Testicular Cancer

Pathophysiology

Germ cell tumors (90%): Seminomas (most common single type, slow-growing, highly radiation-responsive) and nonseminomas (embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma — more aggressive)
Non-germ cell tumors (10%): Leydig cell tumors, Sertoli cell tumors
Metastasis: Lymphatic spread to retroperitoneal lymph nodes. Hematogenous spread to lungs, liver, brain, and bone
Cryptorchidism connection: Undescended testes are exposed to higher temperatures and abnormal hormonal environment, increasing malignant transformation risk — the only consistent risk factor
hCG-secreting tumors can cause gynecomastia

Painless lump or enlargement of one testicle (most common presenting sign)
Heaviness or dull ache in the lower abdomen, groin, or scrotum
Sudden collection of fluid in the scrotum (hydrocele)
Occasionally tender or enlarged breasts (gynecomastia from hCG-secreting tumors)
Back pain (retroperitoneal lymph node involvement)
Constitutional signs in advanced disease: unexplained weight loss, persistent fatigue, night sweats

Painless testicular lump in a young male: Immediate medical referral — do not delay
Back pain in a young male with testicular findings: Suggests retroperitoneal lymph node metastasis
Gynecomastia in a young male: May indicate hCG-secreting tumor
Elevated tumor markers (AFP, hCG, LDH): Confirm diagnosis and guide staging
Inguinal lymph nodes: Sentinel nodes for testicular cancer metastasis

Encourage monthly testicular self-examination for early detection (high cure rate)
Refer immediately for any painless testicular lump
During active treatment: Radiation — contraindicated on treatment site. Chemotherapy — coordinate with oncology team, address nausea, fatigue, pain, adjust pressure and duration (see chemotherapy and radiation-therapy)
Post-orchiectomy: Standard post-surgical precautions. Address scar tissue and pelvic floor concerns
Lymphedema risk: Inguinal lymph node removal creates lifelong lower extremity lymphedema risk
Bone metastasis: If present, extreme caution with pressure to avoid pathologic fractures
Psychosocial support: Treatment may cause fertility concerns, altered body image, and emotional distress. Massage provides nurturing touch and stress relief

Most common cancer in males aged 15-35
Cryptorchidism is the primary known risk factor
A painless testicular lump requires immediate medical referral
Monthly testicular self-examination is the primary early detection strategy
Seminomas are slow-growing and radiation-sensitive. Nonseminomas are more aggressive
Inguinal lymph nodes are the sentinel nodes

Testicular cancer is the most common cancer in males aged 15-35 with a high cure rate if caught early
A painless testicular lump is the hallmark sign — immediate medical referral is required
Cryptorchidism is the only consistent risk factor
Seminomas are slow-growing and radiation-sensitive. Nonseminomas are more aggressive
Monthly self-examination is the primary early detection strategy. Inguinal node removal creates lifelong lymphedema risk