas are less sensitive to radiation, men with this type of cancer usually do not undergo radiation therapy.

Radiation therapy interferes with sperm production, but many patients regain their fertility over a period of 1 to 2 years.

Chemotherapy: Chemotherapy is the use of anticancer drugs to treat cancer. It is used as an adjuvant therapy (after surgery) to kill cancer cells. Chemotherapy may be the initial option to treat cancer at an advanced stage. Most anticancer drugs are given by injection into a vein.

Some anticancer drugs interfere with sperm production. Although the reduction in sperm count is permanent for some patients, many others recover their fertility. High doses of chemotherapy are required at advanced stages, but this can affect the bone marrow cells.


The 5-year relative survival rate for all men with this cancer is 90-95% regardless of stage. Metastatic testicular cancer patients have a survival rate of 85 %. Therefore, chances of survival are very good for testicular cancer patients even at an advanced stage.


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  6. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.