Testicular cancer is highly curable, including in many patients whose cancer has spread. Treatment depends on whether the tumor is a seminoma or non-seminoma, where it has spread, and how the blood tumor markers behave after surgery. Most patients start with surgery to remove the affected testicle. Some need only scheduled surveillance afterward, while others benefit from chemotherapy, further surgery, or, in selected cases of seminoma, radiation. [1, 2]
By Dr Raman Narang, Consultant Medical & Hemato-Oncologist, New Delhi
A patient whose cancer is confined to the testicle may be advised to have no immediate treatment after surgery. Another patient with a clear CT scan may need chemotherapy because the blood tumor markers continue to rise. If you are seeking testicular cancer treatment in Delhi, ask your team to explain how the pathology, scans, and marker results fit together. Those three pieces of information guide the next decision.
1. What are the symptoms of testicular cancer, and how is it diagnosed?
The most common presentation is a painless lump or swelling in one testicle. Some people notice that a testicle feels firmer or larger, or that the scrotum feels heavy. A persistent ache can also occur. A new lump or change in size warrants prompt examination. Sudden, severe testicular pain needs emergency assessment, as it can be caused by testicular torsion. [1, 2]
Testicular cancer often affects young adults. A history of an undescended testicle, a previous testicular germ cell tumor, or a family history of testicular cancer increases risk. Many people diagnosed with testicular cancer have no known risk factor. [1, 2]
The initial assessment usually includes:
- Ultrasound of both testicles to determine whether the lump arises inside the testicle.
- Blood tumor markers called alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-hCG), and lactate dehydrogenase (LDH). These are measured before surgery and repeated afterward when appropriate. Normal markers do not exclude testicular cancer.
- Staging scans, usually CT of the chest, abdomen, and pelvis, to look for spread, including to lymph nodes at the back of the abdomen.
- Radical inguinal orchidectomy, which removes the affected testicle through an incision in the groin. For most patients, it confirms the diagnosis and is the first treatment. [1, 2]
Discuss sperm banking before treatment, ideally before surgery when practical and especially before chemotherapy or radiation. Fertility can already be affected at diagnosis. In the uncommon situation where extensive cancer is immediately life-threatening, the team may need to start chemotherapy before orchidectomy. [1, 2]
2. What are the main subtypes of testicular cancer?
Most testicular cancers are germ cell tumors. The pathology report groups them into two main categories because they differ in how they are staged and treated. [1, 2]
| Subtype | What it means for treatment |
|---|---|
| Seminoma | Usually responds well to cisplatin-based chemotherapy and is also sensitive to radiation. Radiation is used selectively. Pure seminoma does not produce AFP, although β-hCG may be raised. |
| Non-seminomatous germ cell tumor | Includes embryonal carcinoma, yolk sac tumor, choriocarcinoma, and postpubertal teratoma. The mix of components can influence follow-up and whether surgery is needed after chemotherapy. |
| Mixed germ cell tumor | If the tumor contains any non-seminoma component, the team follows the non-seminoma treatment pathway, even if most of the tumor is seminoma. |
If the pathology report says pure seminoma but AFP is clearly elevated or rising, the team reviews the pathology and looks for other causes of the AFP elevation. A significant, otherwise unexplained AFP elevation can change management to a non-seminoma approach. A small, stable elevation needs to be interpreted in context. [1, 2]
3. How are stage, relapse risk, and metastatic risk group different?
These three assessments answer different questions. A higher risk of relapse after surgery for stage I disease is a different finding from a poor-prognosis risk group in metastatic disease. [1, 2]
| Assessment | What it tells you |
|---|---|
| Stage | The extent of cancer, based on the testicular pathology, scans, and post-surgery tumor markers. Stage I usually means disease confined to the testicle with markers that normalise as expected. Stage II generally involves regional abdominal lymph nodes. Stage III can include distant spread or certain patterns of higher marker elevation. |
| Relapse risk in stage I | The chance of cancer returning after surgery if you choose surveillance. In non-seminoma, lymphovascular invasion, meaning cancer cells are seen in small blood vessels or lymphatic channels, is an important factor. In seminoma, features such as tumor size help inform the discussion alongside other findings. |
| IGCCCG risk group in metastatic disease | The International Germ Cell Cancer Collaborative Group classification helps guide chemotherapy. It uses the subtype, primary tumor site, sites of spread, and relevant tumor marker levels immediately before chemotherapy. Non-seminoma has good-, intermediate-, and poor-prognosis groups. Seminoma has good- and intermediate-prognosis groups. |
Occasionally, scans show no visible spread but AFP or β-hCG remains elevated or rises after surgery. The team checks whether the markers are falling at the expected rate and considers other possible causes. A confirmed tumor-related elevation can indicate disease below the detection limit of scans and can change the plan from surveillance to chemotherapy. [1, 2]
