Testicular cancer: Signs, symptoms and treatments

Published August 2024 | 5 min read 
Expert contributors Manish Patel, professor of urological oncology at the University of Sydney; Professor Kate Loveland, head of the Testis Development and Male Germ Cell Biology research group at the Hudson Institute of Medical Research 
Words by Angela Tufvesson 

Testicular cancer may be the second most common cancer in young men, but it’s also one of the most treatable. That's why it’s important to see your GP if you notice any symptoms.  

Tom Haddon was just 24 when he found out he had testicular cancer. He’d always been proactive about checking his testicles and following up with a doctor if something didn’t seem right. “And something didn’t quite feel right, so I went to my local GP,” says Tom.  

Testicular cancer isn’t common and affects around 1,000 Aussie men each year, compared with more than 24,000 diagnoses of prostate cancer annually. While testicular cancer can occur at any age, it’s the second most common cancer in young men (19 to 40 years), and, like Tom, most men are diagnosed in their 20s and 30s.  

Two weeks after his diagnosis, Tom had surgery to have his testicle removed and a prosthetic testicle fitted. Thankfully, the cancer hadn’t spread and he didn’t need chemotherapy.  

Testicular cancer has one of the highest survival rates of any cancer apart from skin cancer. 
“The big message is it's highly curable if you examine your testicles,” explains Manish Patel, a professor of urological oncology at the University of Sydney. 

What does testicular cancer look like?

Testicular cancer develops in the cells of a testicle – one of two oval glands that sit behind the penis in a pouch of skin called the scrotum. Usually only one testicle is affected, but in some cases both testicles are affected.

Anyone with a testicle can get testicular cancer, including those who are transgender, male-assigned non-binary or intersex.

An estimated 90 to 95% of testicular cancers start in the cells that develop into sperm. These are called germ cell tumours and there are two main types.

• Seminoma tumours, which tend to develop slowly and usually occur between the ages of 25 and 50.
• Non-seminoma tumours, which usually develop more quickly and are more common in younger people in their early 20s.

“It’s very much a young man's disease,” says Prof Patel. “It's very rare for a 60-year-old to be diagnosed with testicular cancer.”

Signs of testicular cancer

The most common signs of testicular cancer are a painless swelling, a lump in a testicle and a change in the size or shape of your testicles, while less common symptoms include:

• a feeling of heaviness in the scrotum
• feeling that your testicles are uneven
• aches and pains in your testicles, scrotum, stomach or back.

Prof Patel recommends seeing your GP if you notice any changes to your testicles. “Usually, testicular cancer doesn't cause any symptoms apart from a lump.”

He says it can feel like an awkward topic to discuss, but it’s important to understand that your GP has genuinely seen it all before. “The number of men I’ve seen come in with testicles the size of tennis balls – people will just hang on,” says Prof Patel. “Going to the doctor can be lifesaving.”

There’s no routine screening program for testicular cancer in Australia. Prof Patel recommends self-checks from around the age of 14 to 16. You can perform them in the shower by rubbing each testicle between your thumb and fingers.

Testicular cancer risk factors

The incidence of testicular cancer has been rising around the world for the past 50 years.

Certain factors may increase the risk. Prof Patel says undescended testicles – when the testicles don’t move down into the scrotum within the first six months of life – and a family history are the most significant.

“Risk factors don't play a huge role in testicular cancer,” he says, “but if you're born with a testicle that's high, you’re at higher risk, and family history – like a father or brother who’s had it – has a little bit of a role.”

The specific causes of testicular cancer are unknown. Professor Kate Loveland, head of the Testis Development and Male Germ Cell Biology research group at the Hudson Institute of Medical Research, says it’s believed the first signs of testicular cancer may occur in the foetus when something happens that stops cells in the testicles from maturing normally.

“There’s an exposure in foetal life that renders the testes sensitive to developing a tumour later on after puberty,” she says, explaining that these exposures may be environmental and include things like infection and pre-eclampsia during the mother’s pregnancy.

Crucially, Prof Loveland says, “there are no clear lines that say this is the thing that drives testicular cancer”.

“You can't reduce the risk,” she says. “The idea is that men need to be aware that they may be at risk.”

Testicular cancer treatment

The only way to be sure of a testicular cancer diagnosis is to surgically remove the affected testicle and examine it in a laboratory. “It's always possible to put in a prosthesis after the testicle is removed so you can still have two seemingly normal testicles,” says Prof Patel.

If you’d like to talk to another doctor after a diagnosis, eligible HCF members can get a free, confidential second opinion^* from a certified, practising medical specialist based in Australia.

If the cancer hasn't spread beyond the testicle, Prof Patel says further treatment isn’t usually required and doctors will do regular blood tests and CT scans to monitor for any changes. In some cases, you may require chemotherapy and radiotherapy to kill any cancer cells that may have spread to other parts of the body.

Most testicular cancers are successfully treated, and the testicular cancer survival rate at five years is over 95%. “For both types of testicular cancer, there’s a very high chance of cure,” says Prof Patel.

Testicular cancer and infertility

Having one testicle removed won’t usually affect your ability to have children, but there are some links between testicular cancer and infertility – which is noteworthy given it’s usually a young man’s disease.

Prof Patel says that, generally, when someone has a testicular tumour, fertility is usually already reduced even before the testicle is removed. “In addition to the tumour, the rest of the testicle often has changes, so there's a reduction in sperm production,” he explains.

“Chemotherapy can also knock out your sperm count, so it’s recommended to give semen samples beforehand so you’re able to have children with IVF if your sperm count doesn’t recover.”

Do you need to see a doctor?

It’s important to speak to your GP about any abnormal symptoms or risk factors. And if you’d like a second opinion, HCF connects eligible members to a network of independent, Australia-based medical specialists for a free second opinion^* on a health condition you’re worried about. Eligible members have the chance to ask questions so you can confidently make the best decision for your health.