Clinical summary guide

Testicular cancer

13 min

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The GP’s role

GPs are typically the first point of contact for men who have noticed a testicular lump, swelling or pain.

Note on screening: There is little evidence to support routine screening. However, GPs may screen men at higher risk, including those with a history of previous testicular cancer, undescended testes, infertility or a family history of testicular cancer.


Benign cysts

Epididymal cysts, spermatocele, hydatid of Morgagni and hydrocele are all non-cancerous lumps that can be found in the scrotum.

Benign cystsEpididymal cysts, spermatocele, hydatid of Morgagni and hydrocele are all non-cancerous lumps that can be found in the scrotum. Diagnosis can be confirmed via an ultrasound.
Epididymal cystsCommon fluid-filled cysts which feel slightly separate from the testis and are often detected when pea-sized. Should be left alone when small but can be surgically removed if they become symptomatic.
SpermatoceleFluid-filled cysts containing sperm and sperm-like cells. These cysts are like epididymal cysts except they are typically connected to the testis.
Hydatid of MorgagniSmall common cysts located at the top of the testis. They are moveable and can cause pain if they twist. These cysts should be left alone unless causing pain.
HydroceleA hydrocele is a swelling in the scrotum caused by a buildup of fluid around the testes. Hydroceles are usually painless but gradually increase in size and can become very large. Hydroceles in younger men may be a warning of an underlying testis cancer, albeit rarely. In older men, hydroceles are almost always a benign condition, but a scrotal ultrasound will exclude testicular pathology.

Diagnosis and management

Clinical notes

The urologist will form a diagnosis based on inguinal exploration, orchidectomy and en bloc removal of testis, tunica albuginea, and spermatic cord.

Organ-sparing surgery can be attempted in specific cases (solitary testis or bilateral tumours) in specialist referral centres.

Prosthesis may be considered at time of orchidectomy but may also be placed later.


Classification and risk factors

There are three categories of testicular epithelial cancer. Germ cell tumours account for 90-95% of cases of testicular cancer.

Prognostic risk factors 

Clinical (for metastatic disease)

Staging of testicular tumours

The Tumour, Node, Metastasis (TNM) system is recommended for classification and staging purposes. The IGCCCG staging system is recommended for metastatic disease. 

American Joint Committee on cancer staging of testicular cancer

Treatment options for localised testicular cancer

Orchidectomy cures almost 85% of stage I seminoma patients and 70-80% of stage I non-seminomatous germ cell tumour (NSGCT) patients.

Adjuvant treatments may reduce the risk of metastases in those not cured by orcidectomy, but this comes at the cost of possible adverse effects.

Surveillance is another management option. A risk-adapted approach is now used to determine subsequent management.

Treatment of metastatic disease (pT2-pT4)

IGCCCG Prognostic- based staging system for metastatic germ cell cancer

(If all criteria are met)
Any primary site.
No non-pulmonary metastases.
Normal AFP/normal LDH, low hCG.
If all criteria are met:
Testis/retroperitoneal primary
No non-pulmonary metastases (e.g. liver and/or brain)
Lower levels of tumour markers.
(If all criteria are met)
If all criteria are met:
Any primary site
No non-pulmonary metastases
Normal AFP/normal LDH, medium hCG.
If all criteria are met:
Testis/retroperitoneal primary
No non-pulmonary metastases (e.g. liver and/or brain)
Medium levels of tumour markers.
(If any criteria are met)
No seminoma carries poor prognosis.If any criteria are met:
Non-pulmonary metastases (e.g. liver and/or brain)
Higher level of tumour markers
Mediastinal primary for NSGCT.

Additional investigations


The first stage of treatment is usually an orchidectomy: removal of the diseased testis via an incision in the groin, performed under general anaesthetic. Men can be offered a testicular prosthesis implant during or following orchidectomy. 

Patient support

Diagnosis and treatment can be extremely traumatic for the patient and family.

Regular GP consultations can offer patients a familiar and constant person with whom to discuss concerns (e.g. about treatment, cancer recurrence, and the effects of testis removal on sexual relationships and fertility).

Referral to a psychologist may be required.

Semen storage

Men with testicular cancer often have low or even absent sperm production even before treatment begins. Chemotherapy or radiotherapy can, but does not always, lower fertility further.

All men wanting to maintain fertility should have a discussion regarding pre-treatment semen analysis and storage as semen can be stored long-term for future use in fertility treatments.

Men who have poor sperm counts may need to visit the sperm-banking unit on 2 or 3 occasions or, in severe cases, an Andrology referral may be required.

Surgical removal of one testis does not affect the sperm-producing ability of the remaining testis.

Clinical review

Professor Nathan Lawrentschuk, University of Melbourne, Royal Melbourne Hospital & Epworth Healthcare
Testicular cancer

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