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Health condition · Clinically reviewed

Testicular cancer, the most curable solid cancer — modern staging and BEP chemotherapy.

Germ-cell tumours in young men, largely curable — even metastatic disease. Orchidectomy and BEP chemotherapy remain the mainstays; surveillance protocols preserve fertility for many.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced, not summarised

    Every claim is checked against NICE, EAU or a peer-reviewed source you can see at the end.

  • 03

    Updated for 2026

    Reflects current UK guidance on orchidectomy, BEP chemotherapy and modern surveillance protocols.

Key facts

Testicular cancer at a glance.

The essentials, in plain English — what it is, who gets it, how it’s diagnosed in the UK today, and why cure rates are so high.

  • What it is

    A germ-cell tumour of the testis — either seminoma or non-seminoma (NSGCT).

  • Peak incidence

    Most common in men aged 15–35 years — the leading solid cancer in young men.

  • Prognosis

    The most curable solid cancer — around 95% overall survival across all stages.

  • Reference test

    Scrotal ultrasound is the first-line imaging investigation for any testicular lump.

  • First treatment

    Radical inguinal orchidectomy is the first step in almost every case.

  • Fertility

    Sperm banking before any treatment is essential — chemotherapy and radiotherapy affect fertility.

Why this guide matters

Curable — even when it has spread.

Testicular cancer is uniquely chemosensitive. Prompt diagnosis, sperm banking and BEP chemotherapy give the vast majority of patients a normal life expectancy.

  • A lump means an ultrasound

    Any new painless testicular lump needs a scrotal ultrasound — the reference test — without delay.

  • Orchidectomy comes first

    A radical inguinal orchidectomy gives tissue for diagnosis and is the starting point of nearly every treatment plan.

  • Fertility is protected by planning

    Sperm banking before treatment safeguards future fertility — it should be offered to every patient.

How the diagnosis is made

From a lump to a clear plan.

The pathway UK uro-oncology teams follow, in order — so you know what to expect from ultrasound to MDT decision.

  1. 01

    Assessing

    Self-examination + ultrasound scrotum

    A testicular lump found on self-examination is imaged with a scrotal ultrasound — the reference test.

  2. 02

    Assessing

    Tumour markers (AFP, β-hCG, LDH)

    Serum markers help classify the tumour, assess prognosis and follow response to treatment.

  3. 03

    Assessing

    CT chest/abdomen/pelvis

    Staging CT looks for retroperitoneal, lung and other distant disease before treatment.

  4. 04

    Confirming

    Radical inguinal orchidectomy + histology

    Removal of the affected testis through an inguinal incision gives tissue for definitive diagnosis.

  5. 05

    Confirming

    MRI brain if raised hCG

    A markedly raised β-hCG or symptoms prompt MRI brain to exclude cerebral metastases.

  6. 06

    Planning

    Post-op markers

    Repeat AFP, β-hCG and LDH after orchidectomy help confirm complete resection and guide next steps.

  7. 07

    Planning

    Uro-oncology MDT

    A specialist multi-disciplinary team recommends surveillance, chemotherapy or radiotherapy by stage and risk.

Typical timeline: 2–4 weeks from ultrasound to a treatment plan.

Symptoms

What testicular cancer actually shows up as.

A painless lump is the classic sign — but heaviness, ache or breast tissue changes can also be the first clue. Here is what to watch for and when to act.

  • Painless testicular lump

    A firm, painless lump within the testis is the classic presentation — always warrants a scrotal ultrasound.

  • Testicular ache

    A dull ache or discomfort in the testis or scrotum may accompany or precede a lump.

  • Heaviness sensation

    A sensation of heaviness or fullness in the scrotum, often described as a dragging feeling.

  • Gynaecomastia (hCG-related)

    Breast tissue enlargement can occur when a germ-cell tumour secretes β-hCG.

  • Back pain (retroperitoneal)

    Persistent lower back pain can reflect bulky retroperitoneal lymph-node disease.

  • Breathlessness (lung mets)

    New breathlessness may signal pulmonary metastases from advanced disease.

  • Indurated testis

    A hard, woody testis on examination is highly suspicious and needs urgent imaging.

  • Red flag

    SVC obstruction or choriocarcinoma syndrome (massive haemoptysis) — call 999.

Treatment

How testicular cancer is treated in the UK.

Treatment is chosen by stage and histology — from orchidectomy alone with surveillance, through BEP chemotherapy, to selective radiotherapy and salvage regimens.

  • Radical inguinal orchidectomy

    Removal of the affected testis through the groin — first treatment for almost every testicular tumour.

  • Surveillance (stage I seminoma / NSGCT)

    Structured follow-up with markers and imaging — safe for many stage I tumours, avoiding chemotherapy.

  • Adjuvant carboplatin (stage I seminoma)

    A single cycle of carboplatin reduces relapse risk in selected stage I seminoma.

  • BEP chemotherapy

    Bleomycin, etoposide and cisplatin — the standard curative regimen for metastatic germ-cell tumours.

