Testicular Cancer: Why Acting Early Changes Everything
The commonest solid cancer in young men, and one that responds very well to treatment. If you have noticed a painless lump, do not wait — delay turns a readily treatable disease into a harder one.
Last medically reviewed: October 4, 2026 — Assoc. Prof. Dr. Müslüm Ergün
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- Procedure time
- Orchiectomy 45–60 minutes
- Anesthesia
- General or spinal anaesthesia
- Hospital stay
- Day case or 1 night
- Stay in Türkiye
- 7–10 days (for staging and planning)
- Return to work
- 1–2 weeks
- Flight clearance
- 7–10 days
About the condition
Testicular cancer is the commonest solid organ cancer in men aged 15 to 40. Its most important feature is this: it responds very well to treatment, and the chance of cure is substantially high even in advanced disease. That is not a consoling phrase but the reason why coming forward in good time matters so much.
THE COMMONEST SIGN IS A PAINLESS LUMP OR SWELLING IN THE TESTICLE. There is usually no pain, which is why many men reason that "if it does not hurt, there is nothing wrong". That reasoning is mistaken and is the single greatest cause of delayed diagnosis. Sometimes a feeling of heaviness in the testicle, fullness in the lower abdomen or tenderness of the breast tissue accompanies it.
DELAY IS A REAL PROBLEM AND IT USUALLY COMES FROM EMBARRASSMENT. Young men are reluctant to have this area examined and wait for it to "go away on its own". Yet in testicular cancer even weeks can make a difference: where early disease may need only surgery and surveillance, advanced disease may require chemotherapy. The lump you have noticed may not be cancer — but that is settled by examination, not by waiting.
THE FIRST STEPS IN DIAGNOSIS ARE ULTRASOUND AND BLOOD TESTS. Scrotal ultrasound shows whether the mass is inside the testicle or outside it. The tumour markers measured in blood (AFP, beta-hCG, LDH) help both with the diagnosis and with follow-up afterwards, which is why it matters that they are measured BEFORE treatment.
BIOPSY THROUGH THE SCROTUM IS NOT PERFORMED. This is an important point: putting a needle into a testicular mass through the scrotum, or cutting into it, can alter the route by which tumour cells spread. The correct approach is to remove the testicle together with its cord through an incision in the groin (inguinal orchiectomy). This both establishes the diagnosis and is the first step of treatment. Be cautious of anyone proposing a biopsy through the scrotum.
SPERM BANKING MUST BE DISCUSSED BEFORE TREATMENT. Both the disease itself and any chemotherapy or radiotherapy that may follow can affect sperm production. Sperm banking should be done BEFORE surgery and in particular before chemotherapy — afterwards it may be too late. This conversation is often skipped; it should not be.
Who is it suitable for?
May be suitable
- Any man who notices a painless lump, swelling or change in shape of a testicle — urgent assessment is needed
- Men with a solid mass inside the testicle on ultrasound
- Men with raised tumour markers
- Men describing heaviness in the testicle or fullness in the lower abdomen
- Men with a history of an undescended testis or a family history of testicular cancer — the risk is higher
May not be suitable
- Men with a cystic swelling sitting in the epididymis rather than the testicle — these are usually benign and assessed separately
- Men found to have a hydrocele or varicocele — these are not cancer, but must be distinguished on examination
- Men with sudden severe testicular pain — this may be testicular torsion and requires emergency intervention within HOURS; that is excluded first
- Men in whom epididymitis (inflammation) is suspected — the response to treatment is assessed, but if the lump persists the investigation continues
Technology used
- Scrotal ultrasound — establishing whether the mass is inside or outside the testicle
- Tumour markers: AFP, beta-hCG, LDH — before and after treatment
- Inguinal radical orchiectomy — diagnosis and the first step of treatment
- Pathological examination: seminoma versus non-seminoma
- CT scanning for staging
- Sperm banking — before treatment
- An optional testicular prosthesis
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Step 1
Examination and ultrasound — not deferred
Physical examination and scrotal ultrasound can be done the same day. Whether the mass lies within the testicle is largely established at this stage.
- Step 2
Tumour markers
AFP, beta-hCG and LDH are measured BEFORE treatment. These values underpin both the diagnosis and later follow-up.
- Step 3
Sperm banking is discussed
This is raised whether or not you currently want children. Sperm banking should be done before surgery and in particular before chemotherapy.
- Step 4
Inguinal radical orchiectomy
The testicle is removed with its cord through an incision in the groin. The operation takes 45–60 minutes; most men are discharged the same day or the next. A testicular prosthesis can be placed in the same sitting if you wish.
- Step 5
Pathology and staging
Pathology states whether it is a seminoma or a non-seminoma. CT assesses any spread and the markers are measured again. The treatment plan rests on these three pieces of information.
- Step 6
Next treatment: surveillance, chemotherapy or radiotherapy
In early disease, close surveillance alone may be enough. Where needed, chemotherapy or radiotherapy is planned. In some men, surgical removal of the lymph nodes behind the abdomen comes into consideration.
