Testicular Cancer

Testicular cancer arises when cells in the testicles, a part of the male reproductive system, become malignant and start to grow uncontrollably. These testicles are responsible for producing both sperm and male hormones, primarily testosterone.

Testicular cancer, while relatively rare, is the most commonly diagnosed cancer in young men, predominantly affecting those between the ages of 15 and 35. Approximately 1 in 250 men will be diagnosed with testicular cancer at some point during their lifetime.

However, with early detection and appropriate treatment, the prognosis is typically favourable, and the survival rate is high.

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Causes and Risk Factors

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    Genetics and Family History

    Men with a close relative (father or brother) diagnosed with testicular cancer are at a higher risk, suggesting a possible genetic component.

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    Age and Race

    While testicular cancer can affect males at any age, it's more commonly diagnosed in young and middle-aged men, particularly between 15 and 35 years. White men are more likely to develop testicular cancer than men of other racial or ethnic backgrounds.

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    Previous Testicular Cancer or Undescended Testicle

    A history of testicular cancer in one testicle increases the risk of developing cancer in the other testicle. Additionally, having an undescended testicle (cryptorchidism), where one or both testicles fail to descend into the scrotum before birth, is a significant risk factor.

Symptoms and Diagnosis

Common Signs and Symptoms

  • Lump or Swelling in the Testicle: Often the first noticeable sign, any lump or enlargement in either testicle should be evaluated.
  • Testicular Pain or Discomfort: While some men may experience a dull ache, others might feel sharp pain or heaviness in the scrotum.
  • Change in Testicle Consistency: A feeling of sudden firmness or a hard area can indicate an abnormality.
  • Fluid Accumulation in the Scrotum: This can cause the scrotum to feel heavy and enlarged.

Importance of Self-examination

Regular self-examination of the testicles is vital. By familiarising oneself with the usual size, shape, and feel, changes can be detected early, leading to prompt medical evaluation.

Diagnostic Procedures

  • Ultrasound: This imaging test uses sound waves to create images of the inside of the testicles. It helps determine if a mass is solid (potentially cancerous) or filled with fluid (likely a benign cyst).
  • Blood Tests: Certain proteins, termed tumour markers, may be elevated in the blood of men with testicular cancer. Blood tests assess levels of these markers, aiding in diagnosis and monitoring.
  • Biopsy: A tissue sample from the suspicious area is removed and examined under a microscope. It’s essential for determining the type and stage of cancer. In many cases, the entire testicle may be removed due to the risk of spreading cancer cells during a traditional biopsy.

Staging of Testicular Cancer

Staging refers to the process of determining the extent and spread of cancer within the body. It plays a pivotal role in guiding treatment decisions and assessing prognosis. By understanding the stage of testicular cancer, clinicians can tailor treatment to the individual, ensuring that it is both effective and appropriate for the patient’s condition.

Stage 0 (Carcinoma in Situ)

At this stage, abnormal cells are present in the testicles, but they haven’t spread to nearby tissues or elsewhere in the body. It might not become invasive; however, monitoring is essential.

Stage I

Cancer is confined to the testicle and hasn’t spread to lymph nodes or distant sites. It is further divided based on the extent of spread within the testicle and to nearby structures:

  • Stage IA: Limited to the innermost layers of the testicle.
  • Stage IB: Extended into the outer layers of the testicle but not beyond its protective membrane.
  • Stage IS: Cancer markers remain elevated post-surgery, suggesting microscopic disease.

Stage II

Cancer has spread to one or more lymph nodes in the abdomen, but not to distant sites. It’s sub-categorised based on the size and number of lymph nodes affected:

  • Stage IIA: Lymph nodes are no larger than 2 cm.
  • Stage IIB: Lymph nodes are larger than 2 cm but less than 5 cm.
  • Stage IIC: Lymph nodes are larger than 5 cm.

Stage III

Cancer has spread beyond the testicles and lymph nodes in the abdomen. It’s differentiated by:

  • Stage IIIA: Cancer has spread to distant lymph nodes or the lungs, but tumour marker levels are moderately raised.
  • Stage IIIB: Tumour marker levels are considerably elevated, indicating a higher volume of disease.
  • Stage IIIC: Cancer has spread to organs other than the lungs, regardless of tumour marker levels.

Treatment Options

Surgical Options

  • Radical Inguinal Orchiectomy: This surgical procedure involves the removal of the affected testicle through an incision in the groin. It is typically the first step in the treatment of testicular cancer and aids in confirming the diagnosis. Preservation of fertility can be considered before the procedure if future family planning is a concern.
  • Retroperitoneal Lymph Node Dissection (RPLND): This procedure involves the removal of lymph nodes located in the retroperitoneum (the space behind the abdominal organs) to prevent the potential spread of cancer. It is often performed when there’s a high risk of cancer spread to these nodes.

Radiation Therapy

Radiation therapy utilises high-energy beams, like X-rays, to target and destroy cancer cells. It’s often used to treat seminomas, a specific type of testicular cancer, especially when the disease has spread to regional lymph nodes.


Chemotherapy involves the use of drugs to kill cancer cells or prevent their growth. Administered either orally or intravenously, chemotherapy circulates throughout the body and is typically chosen when testicular cancer has spread to other parts of the body. Various regimens with combinations of drugs may be employed depending on the type and stage of the cancer.

