What is testicular cancer?

Testicular cancer is malignancy arising from the testicle — the vast majority (approximately 95%) are germ cell tumours (GCTs), of which approximately 50-55% are seminomas and 45-50% are non-seminomas. It is the most common cancer in young men aged 15-35 and — despite this — has an extraordinary prognosis: overall 5-year survival exceeds 95%, and even widely metastatic stage III disease is cured in approximately 70-80% of cases with cisplatin-based chemotherapy. Testicular cancer is the oncology field's greatest success story.

What are the symptoms?

Painless testicular lump or swelling (the most common presentation — approximately 90%): a hard, smooth, usually painless mass within the testis. Dull ache or heaviness in the scrotum. Rarely, acute pain (from bleeding into tumour). Gynaecomastia (breast enlargement) — from hCG production by choriocarcinoma or embryonal carcinoma. Back pain (from retroperitoneal lymph node metastases). Shortness of breath or haemoptysis (from pulmonary metastases). Key message: any testicular mass in a young man should be assumed cancer until proven otherwise.

How is testicular cancer diagnosed?

Scrotal ultrasound: the first investigation for any testicular mass — highly sensitive (>95%), distinguishes intratesticular from extratesticular pathology. Tumour markers: AFP, hCG, LDH measured before orchiectomy (baseline for staging) and serially after (to confirm complete response or detect relapse). Radical orchiectomy (surgical removal of the entire testicle via inguinal approach): both diagnostic (histopathology confirms cancer type) and therapeutic. CT chest-abdomen-pelvis: staging — identifies lymph node metastases and visceral spread. Brain MRI/bone scan for poor prognosis or specific histologies.

What are the treatments?

Stage I seminoma (confined to testis): surveillance (preferred for most patients — 99% 5-year survival); or adjuvant radiation (obsolete — late effects) or carboplatin (1-2 cycles — for high-risk). Stage I NSGCT: surveillance (preferred for low-risk); adjuvant BEP x1 cycle or RPLND for high-risk (LVI, >50% embryonal carcinoma). Stage II-III: BEP chemotherapy — 3 cycles (good prognosis) or 4 cycles (intermediate/poor prognosis). Post-chemotherapy: residual masses (>1cm on CT) after NSGCT treatment require RPLND (approximately 45% contain viable teratoma requiring resection).

What is the BEP regimen?

BEP (Bleomycin-Etoposide-cisPlatin) is the standard chemotherapy for metastatic testicular GCT — developed by Lawrence Einhorn at Indiana University in 1977. Before cisplatin, disseminated testicular cancer had <10% long-term survival. BEP achieved approximately 70-80% complete remission with long-term cure in disseminated disease — one of oncology's greatest triumphs. Three cycles for good prognosis disease; four cycles for intermediate/poor. Bleomycin (but NOT in those with renal impairment or planned excessive exercise — pulmonary toxicity risk).

Can fertility be preserved?

Testicular cancer treatment — orchiectomy (removes one testis), cisplatin-based chemotherapy, and radiation — can impair fertility. Approximately 30% of testicular cancer patients have pre-existing spermatogenic abnormalities. Sperm banking before any gonadotoxic treatment is strongly recommended for all patients — even those with apparently stage I disease (where treatment may escalate). Post-treatment: fertility often returns (approximately 60-80% of men who desire fatherhood after testicular cancer treatment achieve it — naturally or with assisted reproduction).

What is surveillance for stage I testicular cancer?

Active surveillance — regular clinical assessment, tumour markers and CT scanning, with treatment initiated only if relapse occurs — is the preferred approach for many stage I testicular cancers. Stage I seminoma: 5-year relapse rate approximately 15-20% on surveillance (rising to >25% in large tumours); relapse is treated with radiation or chemotherapy; final cure rate 99%. Stage I NSGCT: 20-30% relapse on surveillance; relapsed patients treated with BEP; long-term cure rate approximately 98-99%. Surveillance avoids overtreatment of the 70-80% who will never relapse but requires compliance with 5+ years of CT follow-up.

How does GMJ News cover testicular cancer?

GMJ News covers GLOBOCAN testicular cancer data, BEP chemotherapy evidence and history, seminoma vs NSGCT distinction, surveillance strategies, fertility preservation, RPLND indications and the remarkable cure rates even in disseminated disease. Testicular cancer exemplifies what cisplatin-based oncology can achieve — directly relevant to PHIG's cancer programme and the Georgian Medical Journal's oncology coverage.

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Testicular Cancer

Q: Can fertility be preserved?

Testicular cancer treatment — orchiectomy (removes one testis), cisplatin-based chemotherapy, and radiation — can impair fertility. Approximately 30% of testicular cancer patients have pre-existing spermatogenic abnormalities. Sperm banking before any gonadotoxic treatment is strongly recommended for all patients — even those with apparently stage I disease (where treatment may escalate). Post-treatment: fertility often returns (approximately 60-80% of men who desire fatherhood after testicular cancer treatment achieve it — naturally or with assisted reproduction).

Q: What is surveillance for stage I testicular cancer?

Active surveillance — regular clinical assessment, tumour markers and CT scanning, with treatment initiated only if relapse occurs — is the preferred approach for many stage I testicular cancers. Stage I seminoma: 5-year relapse rate approximately 15-20% on surveillance (rising to >25% in large tumours); relapse is treated with radiation or chemotherapy; final cure rate 99%. Stage I NSGCT: 20-30% relapse on surveillance; relapsed patients treated with BEP; long-term cure rate approximately 98-99%. Surveillance avoids overtreatment of the 70-80% who will never relapse but requires compliance with 5+ years of CT follow-up.

