Testicular Cancer Symptoms, Diagnosis, and Early Evaluation

Health & Wellness

When ABC News correspondent Will Reeve publicly shared his experience with testicular cancer, the revelation brought renewed attention to how subtly early symptoms can present and why timely medical evaluation matters. He was 34, newly married, and working as an ABC News correspondent. In April, he noticed a tender lump during a routine shower that he initially assumed would resolve on its own. After his wife, Amanda, urged him to seek a medical evaluation, an ultrasound revealed a suspicious mass. His treatment included an orchiectomy in May and a retroperitoneal lymph node dissection (RPLND) in June. Three of the lymph nodes removed during the procedure tested positive for cancer, after which Reeve underwent two cycles of chemotherapy. At a September 8 checkup, Reeve said he was cancer-free. His journey illustrates a central reality: being young does not rule out serious illness, and a new physical change should not automatically be dismissed as harmless.

Differentiating Scrotal Masses

Scrotal masses and swelling are common, but determining whether an abnormality is benign or malignant cannot be done reliably through self-palpation alone. Several benign scrotal conditions share clinical features with testicular malignancies, highlighting why clinical evaluation and appropriate imaging are important.

Condition	Typical Presentation	Why It Can Be Confused With Testicular Cancer
Testicular Cancer	Firm, discrete lump or enlargement arising within the testicle	Can present with or without pain or local tenderness, which may mimic acute inflammation or benign swelling.
Epididymitis / Orchitis	Pain, tenderness, swelling, and sometimes fever or urinary symptoms	Inflammation can produce a noticeable scrotal abnormality or enlargement that can be mistaken for tumor growth.
Hydrocele	A fluid-filled swelling around the testicle that feels soft and fluctuant	Fluid accumulation can obscure the underlying testicle, making manual examination difficult.
Varicocele	Enlarged veins that can feel like a "bag of worms," often more noticeable when standing	Dilated venous clusters can present as an asymmetric scrotal mass or heaviness.
Spermatocele	A smooth, usually painless cyst arising from the epididymis rather than the testicle itself	A distinct cystic nodule adjacent to the testicle can easily be mistaken for an intratesticular mass.

Diagnostic Pathway: Imaging, Markers, and Surgical Confirmation

When an intratesticular abnormality is suspected, clinical evaluation typically combines physical examination, imaging, serum tumor markers, and, when cancer is strongly suspected, surgical tissue diagnosis.

Diagnostic Ultrasound

Scrotal ultrasound is often the first imaging test used to evaluate a suspicious testicular mass. It can help determine whether an abnormality is inside the testicle and whether it appears solid or fluid-filled. Intratesticular solid masses are more concerning for malignancy, while many extratesticular and purely cystic lesions have benign causes.

Serum Tumor Markers

Blood tests measuring specific proteins are drawn prior to surgery to assist in evaluation and staging:

• Alpha-fetoprotein (AFP): Can be elevated in nonseminomatous germ cell tumors; an unexplained tumor-associated AFP elevation is not consistent with a pure seminoma.
• Human chorionic gonadotropin (beta-hCG): Can be elevated in both seminomas and nonseminomas.
• Lactate dehydrogenase (LDH): A less specific marker that can be elevated in testicular cancer and contributes to staging and disease monitoring.

These markers can help with staging and treatment planning and can also be followed over time to monitor the disease, but tumor-marker levels alone do not establish or rule out a diagnosis.

Surgical Tissue Diagnosis

A transscrotal needle biopsy is generally avoided when testicular cancer is suspected because of the risk of local tumor spread. A radical inguinal orchiectomy removes the affected testicle through an incision in the groin rather than through the scrotum. This approach provides tissue for a definitive diagnosis while avoiding the local spread concerns associated with a transscrotal biopsy. Additional surgery or chemotherapy may be needed depending on whether the cancer has spread.

Fertility Preservation and Treatment Impacts

Because testicular cancer often affects men in their reproductive years, fertility should be discussed promptly after diagnosis and before treatments that could impair reproductive function.

Some men with testicular cancer have reduced sperm counts even before treatment, and cancer treatment can further affect fertility. Removing one testicle usually does not eliminate fertility or testosterone production when the remaining testicle is healthy. Chemotherapy can reduce sperm production, while retroperitoneal lymph node surgery can sometimes affect ejaculation if nerves involved in ejaculation are damaged. Radiation therapy can also impair fertility in patients who receive it.