High-dose Chemotherapy and Stem Cell Transplant

For cases where testicular cancer is resistant to traditional chemotherapy regimens or has recurred, high-dose chemotherapy followed by a stem cell transplant might be an option. Stem cells, typically taken from the patient’s own blood before chemotherapy, are reintroduced post-treatment to aid in the recovery of the bone marrow.


For early-stage testicular cancer or cases where there’s a high likelihood of cure with initial treatment, surveillance is a viable option. This involves regular doctor visits, imaging tests, and blood tests to monitor for any signs of cancer recurrence. Immediate treatment is initiated if any evidence of return is detected.

Follow-up and Prognosis

Follow-up Care Post-treatment

  • Physical Examinations: Periodic examinations to check for any physical signs of cancer recurrence or potential treatment-related complications.
  • Blood Tests: Monitoring tumour marker levels to detect any potential increase, which might suggest a recurrence.
  • Imaging: Scans such as CT or MRI may be scheduled at intervals to check for any evidence of disease in the abdomen or other parts of the body.

Factors Affecting Prognosis

  • Stage at Diagnosis: Early detection and treatment typically result in better outcomes.
  • Tumour Type: Some types of testicular cancer may be more aggressive than others.
  • Blood Tumour Marker Levels: Elevated levels post-treatment might suggest a less favourable prognosis.
  • Response to Treatment: An individual’s response to initial treatment can provide insights into their long-term outlook.

Recurrence Risks

  • Initial Cancer Stage and Type: Some stages and types have a higher likelihood of recurrence.
  • Treatment Received: For example, those who undergo surveillance without other treatments might have a different recurrence risk compared to those who receive chemotherapy or radiation.
  • Duration Since Treatment: The majority of recurrences happen within the first two years post-treatment, though late recurrences, although rare, can occur.

Living with Testicular Cancer

Psychological and Emotional Aspects

  • Anxiety and Fear: Concerns about the future, potential recurrence, or the impact on life expectancy can lead to anxiety.
  • Body Image Concerns: Surgery and treatment side effects can change the appearance and function of the testes, which may lead to self-consciousness or concerns about masculinity and fertility.
  • Depression: Feelings of sadness, hopelessness, or loss of interest in activities are common and can benefit from professional intervention.

Physical Challenges and Lifestyle Adaptations

  • Sexual Health: Treatments can influence sexual desire, function, and fertility. It’s vital to discuss concerns with a healthcare professional and explore potential solutions.
  • Activity Levels: Post-treatment fatigue is common. Gradually increasing activity levels can help improve stamina over time.
  • Fertility Concerns: Some treatments can impact fertility. Patients may consider sperm banking before undergoing specific treatments or explore other family-building options.

Support and Resources

  • Support Groups: Engaging with others who’ve experienced testicular cancer can offer emotional support and practical advice.
  • Counselling: Professional therapy can provide coping strategies and tools to manage emotional challenges.
  • Educational Resources: Accurate information about the disease, treatments, and recovery can empower patients to make informed decisions and reduce anxiety.

Prevention and Screening

Recommendations for Regular Screenings

  • Self-examination: Men are encouraged to conduct regular testicular self-examinations. This involves feeling the testes for any unusual lumps or changes, ideally after a warm bath or shower when the skin of the scrotum is relaxed.
  • Medical Examination: Even in the absence of symptoms, it’s prudent for men to have an annual physical examination, during which a doctor can check the testes for lumps or other abnormalities.

Lifestyle Choices and Their Impact

  • Tobacco and Alcohol: While there’s no definitive link between tobacco or alcohol and testicular cancer, refraining from smoking and moderating alcohol consumption is generally advisable for overall health.
  • Diet and Nutrition: A balanced diet, rich in antioxidants and low in processed foods, may contribute to overall well-being and lower risks of various health conditions, though its direct link to testicular cancer prevention is not concrete.
  • Physical Activity: Engaging in regular physical activity can help maintain a healthy weight and boost immune function, factors that may indirectly influence the risk of developing several cancers.

Get an Accurate Diagnosis & Proper Treatment
for Your Urological Conditions


Dr Lee Fang Jann image

Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders

He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).

  • Bachelor of Medicine and Bachelor of Surgery (Singapore)
  • Membership of The Royal College of Surgeons (Edin)
  • Master of Medicine (Surgery) (Singapore)
  • Fellowship of the Academy of Medicine (Urology)
  • Clinical fellowship at Oxford Transplant Centre in the UK

Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.

Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.

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    Frequently Asked Questions

    How often should I perform a testicular self-exam?

    It’s recommended that men conduct a testicular self-examination monthly, ideally after a warm bath or shower.

    Are there noticeable early signs of testicular cancer?

    Early signs can include a lump or swelling in the testicle, a heavy feeling in the scrotum, or a change in the size or shape of the testicle. However, some men might not experience noticeable symptoms in the early stages.

    What is the survival rate for testicular cancer?

    The survival rate for testicular cancer is relatively high compared to other cancers. The exact rate can vary based on the stage at diagnosis and other factors.

    Is it possible to have children after testicular cancer treatment?

    Yes, many men can father children following treatment. However, certain treatments may affect fertility. It’s advisable to discuss fertility preservation options, such as sperm banking, before undergoing treatment.

    How do I choose between surveillance and active treatment?

    The choice between surveillance and active treatment depends on the stage of the cancer, its type, and individual factors. Discussing the risks and benefits of each option with a healthcare provider can guide the decision-making process.