Testicular cancer

Testicular cancer is a malignant cancer found in men that develops in the testicles. As a rule, testicular tumors originate in the germ cells in the testes, i.e., the cells that develop into sperm cells (semen). Doctors also speak of germ-cell tumors when it comes to testicular cancer.

With germ-cell tumors, a distinction is made between seminomas and non-seminomas. Seminomas originate in the germ cell tissue in the testes only. Non-seminomas, on the other hand, are mixed tumors. They originate in tissue types other than germ cell tissue. For example, they may have components consisting of embryonic carcinomas, chorionic carcinomas, yolk sac tumors or teratomas. A non-seminoma may also contain a seminoma component.

Many men who get testicular cancer become aware of the changed testicle themselves. A painless swelling of the scrotum is a typical warning sign. With some men, doctors notice the tumor by chance, for example while they are performing a testicular ultrasound following an injury. 

Symptoms of testicular cancer can include: 

• a feeling of heaviness in the scrotum 
• a dragging sensation on one side of the groin or testicle 
• a feeling of hardening inside the testicle or on its surface 
• pain in the testicle 
• enlargement in the breast tissue (gynecomastia) and chest pain due to the hormonal activity of the tumor 
• build-up of fluid (hydrocele) in the testicle 
• infertility 

There are factors known to increase the risk of men getting testicular cancer. The German Society of Urology (DGU) names the following: 

• a pre-existing condition with one-sided testicular cancer 
• an undescended testicle in childhood, even if this was treated 
• a brother or father with testicular cancer 
• an infertility problem 

Those who are in the risk group for testicular cancer should not only make sure to regularly examine their own testicles, but also get specialist tests performed by a urologist, as recommended by DGU. 

Men for whom the risk factors do not apply can also get testicular cancer. Sometimes cancer can happen purely by chance without a reason being found. 

You can find further information about risk factors for testicular cancer on the German Society of Urology website.

Around 4,100 men in Germany get testicular cancer every year. Testicular cancer is the most common cancer in men aged between 25 and 45. In this age group, testicular cancer accounts for about a quarter of all cancers. 

There is currently no statutory screening program specifically for testicular cancer. However, an examination of the testicles by touch is included in the general free screening by a doctor available once a year for men aged 45 years and above. 

Exception 

Young men (under 45 years of age) who have an increased risk of testicular cancer should speak to their doctors about whether they need regular screening tests. 

Self-exam 

Health professionals recommend that boys from the age of puberty and men do a regular self-examination of their testicles. Boys and men who notice changes in their testicles should get these checked out by a doctor. 

You can find information about the best way of checking your testicles yourself and what you need to look out for on the German Society of Urology website.

Boys and men who notice changes in their testicles should get these checked out by a doctor.

If a testicular tumor is suspected, the doctor feels the testicles with their fingers and examines them using an ultrasound device. They also examine other parts of the body by touch, such as the abdomen and groin area. Certain markers in the blood are also elevated in many patients with testicular cancer. The patients have their blood taken to detect these.

Exposing the testicle

If testicular cancer is still suspected after the initial examinations, surgery is required. This involves the doctor cutting open the groin to expose the suspicious testicle. They can then see with the naked eye whether it is actually a tumor and, if in doubt, take tissue samples (biopsy) of tumor tissue and testicles. If testicular cancer is established, then the affected testicle is completely removed.

Determination of cancer spread

As part of the examinations, the doctor will also check whether the testicular tumor has spread to other organs. Determination of cancer spread generally involves an ultrasound scan of the abdomen and a computed tomography (CT) scan of the pelvis, abdomen and chest area. 

Information about how a computed tomography scan works can be found on the website of the Cancer Information Service of the German Cancer Research Center (in German).

Patients with testicular cancer have very good chances of recovery. Even at an advanced stage, testicular cancer can still be cured. However, patients should, if possible, be treated at a specialized center for testicular cancer at this stage. This increases the chance of recovery. 