Method comparison
| Finding | Typical feature | Urgency |
|---|---|---|
| Painless firm lump (within the testicle) | Grows over time, no pain | URGENT assessment — within days |
| Sudden severe pain | Nausea may accompany it | VERY URGENT — within hours (may be torsion) |
| Pain and swelling with fever | Urinary symptoms may accompany it | Urgent — may be inflammation, which is treated |
| Soft, fluid-filled swelling | Transmits light when shone through | Not urgent — a hydrocele is likely |
| Small cystic structure above the testicle | Felt separately from the testicle | Not urgent — an epididymal cyst |
This table is not for diagnosing yourself but to show which situations will not wait. Every lump that can be felt should be examined; ultrasound makes the distinction.
Risks
- DELAY IN DIAGNOSIS: the most important risk on this page is not the risk of treatment but the risk of waiting. Where early disease may need only surgery and surveillance, delayed disease may require chemotherapy
- Effects on fertility: both the disease and its treatment can reduce sperm production — which is why sperm banking is done before treatment
- Living with one testicle: if the remaining testicle is healthy, hormone production and fertility usually continue, though that is not guaranteed; the testosterone level is monitored
- Risks of the operation: bleeding, infection, swelling and bruising of the scrotum
- Altered sensation or numbness in the groin
- Side effects of chemotherapy if it is given — discussed separately with medical oncology
- RECURRENCE: the disease can return after treatment, which is why follow-up with markers and imaging continues for years and must not be abandoned
Alternatives
- There is NO alternative to orchiectomy — it is the first step of both diagnosis and treatment. The alternatives arise at the next step:
- Close surveillance in early disease — with regular markers and imaging; not everyone needs chemotherapy
- Chemotherapy — according to stage and pathology type
- Radiotherapy — in selected seminoma cases
- Retroperitoneal lymph node dissection — in selected non-seminoma cases
- Testis-sparing surgery — only in very selected men with a solitary testicle or bilateral tumours
- A testicular prosthesis — not a medical necessity but entirely your own choice
Recovery
First 48 hours
Swelling, bruising and tenderness in the groin and scrotum are expected. Ice and supportive underwear bring relief.
Week 1
Gentle walking is allowed. Heavy lifting and movements that strain the abdominal muscles are not. The pathology result comes through during this period.
Week 2
A return to desk work is possible. Staging is completed and the next treatment plan becomes clear.
Weeks 4–6
A gradual return to sport and heavy physical activity. If chemotherapy has been planned, it may have begun during this period.
Long term
Regular follow-up with markers and imaging. It spans years and is more frequent in the early ones. The testosterone level is also monitored.
Frequently asked questions
There is a lump in my testicle but it does not hurt at all. Can I wait?
No. That is precisely the most typical sign of testicular cancer: a painless lump. The idea that "if it does not hurt, there is nothing wrong" is the commonest cause of delayed diagnosis. The lump you have found may not be cancer — but you establish that by examination and ultrasound, not by waiting. It should be assessed within days.
I feel awkward about being examined.
That feeling is very common, and it is exactly why many young men come forward late. But testicular cancer responds very well to treatment when caught early, whereas delay turns a straightforward treatment into a harder one. The examination takes a few minutes. That brief discomfort may spare you months of treatment.
Will a biopsy be taken?
A biopsy through the scrotum is NOT performed. Passing a needle through the scrotum or cutting into it can alter the route by which the tumour spreads. The correct approach is to remove the testicle with its cord through an incision in the groin; this both establishes the diagnosis and is the first step of treatment. If a biopsy through the scrotum is proposed to you, seek a second opinion.
If my testicle is removed, can I still father children?
If the remaining testicle is healthy, fertility usually continues, but it cannot be guaranteed — both the disease itself and any chemotherapy that may be needed can affect sperm production. That is why sperm banking must be discussed BEFORE treatment. This step is often skipped; ask about it.
Could I bank sperm later instead?
Possibly not. Once chemotherapy has begun, sperm quality can fall markedly and recovery may take months or years, and sometimes does not happen at all. The timing is critical: banking should be done before surgery and in particular before chemotherapy.
Will my hormones be affected with one testicle?
If the remaining testicle is healthy it usually produces enough testosterone and sexual function is unaffected. The testosterone level is nevertheless measured at follow-up; if it falls, replacement treatment may come into consideration.
Do I have to have a prosthesis?
No. A testicular prosthesis is not a medical necessity; it is entirely a matter of appearance and personal comfort. It can be placed at the same sitting as the orchiectomy or later if you wish. If you do not want one, there is no medical disadvantage.
Will I definitely need chemotherapy?
No. In early disease, where the pathology and markers are favourable, close surveillance alone may be sufficient; this is a legitimate and frequently used approach. The decision about chemotherapy or radiotherapy rests on the pathology type, the stage and the behaviour of the markers.
If the disease has already spread, do I still have a chance?
Yes. Testicular cancer responds very well to treatment even when it has spread — that is what sets it apart from many other cancers. The possibility that it has advanced is therefore not a reason to put off coming forward but a reason to come forward at once.
How long does follow-up last?
It lasts years and is more frequent in the early ones. It is carried out with markers and imaging. Feeling well is not a reason to stop; recurrences usually show up in the markers before causing any symptoms, and at that point they can be treated.
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