What are the symptoms of testicular cancer?

In the early stages, testicular cancer may not present any obvious symptoms. As the disease progresses, symptoms such as a painless lump in the testicle, a feeling of heaviness in the scrotum, dull pain in the lower abdomen, or abnormal enlargement or hardening of the testicle may occur. The main symptoms of testicular cancer include a lump in the testicle, discomfort in the scrotum, back pain, gynecomastia in men, and weight loss.

1. Testicular mass

In about 90% of cases, the initial symptom is the appearance of a hard lump in the testicle, which is usually located at the lower pole or lateral edge of the testicle. The lump is generally painless upon touch and its boundary with the epididymis is not clearly defined. It may be associated with conditions such as testicular germ cell tumors or interstitial cell tumors of the testis, and is often accompanied by an increase in testicular size or changes in its shape. Clinically, alpha-fetoprotein testing is commonly used in conjunction with ultrasound examination for diagnosis. Treatment should be based on the pathological type and may involve orchiectomy combined with radiotherapy and chemotherapy.

2. Discomfort in the scrotum

Patients may experience a sensation of heaviness, swelling, or dull pain in the scrotum, which worsens after standing or engaging in physical activity and alleviates when lying down. This symptom is commonly seen in cases of hydrocele associated with a tumor, or varicocele accompanied by a tumor. Upon examination, it will be found that the skin temperature of the scrotum on the affected side is increased, and the transillumination test may yield a positive result. Differential diagnosis must be made between scrotal MRI and orchitis.

3. Lower back pain

When tumors metastasize to the retroperitoneal lymph nodes, they can compress the nerve plexuses, causing persistent low back pain that often radiates to the groin area. It is commonly seen in non-seminomatous tumors such as choriocarcinoma and is often accompanied by abdominal pain and gastrointestinal symptoms. The diagnosis requires an enhanced abdominal CT scan, and the treatment involves retroperitoneal lymph node dissection combined with chemotherapy regimens such as bleomycin.

4. Gynecomastia in males

Some testicular tumors that secrete human chorionic gonadotropin can lead to increased levels of estrogen, resulting in breast tenderness and darkening of the areola. Chorionic carcinoma or mixed germ cell tumors, which are more common in younger patients, can be identified by significantly elevated levels of β-HCG in laboratory tests. The treatment requires radical resection of the primary lesion combined with an EP chemotherapy regimen; breast symptoms usually improve after chemotherapy.

5. Weight loss

In advanced stages of the disease, patients may experience unexplained weight loss, with their weight decreasing by more than 10% within six months. It is commonly seen in embryonal carcinomas that have already metastasized to distant sites and is often accompanied by symptoms such as loss of appetite and low-grade fever. Whole-body PET-CT can detect metastatic lesions; in such cases, a high-dose TIP chemotherapy regimen combined with hematopoietic stem cell transplantation is required.

If the aforementioned symptoms occur, it is necessary to seek medical attention at a urology department promptly. A definitive diagnosis can be established through tumor marker tests, imaging examinations, and pathological biopsies. Early-stage testicular cancer has a high cure rate, and treatment plans must be tailored individually based on the pathological type and clinical stage of the disease.