The 2025 ASCO fertility-preservation guideline recommends discussing reproductive risks at diagnosis and offering sperm cryopreservation to pubertal and postpubertal males before cancer-directed treatment. In Reeve's case, he and his wife went directly to a sperm bank the day after his diagnosis to bank sperm prior to surgical intervention and systemic therapy, preserving options for future family building, including assisted reproductive treatment such as IVF.

Prognosis and Staging

Testicular cancer is highly treatable, and current survival statistics remain very favorable, particularly when the disease has not spread beyond the testicle. The American Cancer Society tracks survival outcomes using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, based on men diagnosed between 2015 and 2021:

SEER Stage (Disease Extent)	5-Year Relative Survival Rate	Disease Extent Description
Localized	99%	Cancer is confined entirely within the testicle.
Regional	96%	Cancer has spread outside the testicle to nearby structures or lymph nodes.
Distant	72%	Cancer has spread to distant parts of the body.

These are SEER summary stages and should not be read as a one-to-one equivalent of AJCC Stage I, II, or III.

These statistics describe populations, not an individual patient's prognosis. They do, however, show how strongly the extent of disease is associated with survival.

Testicular Self-Exams: Guidelines and Practical Takeaways

Advice regarding routine self-examination reflects different clinical perspectives across organizations:

The American Cancer Society does not present routine monthly testicular self-examination as a blanket recommendation for all men. Its current guidance notes that some doctors recommend monthly exams, while men with certain risk factors should seriously consider them and discuss the approach with their doctor. Instead, the ACS advises men to be aware of testicular cancer and to see a doctor promptly if they notice a lump or other unexplained changes in the size, shape, or consistency of a testicle.

The USPSTF's current posted recommendation, issued in 2011, advises against routine screening for testicular cancer in asymptomatic adolescent and adult men. The task force found insufficient evidence that self-examination or clinician examination improves detection at more curable stages and noted potential harms such as false-positive results, anxiety, and harms from unnecessary diagnostic tests or procedures.

These positions address screening in asymptomatic men; they do not mean that a man who notices a new lump or other change should wait or avoid medical evaluation.

The key point is that a monthly self-exam should not be presented as a universal requirement for every man. Whatever approach you take, the practical goal is to know what is normal for you and recognize new changes:

• Examine when relaxed: A warm shower or bath relaxes the scrotal skin, making it easier to feel the testicles.
• Understand normal anatomy: The epididymis is a soft, cord-like structure located at the back of each testicle. Recognizing this structure prevents mistaking normal tissue for a growth.
• Identify new changes: Look for a new lump, swelling, or noticeable change in the size, shape, or firmness of either testicle.

The lesson is not that every lump is cancer or that finding cancer early guarantees a cure. It is that a new or unexplained change deserves evaluation rather than dismissal simply because you are young or because it does not hurt. Any new testicular lump, swelling, change in size or firmness, persistent heaviness, or unexplained scrotal change warrants prompt medical evaluation. A clinician can determine whether a scrotal ultrasound or other testing is needed.

---

Sources and Medical References

• People: GMA's Will Reeve Reveals the First Sign of Testicular Cancer He Nearly Dismissed
• People: Will Reeve Says He and Wife Amanda Went 'Right to the Sperm Bank' After His Testicular Cancer Diagnosis
• ABC News: ABC News' Will Reeve Reveals Testicular Cancer Diagnosis, Chemotherapy Treatment
• American Cancer Society: Can Testicular Cancer Be Found Early?
• American Cancer Society: Survival Rates for Testicular Cancer (SEER 2015–2021)
• National Cancer Institute (PDQ®): Testicular Cancer Treatment – Health Professional Version
• American Society of Clinical Oncology (ASCO): Fertility Preservation in People With Cancer Guideline Update
• U.S. Preventive Services Task Force (USPSTF): Screening for Testicular Cancer Recommendation

Medical Notice: This article provides general educational information based on publicly available clinical guidance from the American Cancer Society, National Cancer Institute, ASCO, and USPSTF, along with reporting on Will Reeve's experience. It is not a substitute for individualized medical advice. Anyone with a new or unusual lump, swelling, or persistent pain in the testicular or scrotal area should seek evaluation from a qualified healthcare professional.