  • Retroperitoneal lymph-node dissection

    Surgical removal of residual retroperitoneal masses after chemotherapy in selected NSGCT cases.

  • Radiotherapy (para-aortic, seminoma)

    Para-aortic radiotherapy is an option for selected stage IIA/B seminoma.

  • High-dose chemotherapy + stem-cell rescue

    Reserved for relapsed or refractory germ-cell tumours after standard chemotherapy.

  • Sperm banking prior to treatment

    Cryopreservation of sperm before orchidectomy or chemotherapy protects future fertility.

What this guide is based on

The sources behind every number on this page.

UK and European guidance, specialist society standards and patient-organisation resources, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or uro-oncology team knows your history and can tell you which parts apply to you.

  • National Institute for Health and Care Excellence (NICE). Testicular cancer guidance.

  • European Association of Urology (EAU). Guidelines on testicular cancer.

  • Movember Foundation. Testicular cancer patient information.

  • Orchid Male Cancer. Patient resources and support.

Red flags

When testicular cancer becomes an emergency.

Most of the pathway is planned and predictable. These are the situations that need same-day action — from choriocarcinoma syndrome to neutropenic sepsis on BEP.

  • Choriocarcinoma syndrome

    Massive haemoptysis from pulmonary metastases in a patient with very high β-hCG — a medical emergency.

  • SVC obstruction

    Facial swelling, distended neck veins and breathlessness from a bulky mediastinal mass — same-day assessment.

  • Cord compression

    New back pain with leg weakness, numbness or bladder/bowel change — call 999 or attend A&E immediately.

  • Neutropenic sepsis on BEP

    Fever above 38°C during chemotherapy — an emergency; ring the acute oncology line without delay.

  • Bleomycin lung toxicity

    New dry cough or exertional breathlessness during or after BEP — needs urgent oncology review.

  • Post-op complications

    Fever, spreading redness, severe pain or bleeding after orchidectomy — seek urgent help.

  • Fertility loss without banking

    Starting chemotherapy or radiotherapy without sperm banking risks permanent loss of fertility.

  • Late relapse >5 years

    Germ-cell tumours can relapse late — persistent symptoms years after treatment deserve review.

  • Contralateral primary

    A new lump in the remaining testis needs urgent ultrasound — around 2% risk of a second primary.

Living with it

A curable cancer, with long-term follow-up.

Four things that make the biggest difference — monitoring, fertility, late effects and specialist follow-up.

A quiet reminder

Bank sperm before treatment starts.

Fertility, cardiovascular follow-up and clear surveillance schedules all work best when they’re set up from the start.

  1. 01 Monitoring

    Markers and imaging drive follow-up

    AFP, β-hCG and LDH, plus scheduled CT or MRI, form the backbone of surveillance after treatment.

  2. 02 Fertility

    Sperm banking is worth it

    Even if you feel ready to start treatment straight away, cryopreservation before orchidectomy protects your options.

  3. 03 Late effects

    Cardiovascular and metabolic health

    Cisplatin-based chemotherapy has long-term cardiovascular effects — annual blood pressure, lipids and lifestyle review matter.

  4. 04 Reviews

    Structured uro-oncology follow-up

    Regular clinic reviews, tailored to your stage and treatment, catch the small number of relapses early.

Frequently asked

Everything we get asked about testicular cancer.

Quick answers on ultrasound, markers, BEP chemotherapy, sperm banking and when to worry.

  • What is testicular cancer?

    Testicular cancer is a germ-cell tumour arising from the cells of the testis — either a seminoma or a non-seminoma (NSGCT). It is the most common solid cancer in young men aged 15–35 and one of the most curable, with around 95% overall survival.

  • What is the first test if I find a lump?

    A scrotal ultrasound is the reference test for any testicular lump. If cancer is suspected, blood tumour markers (AFP, β-hCG, LDH) and a staging CT chest/abdomen/pelvis follow before radical inguinal orchidectomy.

  • Why is sperm banking important?

    Chemotherapy and radiotherapy for testicular cancer can permanently affect fertility. Cryopreserving sperm before orchidectomy or systemic treatment protects your ability to have biological children later — it should always be offered.

  • What is BEP chemotherapy?

    BEP is the combination of bleomycin, etoposide and cisplatin, given in three or four cycles. It is the standard curative regimen for metastatic germ-cell tumours and cures most patients, even those with advanced disease.

  • Can testicular cancer be cured if it has spread?

    Yes. Even with lung, liver or brain metastases, cure rates remain high — testicular cancer is uniquely chemosensitive. BEP chemotherapy, sometimes followed by surgery to remove residual masses, cures the majority of patients with metastatic disease.

  • When should I worry about symptoms?

    Any new painless testicular lump, hardening of the testis or persistent scrotal ache warrants an urgent scrotal ultrasound. Massive haemoptysis, facial swelling with breathlessness, or leg weakness with back pain — call 999.

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