Testicular cancer is a relatively uncommon cancer but one that can cause extreme distress to the roughly 9,600 American men estimated to be diagnosed in 2020.﻿﻿ As there are no screening tests available to detect the disease, detection depends largely on your ability to spot its common (and not-so-common) symptoms, which may include a lump in the testicle, a heaviness in the scrotum, testicular pain, fatigue, lower back pain, and unexplained weight loss.

By knowing the signs and symptoms of testicular cancer, you can be diagnosed and treated early and, more often than not, achieve complete remission.

Illustration by Joshua Seong, Verywell

Frequent Symptoms

The most common sign of testicular cancer (also known as malignant neoplasm of the testes) is a lump in one and sometimes both testicles.﻿﻿ The lump is usually found while taking a shower, when performing a routine testicular self-exam (TSE), or by your partner during sex.

Testicular lumps are most often painless, although some do cause pain. They can also be movable or immovable. Some tumors may be smaller than a pea, while others can be larger than a marble. Many of the tumors will feel hard and rock-like.

Other common signs and symptoms include:

A feeling of heaviness in the scrotum

A dull ache or sharp pain in the scrotum or lower abdomen

The swelling of one testicle but not the other

The accumulation of fluid in a testicle

While a testicular lump can be scary, it doesn’t necessarily mean that you have cancer. There can be many different explanations for this of which cancer may be the least likely. With that being said, you should never ignore a testicular lump or any other symptoms suggestive of cancer.

Some men with testicular cancer may have no symptoms and will only be diagnosed during an unrelated medical exam (such as a fertility test or routine physical).﻿﻿

Rare Symptoms

There is a rare type called testicular choriocarcinoma that is extremely aggressive and is more likely to spread to the lungs, bones, and brain. Other uncommon forms, like embryonal carcinoma, are also more prone to metastasis.

Testicular cancers like these can trigger the excessive production of a hormone known as human chorionic gonadotropin (HCG), also known as the "pregnancy hormone." If this occurs, a man may experience gynecomastia, the abnormal enlargement of breast tissue.﻿﻿

Other types can cause gynecomastia by increasing the production of the female hormone, estrogen. One such example is Leydig cell tumors of which 10% will develop into testicular cancer.﻿﻿

While testicular cancer is exceedingly rare before the age of 14, it can occasionally occur. If it does, early puberty (also known as precocious puberty) may be the first sign. The condition is most often associated with the development of Leydig cell tumors.

Later-Stage Symptoms

If left undiagnosed and untreated, testicular cancer may begin to spread, moving from the site of the original tumor (known as stage 1 cancer) to nearby lymph nodes (stage 2) and, finally, to distant organ systems (stage 3). The original cancer is referred to as the primary tumor, while the site of the new cancer is known as either a secondary or metastatic tumor.

If metastasis does occur, the symptoms can vary based on the location of the secondary tumor. Among the possible signs and symptoms:﻿﻿

Lower back pain may develop if the cancer starts to spread to nearby lymph nodes.

Swollen lymph nodes may develop in the neck as the cancer further spreads to distant organs.

Swelling and pain of the lower extremities may be a sign of a blood clot known as deep vein thrombosis (DVT). As cancer progresses, it places people in a hypercoagulative state wherein blood cells called platelets will begin to stick together abnormally. ﻿ ﻿

﻿ Shortness of breath (dyspnea), a chronic cough, or the coughing up blood (hemoptysis) can occur if the malignancy spread to the lungs. This is typically associated with the formation of a blood clot in the lungs known as a pulmonary embolism.

Headaches, confusion, and other neurological symptoms may develop if a secondary tumor is established in the brain.

Chronic fatigue and unexplained weight loss are common signs of late-stage cancer.

When to See a Doctor

If you discover a lump on your testicle, see your doctor as soon as you can. While it is important to be proactive and vigilant, try not to jump to conclusions or let anxiety get the best of you.

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According to the National Cancer Institute, only around six of every 100,000 American men are diagnosed with testicular cancer each year, making it one of the least common causes of cancer in the United States.﻿﻿ Unless you are at high risk, the chances are pretty good you’ll be cancer-free.

Some of the more likely causes of testicular lump are infection and injury, either of the testicle itself or the tube through which sperm is transported from the testicle (called the epididymis).

On the off-chance you do have cancer, treatment is such that more than 95% of cases have a five-year survival rate , including 73% of men diagnosed with metastatic disease.﻿﻿