4. How is early-stage testicular cancer treated after surgery?
Stage I seminoma
Active surveillance is the preferred approach for most patients who can attend regular follow-up. It involves scheduled visits and imaging, with blood tests according to the follow-up plan. Many patients are cured by orchidectomy alone. If the cancer returns during surveillance, treatment is usually still given with the aim of cure. [1, 2]
A single cycle of carboplatin may be discussed for selected patients who want to reduce the risk of relapse after weighing the benefits, side effects, and follow-up requirements. Radiation after surgery has a limited role because of potential long-term side effects. [1, 2]
Stage I non-seminoma
Surveillance is an established option, especially when there is no lymphovascular invasion and scheduled follow-up is feasible. If lymphovascular invasion is present, the chance of relapse is higher. Some patients choose one cycle of BEP chemotherapy to reduce that risk. BEP stands for bleomycin, etoposide, and cisplatin. [1, 2]
Retroperitoneal lymph node dissection (RPLND) is surgery to remove lymph nodes at the back of the abdomen. It can be considered in selected stage I cases after specialist review. When deciding between surveillance and additional treatment, ask what your individual relapse risk is and what treatment would involve if the cancer returned. [1, 2]
5. How is testicular cancer treated when it has spread?
Stage II disease often involves lymph nodes at the back of the abdomen. In selected patients with small-volume stage IIA or IIB seminoma, the team may discuss chemotherapy or radiation. In non-seminoma, the size and location of the nodes and the tumor marker results help guide the choice. Specialist RPLND may be appropriate in selected patients with limited nodal disease and normal markers. Rising markers or more extensive disease usually favour chemotherapy. [1, 2]
Metastatic testicular germ cell cancer is often treated with the aim of cure. Cisplatin-based combination chemotherapy is the main treatment. A common approach is three cycles of BEP for good-prognosis disease and four cycles for intermediate- or poor-prognosis disease. Alternative regimens may be appropriate when bleomycin is unsuitable. The team considers lung health, kidney function, hearing, and other medical factors before choosing a regimen. [1, 2]
A mass that remains after chemotherapy is assessed differently in the two subtypes. In non-seminoma, a residual mass may contain teratoma or viable cancer even when the blood markers have normalised, so surgery may be needed. In seminoma, a residual mass can be scar tissue. The team may monitor it or use a carefully timed FDG PET/CT in selected cases, depending on its size and the clinical findings. [1, 2]
If cancer returns after cisplatin-based treatment, specialist review can help determine whether salvage chemotherapy, high-dose chemotherapy with stem cell support, or surgery is appropriate. [1, 2]
What I look for clinically before recommending treatment
I review the orchidectomy pathology, original scan images, and dated marker results together. I want to know whether AFP and β-hCG fell as expected after surgery, whether a lymph node on the scan is clearly abnormal, and whether the pathology shows lymphovascular invasion. For a patient choosing surveillance, I discuss whether the follow-up schedule is practical. For someone starting chemotherapy, I discuss fertility and what we will monitor during and after treatment.
How the next step is decided
| If the reports show… | The next discussion is about… |
|---|---|
| Stage I seminoma with reassuring post-surgery assessment | Active surveillance and whether carboplatin offers enough benefit to consider it |
| Stage I non-seminoma with lymphovascular invasion | Surveillance versus one cycle of BEP, based on relapse risk and follow-up preferences |
| Persistently raised or rising AFP or β-hCG after surgery | Confirming the trend, reviewing possible causes, and deciding whether chemotherapy is needed |
| Limited abdominal lymph node involvement | The subtype, node size, and marker results that guide chemotherapy, radiation, or surgery |
| Metastatic disease | The IGCCCG risk group, cisplatin-based treatment, and how response will be assessed |
| A residual mass after chemotherapy | Whether follow-up imaging or surgery is appropriate for that subtype |
What to bring to a testicular cancer consultation in Delhi
- Testicular ultrasound report.
- Orchidectomy and pathology reports, including subtype and lymphovascular invasion.
- AFP, β-hCG, and LDH results with dates, ideally from before and after surgery.
- CT reports and the original scan images.
- Details of any chemotherapy, radiation, or lymph node surgery already received.
- Questions about sperm banking, fertility, testosterone, and long-term follow-up.
Frequently asked questions
Can testicular cancer be cured after it has spread?
Yes. Many patients with metastatic germ cell tumors can be cured with cisplatin-based chemotherapy, sometimes followed by surgery. The individual outlook depends on the subtype, sites of spread, and risk group. [1, 2]
Will removing one testicle affect fertility or testosterone?
One healthy remaining testicle can often produce enough testosterone and sperm. Fertility may already be affected before treatment, and chemotherapy or radiation can add to that risk. Discuss sperm banking early if future fertility matters to you. [1, 2]
Do normal tumor markers mean the cancer is gone?
Some germ cell tumors produce little or no measurable AFP or β-hCG. The team uses markers alongside scans and pathology to judge response and plan follow-up. [1, 2]
How long will I need follow-up?
The schedule depends on the subtype, stage, and treatment received. Ask for a written plan that covers the timing of visits, blood tests and scans, and any long-term effects that need attention. [1, 2]
After surgery, ask your team to write down your subtype, stage, and post-surgery marker trend. If surveillance is recommended, ask for the schedule. If chemotherapy is recommended, ask which finding makes it necessary and how the team will assess response.
This page is for general education. Individual treatment decisions require review of your pathology, imaging, tumor markers, and overall health by your treating team.
Clinical references
- European Association of Urology. EAU Guidelines on Testicular Cancer, 2026. Diagnostic Evaluation, Staging and Classification Systems, Disease Management, and Follow-up After Curative Therapy.
- Spanish Society of Medical Oncology and Spanish Germ Cell Cancer Group. SEOM-GG Clinical Guidelines for the Management of Germ-Cell Testicular Cancer (2023).