The chances of recovery are more favorable with a seminoma than with a non-seminoma. Treatment may differ slightly, depending on which of the two tumor types is involved.

Surgery

During treatment, the doctor removes the affected testicle including the spermatic cord by making a cut in the groin. Health professionals call the procedure orchiectomy. For the surgery, the patient is put under general anesthetic. For some patients, doctors also remove the lymph nodes in the back of the abdomen in an additional operation.

After the operation

How the treatment continues after the operation will depend on the type of tumor and on the stage of the disease. Chemotherapy, radiotherapy or monitoring the disease without further treatment are options.

The monitoring strategy has gained in importance in the last few years. It makes it possible to minimize the risk of overtreatment with possible complications for the mostly young patients.

Details about the different treatment procedures for cancer and possible side effects can be found on the Cancer Information Service of the German Cancer Research Center website (in German).

Cancer can be very stressful, both physically and psychologically. For patients with testicular cancer there is the option of rehabilitation (rehab). This ideally takes place in a rehab clinic that may also have options on offer for young men.

The rehab helps to prevent or minimize complications from the condition and treatment. For people in employment, the aims of rehabilitation also include returning to work.

Anyone wishing to enter rehab can discuss it with the doctors treating them. They will certify the need for rehabilitation. The clinic social services in hospitals and local cancer advice centers and health insurance providers also answer any questions about rehab.

Further information about rehabilitation after cancer can be found on the Cancer Information Service of the German Cancer Research Center website (in German).

The goal of the aftercare for testicular cancer is for a relapse to be detected as early as possible. Another goal is to prevent any complications of the cancer and cancer treatment, identify them and treat them appropriately. 

The risk of relapse for testicular cancer is at its highest within the first two years after the end of the treatment. A late relapse may occur in rare cases. Such late relapses may even occur after 5 to 10 years. Aftercare is intensive during the first few years. Those affected have several follow-up appointments throughout the year. 

Aftercare involves doctors examining the patient physically, regularly checking the tumor markers and carrying out imaging tests, such as computed tomography (CT) or magnetic resonance imaging. 

Long-term aftercare 

Aftercare beyond 5 years – if necessary life-long – is important to identify complications early on. It depends on the affected individual and their situation in life and their previous treatment as to what examinations are appropriate at what intervals with which doctors.

Infertility 

One in two testicular cancer patients’ fertility is already impaired at the time of their diagnosis. Surgery and chemotherapy, possibly also radiotherapy can further reduce fertility. 

Before they are treated, patients with testicular cancer should talk to their doctor about the possibility of deep freezing and storing their own sperm in a sperm bank. Since July 2022, a procedure known as cryopreservation has been covered by health insurance providers. 

Testosterone deficiency 

For some patients, the disease leads them to have a deficiency in the male sex hormone testosterone. This can affect their quality of life and lead to them gaining too much weight or having high blood pressure. This type of hormone deficiency can be managed with testosterone medication.  

Testicular prosthesis/implant  

When one testicle is missing, some men suffer from this change in their physical appearance. There is the option of replacing the missing testicle with an implant. Those affected should check beforehand whether their health insurance provider will cover the costs of this.

Hospitals where there are doctors who have a great deal of experience in the treatment of patients with testicular cancer can have this confirmed with certification. Some centers also offer testicular cancer patients a second opinion.

You can find an overview of the specialized centers for testicular cancer certified by the German Cancer Society on the OncoMap website.

The German Society of Urology (DGU) provides information about testicular cancer on the Hodencheck website, where men can find information about things like how to detect early signs of testicular cancer and how to do a self-exam.

Do you have further questions about dealing with the condition in everyday life and additional support options? You can find information about this on the Cancer Information Service of the German Cancer Research Center website (in German).

For all questions about testicular cancer, you can also make contact with Cancer Information Service doctors by dialing the freephone number (0800) 420 30 40 or by sending an e-mail to krebsinformationsdienst@dkfz.de.