More than ninety percent of patients present with a painless lump or mass in the testicle. Patients may also notice a sensation of heaviness in the scrotum or lower abdominal aching. Scrotal enlargement or swelling is also common in patients with testicular cancer.

Some patients with testicular cancer have no symptoms at all, especially in the early stage. Their cancer may be found incidentally during routine physical exams, such as ultra sound test or biopsy for diagnosis of infertility.

Certain types of testicular cancers, i.e., germ cell tumours, can secrete high levels of human chorionic gonadotropin hormone (HCG), which stimulates breast development. One of the uncommon symptoms for testicular cancer patients is breast tenderness or breast growth. This symptom results from the abnormal secretion of HCG from certain types of testicular cancer. Blood tests can measure HCG levels; these tests are important in diagnosis, staging, and in follow-up of some testicular cancers.

Two types of testicular tumours, Leydig cell tumours and Sertoli cell tumours, may produce androgens (male sex hormones) or oestrogens (female sex hormones). Oestrogen can cause breast growth in men and cause decreased libido (loss of sexual desire). Over production of androgen may or may not cause any specific symptoms in adult males; however, it can cause growth of facial and body hair at an abnormally early age.

Even with metastatic disease (when cancer has spread to other organs), only about 25% of patients may experience symptoms related to the metastasis before the diagnosis. The most common place for the disease spread is to the lymph nodes in the posterior part of the abdomen. Therefore, lower back pain is a frequent symptom of later-stage testicular cancer. If the cancer has spread to the lungs, cough, chest pain, and/or shortness of breath can occur. Haemoptysis (sputum with blood) may also develop.

The above is a summary of symptoms and signs of testicular cancer. Keep in mind that some of these symptoms may be caused by other conditions, such as testicle injury or testicle infection. Inflammation of the testicle, known as orchitis, can cause painful swelling. Causes of orchitis include viral or bacterial infections. About 1 man in 5 who contracts mumps as an adult experiences orchitis in one or both testes. However, it is important to see a physician if any of these symptoms lasts 10 days or longer. Early diagnosis of testicular cancer is extremely important.

• A lump or mass in either testicle
• Any enlargement or swelling of a testicle
• A collection of fluid in the scrotum
• A dull ache in the lower abdomen, back, or in the groin
• A feeling of heaviness in the scrotum
• Discomfort or pain in a testicle or in the scrotum
• Enlargement or tenderness of the breasts

There are several different ways to treat testicular cancer. Perhaps the most common start is a Orchiectomy. Once removed, the testicle can be analyzed by a clinical pathologist to diagnose the stage of the cancer. The stages are listed below. Other treatment options are lymph node dissection, chemotherapy, radiation and surveillance.

Stage I Testicular Cancer

Treatment depends on what the cancer cells look like under a microscope (cell type). If a tumour called a seminoma is found, treatment will probably be surgery to remove the testis (radical inguinal orchiectomy), followed by external-beam radiation to the lymph nodes in the abdomen. Clinical trials are also being performed on radical inguinal orchiectomy alone followed by careful testing to see if the cancer comes back.

If a tumour called a nonseminoma is found, treatment may be one of the following:

1. Radical inguinal orchiectomy and removal of some of the lymph nodes in the abdomen (lymph node dissection). Patients may undergo surgery that will preserve fertility. Blood tests and chest x-rays must be done once each month for the first year following the operation and at least every 2 months during the second year. A CT scan, a special kind of x-ray, may also be done. If results of the tests don't look normal and the cancer has recurred (come back), the doctor will give the patient systemic chemotherapy as soon as possible.
2. Radical inguinal orchiectomy alone followed by careful testing to see if the cancer comes back. The doctor must check the patient and do blood tests and x-rays every month for 2 years. This option is chosen only if the tumour has certain special features.

Stage II Testicular Cancer

Treatment depends on what the cancer cells look like under a microscope (cell type). If a tumour called a seminoma is found and the tumour is non-bulky (no lymph nodes can be felt in the abdomen, and no lymph nodes block the ureters [the tubes that carry urine from the kidney to the bladder]), treatment will probably be surgery to remove the testis (radical inguinal orchiectomy). External-beam radiation is then given to the lymph nodes in the abdomen.

If a tumour called a seminoma is found and the tumour is bulky (lymph nodes can be felt in the abdomen and/or the lymph nodes block the ureters, or if a CT scan shows them to be large), treatment will probably be a radical inguinal orchiectomy followed by systemic chemotherapy or external-beam radiation therapy.

If a tumour called a nonseminoma is found, treatment will probably be one of the following:

1. Radical inguinal orchiectomy and removal of the lymph nodes in the abdomen (lymph node dissection). The doctor will check the patient each month and do blood tests, chest x-rays, and CT scans. If the test results are not normal, patients will probably receive systemic chemotherapy.
2. Radical inguinal orchiectomy and lymph node dissection, followed by systemic chemotherapy. Blood tests and chest x-rays must be done once each month for the first year after the operation. CT scans are also done regularly.
3. Radical inguinal orchiectomy followed by systemic chemotherapy. If x-rays following chemotherapy show that cancer remains, surgery may be done to remove the cancer. After the operation, the doctor will check the patient each month and do blood tests, chest x-rays, and CT scans. In some cases, chemotherapy may be given before the radical inguinal orchiectomy.
4. Clinical trials of systemic chemotherapy instead of lymph node dissection (in selected patients).

Stage III Testicular Cancer

Treatment depends on what the cancer cells look like under a microscope (cell type). If a tumour called a seminoma is found, treatment will probably be surgery to remove the testis (radical inguinal orchiectomy), followed by systemic chemotherapy. Clinical trials are testing radical inguinal orchiectomy followed by systemic chemotherapy. If a tumour called a nonseminoma is found, treatment will probably be one of the following:

1. Systemic chemotherapy. Clinical trials are testing new chemotherapy drugs.
2. Systemic chemotherapy, followed by surgery to take out any masses that remain to see if there are any cancer cells left. If cancer cells remain, patients will probably receive more systemic chemotherapy.
3. Clinical trials of systemic chemotherapy.
4. Clinical trials of high-dose systemic chemotherapy with autologous bone marrow transplantation (in some patients).

Recurrent Testicular Cancer

Treatment depends on what the cancer cells look like under a microscope, where the cancer recurred (came back), and other factors. Treatment options include systemic chemotherapy, high-dose systemic chemotherapy with autologous bone marrow transplantation, surgery, and clinical trials testing new chemotherapy drugs.

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