PassFinals
Renal & Urology

Testicular Cancer

Testicular cancer is usually a germ-cell tumour presenting as a persistent intratesticular mass in a young adult; urgent ultrasound, tumour markers and radical inguinal orchidectomy establish the diagnosis, while stage-directed specialist treatment achieves very high cure rates.

In a nutshell

Testicular cancer is usually a germ-cell tumour in a young adult, presenting as persistent painless testicular enlargement or a solid intratesticular mass. Arrange urgent ultrasound and AFP, beta-hCG and LDH, then radical inguinal orchidectomy rather than trans-scrotal biopsy. Stage in a specialist MDT, protect fertility and choose surveillance, chemotherapy, selected radiotherapy or surgery according to histology, markers and stage.

Classic presentation

A man in his twenties notices a painless firm change in one testis; ultrasound shows a solid intratesticular lesion and serum markers are sent before urgent radical inguinal orchidectomy.

Key points

  • A non-painful testicular enlargement or change in shape/texture warrants suspected-cancer referral; unexplained persistent symptoms warrant urgent ultrasound.
  • Most testicular cancers are germ-cell tumours: seminoma or NSGCT.
  • Measure AFP, beta-hCG and LDH before and after orchidectomy; normal markers do not exclude cancer and AFP elevation is incompatible with pure seminoma.
  • The standard diagnostic operation is radical inguinal orchidectomy; avoid a trans-scrotal biopsy or approach.
  • Stage with CT chest, abdomen and pelvis and involve a specialist testicular-cancer MDT.
  • Offer sperm cryopreservation before chemotherapy or radiotherapy, and ideally before surgery when safe; treatment decisions must balance cure with fertility and late toxicity.
  • Stage I disease may be managed with surveillance or selected adjuvant treatment; metastatic disease needs specialist cisplatin-based therapy and risk-group assessment.

First-line investigation

Urgent scrotal ultrasound plus pre-operative AFP, beta-hCG and LDH, followed by CT staging when a testicular tumour is suspected.

Management

Refer and image the testis

  • A non-painful enlargement or change in shape/texture warrants suspected-cancer referral; arrange urgent ultrasound for unexplained or persistent symptoms and explore immediately if torsion is possible.1,2

Send markers and protect fertility

  • Measure AFP, beta-hCG and LDH before orchidectomy, arrange staging and discuss sperm banking before treatment that may impair fertility; normal markers do not exclude a germ-cell tumour.3,4,7

Use radical inguinal orchidectomy

  • Treat a suspected intratesticular tumour through a radical inguinal orchidectomy with high cord control; never use a trans-scrotal biopsy as the routine diagnostic route.3,6

Stage and treat in the specialist network

  • Use post-operative markers and CT staging to select surveillance, adjuvant therapy, cisplatin-based chemotherapy, selected radiotherapy or post-chemotherapy surgery; urgent specialist escalation is needed for bulky or organ-threatening metastatic disease.4,7,5

Monitor relapse and late effects

  • Follow with risk-adapted markers and imaging, and actively manage fertility, testosterone, cardiovascular, renal, pulmonary, neurological, hearing, psychological and second-cancer risks.11,7,5

Exam traps

  • A solid intratesticular mass is not safely labelled a hydrocele or epididymal cyst because the swelling is painless.
  • Do not perform a trans-scrotal biopsy; the standard initial operation is radical inguinal orchidectomy.
  • AFP elevation indicates non-seminomatous elements; pure seminoma does not produce AFP, but normal markers do not exclude cancer.
  • A painful testis still needs urgent assessment: torsion is an emergency, but pain can occur with tumour haemorrhage or infarction.
  • Sperm banking should be discussed before chemotherapy or radiotherapy and ideally before surgery if this does not compromise urgent care.
  • Do not memorise a single BEP/radiotherapy plan: histology, marker behaviour, stage, prognostic group, fertility goals and specialist protocol determine treatment.
  • Long-term follow-up matters because relapse and treatment-related cardiovascular, endocrine, pulmonary, renal and second-cancer effects can occur.

Illustrations

Seminoma histologyHigh-magnification H&E micrograph of seminoma showing sheets of large tumour cells with pale cytoplasm and prominent nuclei.Nephron, Wikimedia Commons · CC-BY-SA-3.0

Key sources

  1. NICE NG12, Suspected cancer: recognition and referral (Current NICE referral guidance: non-painful testicular enlargement or change in shape/texture prompts suspected cancer referral consideration and unexplained/persistent testicular symptoms prompt urgent ultrasound; published 23 June 2015 and last updated 15 April 2026)Published 23 Jun 2015
  2. NICE CKS, Scrotal pain and swelling (NICE CKS diagnostic anchor for urgent scrotal symptoms and differential assessment; direct access may require NHS or institutional login)
  3. British Association of Urological Surgeons, Testicular cancer (Current BAUS professional testicular-cancer pathway: radical inguinal orchidectomy, specialist staging, chemotherapy and long-term follow-up; page updated 7 March 2024)
  4. European Association of Urology, Testicular Cancer Guidelines 2026 (Current international specialist guideline used only for detailed staging, stage-directed therapy and metastatic management because no complete current UK national testicular-cancer clinical guideline was identified; 2026 evidence search covered literature through May 2025)Published 1 Jan 2026
  5. NHS, Treatment for testicular cancer (Current NHS treatment and survivorship information: orchidectomy, chemotherapy/radiotherapy, sperm banking and regular follow-up)
  6. Guy's and St Thomas' NHS, Testicle removal surgery (UK NHS surgical information: radical orchidectomy is the diagnostic and treatment procedure, with pre- and post-operative tumour markers)
  7. NHS England, Testicular cancer service specification (UK supra-regional specialist service specification: specialist MDT/network treatment, recurrence pathways and sperm cryopreservation for patients who may wish to father children)Published 1 Jan 2019
  8. Cambridge University Hospitals NHS, Cancer and fertility: a guide for men with testicular cancer (Current NHS fertility-preservation information, including sperm banking before treatment that may impair spermatogenesis; page accessed 2026)Published 1 May 2025
  9. BNF, Anticancer medicines (Current UK prescribing, interaction, fertility, organ-function and toxicity checks for platinum chemotherapy and supportive medicines; specialist oncology protocols determine the regimen)
  10. NICE NG234, Spinal metastases and metastatic spinal cord compression (Current NICE escalation pathway for suspected spinal metastasis or cord compression)Published 28 Sept 2023
  11. EAU Testicular Cancer Guidelines 2026, Follow-up after curative therapy (Current specialist follow-up framework using tumour markers and risk-adapted imaging, with late-relapse and survivorship considerations)Published 1 Jan 2026

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.