Testicular cancer: signs not to ignore
The usual sign is a firm lump in one testis (andkosh), or a testis that has become larger, harder or heavier. It often does not hurt, which is why men wait. Some feel a dull ache in the lower belly or groin. Testicular cancer is most common between about 15 and 45 years of age.
Men who had an undescended testis as a child, a previous testicular cancer, or a father or brother with it have a higher risk. See undescended testis and orchiopexy.
Many swellings in the scrotum are not cancer, such as a hydrocele (fluid around the testis), a varicocele (swollen veins) or infection. A lump in the testis itself, though, should be seen within days, not months. Checking your testes once a month in the shower helps you notice a change early.
Tests: ultrasound and tumour markers
- Examination of both testes, the abdomen and the neck.
- Scrotal ultrasound: quick, with no radiation. It shows whether a lump is inside the testis and checks the other testis.
- Tumour markers: blood tests for AFP (alpha-fetoprotein), beta-hCG (human chorionic gonadotropin) and LDH (lactate dehydrogenase). They are taken before surgery and repeated afterwards to see whether they fall as expected.
- CT scan of the chest, abdomen and pelvis to look at the lymph nodes at the back of the abdomen and the lungs.
A needle biopsy through the scrotum is not done, because it can spread cancer cells into the scrotal skin. The diagnosis is made by examining the whole removed testis.
Who needs radical inguinal orchiectomy
Almost every man with a solid tumour inside the testis on ultrasound needs the testis removed, usually within days to a couple of weeks. It is both the diagnosis and the first treatment.
There are exceptions. If the cancer has spread widely and is making you unwell, chemotherapy may be started first and the testis removed later. If there is a very small lump in a man with only one testis, or tumours in both, removing only the lump (partial orchiectomy) may be considered in carefully selected cases.
Why the testis is removed through the groin
The testis forms inside the abdomen before birth and moves down into the scrotum, so its blood vessels and lymph channels run up through the groin to glands at the back of the abdomen. The scrotal skin drains to different glands, in the groin.
Operating through the groin lets the surgeon clamp the cord (the vessels and lymph channels) high up, before the testis is handled, and remove everything along the natural route of spread. A cut on the scrotum could open a new route and complicate later treatment.
Before surgery: sperm banking and the prosthesis option
Sperm banking: one healthy testis is usually enough for fertility and male hormones. But the cancer itself, and chemotherapy or radiotherapy afterwards, can lower sperm production. If you may want children, freezing semen samples at a sperm bank before surgery is advised when time allows, and certainly before chemotherapy. This is especially important if the other testis is small or has its own problem. See male infertility treatment.
Testicular prosthesis: a soft silicone implant shaped like a testis can be placed in the scrotum, at the same operation or later. It is for appearance and confidence only; it does not make hormones or sperm. It feels firmer than a natural testis and has small risks of infection or moving out of place. Whether to have one is entirely your choice, and its availability and cost are discussed before surgery.
How the surgery is done, step by step
- Spinal or general anaesthesia is given.
- A cut of a few centimetres is made in the groin, just above the pubic bone, similar to a hernia operation.
- The cord is clamped and tied high up.
- The testis is gently brought up from the scrotum into the wound and removed with its cord.
- A prosthesis is placed in the scrotum if chosen, and the wound is closed, often with dissolving stitches.
The operation usually takes under an hour. It is done at ManglamPlus Medicity with standard surgical instruments. The testis goes to the pathologist, who reports the tumour type, mainly seminoma or non-seminoma, and features that guide further treatment.
Recovery after orchiectomy
| Time | What to expect |
|---|---|
| Day of surgery | Walking within hours; home the same day or next morning |
| Days 1-3 | Groin soreness and some scrotal bruising; simple painkillers; supportive underwear |
| Week 1-2 | Desk work and light activity; wound check |
| Weeks 2-4 | Pathology and repeat tumour markers reviewed; further plan made |
| After about 4 weeks | Sport, heavy lifting and sexual activity as comfortable |
Call the clinic if the scrotum swells up quickly or becomes very painful, if you have a fever, or if the wound becomes red or leaks.
