Guide to Testicular Cancer: Recognizing Symptoms, Diagnosis and Treatment

by Amy Seczek  MScPT
Registered Physiotherapist
updated Mar 30, 2026

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Testicular cancer makes up only 1-2% of all male cancers but it is the most common cancer in young men between the ages of 15-35. Testicular cancer rates have increased over time, but it is also highly treatable, especially if caught early. This is why it’s so important to improve awareness about testicular self exams.

The testicles play an important hormonal role as about 95% of the body’s testosterone is produced in the testicles. The testicles also play a reproductive role as they produce sperm before storing it in the epididymis. There are many things that can cause scrotal and testicular pain, so it is important to discuss your symptoms with your family physician to rule out testicular cancer.

 

What are the risk factors for testicular cancer?

Known risk factors for testicular cancer include:

• History of undescended testicle (cryptorchidism)
• Family history or personal history of testicular cancer
• Klinefelter syndrome

Possible risk factors include:

• Testicular microlithiasis (small calcium deposits within the seminiferous tubules of the testicles)
• HIV infection or AIDS
• Early puberty
• Taller height than average
• Decreased fertility
• Pesticide exposure
• Marijuana use
• Prenatal exposure to estrogen

 

How do I perform a self-check for testicular abnormalities?

Just as self-checking is recommended for breast cancer, it is recommended to perform a testicular self exam once monthly. Regular self checks can help you to understand what is normal for you, and catch any changes early.
Follow these instructions to perform a self-check:

1. Check your testicles just after you’ve had a bath or shower, when the muscles in the scrotum are relaxed, making it easier for you to feel any lumps, growths or tenderness.
2. Observe your testicles. Stand in front of the mirror. Look for any swelling on the skin of your scrotum.
   Hold them in your hands and feel the size and weight of each testicle. It is common for one testicle to be larger or hang lower than the other.
3. Feel each testicle and gently roll it between your thumb and finger. It should feel smooth. It is normal to feel a soft, tender tube towards the back of each testicle. You shouldn’t feel any pain.
4. Repeat: once familiar with how your testicles feel, keep an eye out for any changes. If you detect a change, stay calm and see your doctor as soon as possible.

 

What are the signs and symptoms of testicular cancer?

Early signs and symptoms include a painless lump on the testicle, feeling of heaviness or aching in the lower abdomen or scrotum, swelling of a testicle, or enlarged lymph nodes in the abdomen or neck. Most cases are painless, but occasionally testicular cancer can present with pain.

Late stage symptoms include back pain (if the cancer has spread to the retroperitoneal lymph nodes), ascites (buildup of fluid in the abdomen), a persistent cough with or without blood stained sputum, or shortness of breath (if the cancer has spread to the lungs).

 

How is testicular cancer diagnosed?

Physicians usually start with a physical exam to assess for lumps, swelling or tenderness in the scrotum, then checking the lymph nodes and abdomen for discomfort. Physicians will then order an ultrasound to determine if a lump is solid (potentially cancerous) or fluid filled (usually benign). Blood tests for tumor markers are obtained. If the mass is believed to be cancer based on these results, the diagnosis is usually confirmed after surgical removal of the testicle. If cancer is confirmed, CT scans are done to look for signs of spread.

 

How is testicular cancer treated?

The main treatment for testicular cancer is surgery, and the type of surgery will depend on where the cancer is, the stage and spread. Surgical options include:

• Partial orchiectomy: a mass on the testicle is removed and the testicles are spared. This may be considered in select cases, such as when patients have a single testicle or there are tumors in both testicles. Fertility may be preserved in this case, but is not guaranteed.
• Radical inguinal orchiectomy (most common): removal of one entire testicle and most of the spermatic cord. Fertility is often preserved, but can still be impacted by other treatments.
• Cancer rarely occurs in both testicles simultaneously (about 2% of cases), but in this case, a bilateral orchiectomy is required. Because the testicles produce approximately 95% of the body’s testosterone, surgical procedures that involve the removal of both testicles leads to a near complete loss of testosterone production. Patients typically require lifelong testosterone replacement therapy, as side effects of this can present similar to menopause symptoms, including:

-Decreased libido
-Erectile dysfunction
-Reduced penile size and loss of testicular tissue
-Hot flashes
-Breast tenderness and growth of breast tissue
-Osteoporosis
-Increased cholesterol
-Depression
-Anemia
-Decreased mental sharpness
-Loss of muscle mass
-Weight gain
-Fatigue

• Retroperitoneal lymph node dissection: removal of all retroperitoneal lymph nodes for stage I/IIA non-seminoma or masses following chemotherapy. The primary potential side effect of this treatment option is retrograde ejaculation where semen flows backward into the bladder instead of exiting through the penis, and this can impact fertility.
• Treatment may also include systemic chemotherapy or radiation depending on the spread, type and risk of recurrence of the cancer.
  Side effects of cancer treatment can have a significant impact on quality of life. That is why supportive care during and after testicular cancer treatment is so important.

 

How can physiotherapy help?

Pelvic floor physiotherapy is a crucial piece in restoring and optimizing your quality of life after testicular cancer treatment. Your physiotherapist will carry out a thorough assessment of your medical history and physical function and will develop a comprehensive treatment plan tailored to your goals.
Treatment may include:

• Education surrounding what to expect during treatment and post surgery
• Pelvic floor muscle relaxation, strengthening and coordination exercises
• Breathing strategies to reduce nervous system sensitization
• Hands-on techniques to mobilize and release scar tissue and muscle tension
• Managing symptoms related to chemotherapy, including chemotherapy induced peripheral neuropathy and fatigue
• Managing symptoms related to radiation, including prevention of lymphedema development
• Cardiovascular training

Our approach to treatment aims to target a wide range of challenges you may be facing following a testicular cancer diagnosis. Whatever symptoms you’re dealing with, we’re here to help. Book your pelvic physiotherapy assessment today to learn how we can help you recover better.