Most commonly, patients will present with a 'self' detected mass in the involved testis. The mass is usually painless but occasionally pain and dragging may be described.
Other modes of presentation include:

  • Incidental finding on imaging or bloods performed for unrelated problems
  • Symptoms of metastatic disease (very rare for seminoma)

Initial Consult

History of Presenting Complaint

  • When the lump was first noticed
  • Any symptoms associated with the lump

Past Medical History

  • Previous inguinal surgery
  • Undescended testis as a child
  • Other medical problems


  • Standard questions only

Family History

  • Any history of germ cell tumours in the family (about 1 - 2% hereditary)

Social History

  • Current fertility status (subfertility is commonly associated with malignancy)
  • Plans for further children (radiotherapy may render patient sterile)
  • Ability to attend radiotherapy
  • Home supports
  • Work


  • Examine contralateral testis (50 fold increased risk for development of disease in other testis)
  • Examine location of scar (dissemination of disease to scrotum can cause lymphatic spread to inguinal and iliac nodes)
  • Examine lymph nodes of inguinal region, supraclavicular fossa and axilla (possible sites of spread for advanced disease)
  • Examine chest (common site of haematogenous spread)
  • Examine abdomen (for bulky abdominal nodes, liver metastases)


  • Must be staged with CT Chest/Abdomen/Pelvis to identify lymphatic/haematogenous metastases
  • AFP / β-hCG / LDH commonly performed but usually negative in seminoma (β-hCG may be elevated in a population with syncytiotrophoblasts mixed with seminoma cells)
    • These are useful markers if disease has transformed to a more aggressive form (teratoma, choriocarcinoma)


TNM Staging

TNM staging is unusual for testicular malignancy, as metastatic disease is Stage III, there is no Stage IV, and tumour markers are included in staging.

T Stage

T0 - No evidence of primary tumour
Tis - Intratubular germ cell neoplasia (carcinoma in situ)
T1 - Limited to testis/epididymis, no lymphovascular invasion, may invade tunica albuginea but not tunica vaginalis
T2 - As for T1 but with lymphovascular invasion and/or the tunia vaginalis
T3 - Invasion of spermatic cord
T4 - Invasion of scrotum

N Stage

N0 - No evidence of lymph node metastases
N1 - Involvement of para-aortic lymph nodes, no mass < 2 cm
N2 - Involvement of para-aortic lymph nodes, individual masses 2 - 5 cm
N3 - Involvement of para-aortic lymph nodes, at least one mass > 5 cm

M Stage

M0 - No evidence of distant metastases
M1a - Other lymphadenopathy or pulmonary metastases
M1b - Metastases to other areas

S Stage

Stage β-hCG AFP LDH
S0 Not elevated Not elevated Not elevated
S1 < 5,000 < 1,000 < 1.5 × normal
S2 5,000 - 10,000 1,000 - 10,000 1.5 - 10 × normal
S3 > 10,000 > 10,000 > 10 × normal

Final Stage

Stage T stage N stage M stage S stage
0 Tis N0 M0 S0
IA T1 N0 M0 S0
IB T2-4 N0 M0 S0
IS Any N0 M0 S1-3
IIA Any N1 M0 S0-1
IIB Any N2 M0 S0-1
IIC Any N3 M0 S0-1
IIIA Any Any M1a S0-1
IIIB Any Any M1a S2
IIIC Any Any M1a S3
IIIC Any Any M1b Any