Risks of radical inguinal orchiectomy
Problems are uncommon but include a collection of blood in the scrotum, wound infection, numbness or nerve pain in the groin and upper thigh, and problems with a prosthesis if one is placed. If the other testis is weak, testosterone may be low; a blood test checks this and replacement is possible. The emotional effect of losing a testis is real, and talking about it helps.
After surgery: further treatment by oncologists and follow-up
The stage is worked out from the pathology report, the tumour markers after surgery and the CT scan. Depending on these, the next step may be:
- Surveillance: regular markers, examinations and scans, with treatment only if the cancer returns.
- Chemotherapy, given by medical oncologists.
- Radiotherapy for some seminomas, given by radiation oncologists.
- Surgery to remove lymph nodes at the back of the abdomen in some men, planned with the cancer team.
Follow-up continues for several years, and the other testis is checked each time. See the overview of urology cancer surgery.
Cost of testicular cancer surgery in Jaipur
The clinic gives you a written estimate after the consultation and any scans, because the final bill depends on your own case. What changes the cost:
- Ultrasound, tumour marker blood tests and CT scan before surgery
- Whether a testicular prosthesis is placed, and its cost
- Day-care or overnight stay, and the room category at ManglamPlus Medicity
- The pathology report on the removed testis
- Sperm banking, and any chemotherapy or radiotherapy afterwards, which are arranged and billed separately
Insurance and government schemes
Most health insurance policies cover planned surgery of this kind, subject to their terms, such as waiting periods and room-rent limits. Whether you can go cashless depends on the hospital’s agreement with your insurer or TPA. Empanelment for government schemes such as RGHS, MAA Yojana, PM-JAY and CGHS belongs to the hospital, not the doctor, so please confirm your scheme with the ManglamPlus Medicity billing desk before admission.
Why Dr. Nitin Negi
Testicular cancer surgery with Dr. Nitin Negi, urologist in Jaipur
- MCh super-specialistMBBS, MS (Surgery), MCh in Genitourinary Surgery; senior residency at AIIMS, New Delhi.
- 12+ years in urologyEndourology including RIRS, Mini-PERC, PCNL, HoLEP, TURiS and TURP; laser surgery since 2016.
- 150W Holmium laserAvailable at ManglamPlus Medicity for kidney stone and prostate surgery.
- Clear explanationsEvery option, risk and cost discussed before treatment; two Jaipur locations.
Frequently asked questions
Is every lump in the testis cancer?
No. Many scrotal swellings are fluid, swollen veins or infection. But a solid lump inside the testis is treated as possible cancer until proven otherwise, so it needs an ultrasound soon.
Can I still father children with one testis?
Usually yes, if the other testis is healthy. Because further treatment can affect sperm, storing semen before treatment is advised if you may want children.
Will my hormones and sex life change?
Usually not. One healthy testis normally makes enough testosterone for normal erections, sex drive and energy. If levels are low, replacement treatment is available.
Why can’t a biopsy be taken before removing the testis?
A needle through the scrotum risks spreading cancer cells into the scrotal skin. Ultrasound and tumour markers give enough information to plan surgery, and the removed testis gives the final diagnosis.
Will I need chemotherapy after orchiectomy?
Not always. Some men need only surveillance. Others need chemotherapy or radiotherapy, depending on the tumour type, markers and scan, and this is planned with oncologists.
Should I have a testicular prosthesis?
It is a personal choice. Some men feel more comfortable and confident with one; others prefer not to have an implant. It can be placed at the same operation or months later, so you do not have to decide in a hurry.
How often should I check my testes?
Once a month, gently, after a warm bath or shower. Feel each testis between thumb and fingers and report any new lump, hardness or change in size.
This page is general information, not a diagnosis or a promise of any result. Please read our medical disclaimer.