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

Testicular cancer — with approximately 74,000 new cases per year globally — is the most common cancer in young men aged 15-35 and carries the distinction of being the most curable solid tumour in oncology: overall 5-year survival exceeds 95% globally, and even disseminated (stage III) testicular cancer achieves cure in approximately 70-80% of patients with cisplatin-based chemotherapy (IARC GLOBOCAN 2020). The BEP regimen (bleomycin, etoposide, cisplatin — developed at Indiana University by Lawrence Einhorn in 1974) transformed testicular cancer from a disease with <10% survival to one of oncology's greatest success stories. Tumour markers (AFP, hCG, LDH) are essential for diagnosis, staging, monitoring and relapse detection.

Key messages

Most curable solid tumour — 95%+ survival

Testicular cancer is the most common cancer in young men aged 15-35 and carries the distinction of being the most curable solid tumour in oncology — with overall 5-year survival exceeding 95% and even disseminated stage III disease achieving cure in approximately 70-80% of patients.

BEP chemotherapy — a landmark

The BEP regimen (bleomycin, etoposide, cisplatin) — developed by Lawrence Einhorn at Indiana University in 1977 — transformed testicular cancer from a disease with <10% survival in disseminated disease to one of oncology's greatest cures. Cisplatin was the key innovation.

Tumour markers are essential

AFP (alpha-fetoprotein), hCG (human chorionic gonadotropin) and LDH (lactate dehydrogenase) are essential for staging, monitoring treatment response, and detecting relapse. Rising markers after treatment = relapse; they often rise before imaging.

Cryptorchidism — the major risk factor

Undescended testis (cryptorchidism) is the strongest risk factor for testicular cancer — increasing risk approximately 3-5 fold. Orchiopexy (surgical correction) before puberty reduces (but does not eliminate) the cancer risk.

Two main types — seminoma and non-seminoma

Seminomas (approximately 50-55%): highly sensitive to radiation and cisplatin, excellent prognosis. Non-seminomas (teratoma, embryonal, yolk sac, choriocarcinoma, mixed germ cell tumours — approximately 45-50%): more aggressive but highly cisplatin-responsive.

Sperm banking before treatment

Chemotherapy and radiotherapy for testicular cancer can impair fertility. All patients should be offered sperm banking before any gonadotoxic treatment — even in apparently low-risk disease where treatment may unexpectedly escalate.

Key statistics

~74K

new testicular cancer cases/year (2020)

IARC GLOBOCAN

>95%

overall 5-year survival (all stages)

ESMO/ACS

70-80%

cure rate for disseminated (stage III) testicular cancer

ESMO

15-35yr

peak incidence age (most common cancer in young men)

IARC

3-5x

increased risk with cryptorchidism (undescended testis)

ESMO/EAU

1977

year BEP regimen developed — transforming outcomes

Einhorn/NEJM

Testicular cancer 5-year survival by stage — ESMO/SEER data

Source: ESMO/SEER. Exceptional prognosis even at advanced stage — the hallmark of testicular cancer.

Glossary of key terms

Seminoma
ESMO/EAUA germ cell tumour arising from seminiferous tubules — uniform cells with clear cytoplasm, resembling primitive germ cells. Comprises approximately 50-55% of testicular cancers. Highly radio- and chemosensitive. AFP is never elevated in pure seminoma (if AFP elevated with "seminoma" histology → treat as non-seminoma). Excellent prognosis.

Non-seminomatous germ cell tumours (NSGCTs)
ESMOEncompasses teratoma, embryonal carcinoma, yolk sac tumour, choriocarcinoma, and mixed germ cell tumours. AFP elevated in yolk sac; hCG elevated in choriocarcinoma and some embryonal. Require cisplatin-based chemotherapy (BEP or EP) for metastatic disease — not radiosensitive. Highly responsive to platinum.

BEP chemotherapy
ESMO/EinhornBleomycin + Etoposide + cisPlatin — the standard chemotherapy for metastatic testicular cancer. Developed by Lawrence Einhorn at Indiana University (1977). Cisplatin was the key advance — producing 70-80% complete remission in disseminated disease. 3 or 4 cycles depending on prognostic classification. BEP transformed testicular cancer mortality.

IGCCCG staging (International Germ Cell Cancer Collaborative Group)
ESMOThe global staging system for metastatic testicular cancer — classifying patients as good, intermediate or poor prognosis based on primary tumour site, AFP/hCG/LDH levels, and metastatic sites. Determines number of BEP cycles (3 for good prognosis; 4 for intermediate/poor) and surveillance intensity.

RPLND (Retroperitoneal lymph node dissection)
EAU/ESMOSurgical removal of retroperitoneal lymph nodes — used in non-seminoma stage I (primary RPLND) or after chemotherapy for residual retroperitoneal masses. Post-chemotherapy RPLND reveals teratoma in approximately 45%, necrosis/fibrosis 45%, viable cancer 10% — pathological result guides further management.

Surveillance strategy
ESMO/EAUActive surveillance (no adjuvant treatment, close monitoring with CT and markers) is the preferred approach for stage I seminoma after orchiectomy (98-99% 5-year survival — relapse treated at that point). Also an option for stage I NSGCT. Avoids overtreatment; requires patient compliance with CT follow-up (2+ years of regular imaging).