What is a testicular tumor?
Any new growth of tissue in the testicle is called a testicular tumor. In children it is very rare: about 0.5–2 in every 100,000 children, most often between 0 and 4 years of age.
The question that worries parents most is cancer. In boys before puberty, most testicular tumors (60–75%) are benign. The most common type is a teratoma, which behaves benignly in young children. Among malignant tumors, the most common is the yolk sac tumor, usually in the first two years of life.
This page is about boys before puberty. In teenagers, testicular tumors behave like those in adults and need a different approach.
Signs
- a painless lump, firm area or enlargement of the testicle: this is the main sign in more than 90% of children,
- some children also have fluid around the testicle (hydrocele),
- very rarely, with a hormone-producing tumor, signs of early puberty.
A tumor is usually not painful. Sudden, severe pain may be testicular torsion and needs urgent care.
How soon should we see a doctor?
A painless lump does not need a night-time trip to the emergency department. But do not wait for it to “go away on its own” either. Have a pediatric urologist see your child within a few days. If a tumor is confirmed, surgery is also planned without delay, preferably within a few days.
Diagnosis
- Ultrasound: a high-resolution ultrasound, preferably with Doppler, almost always shows the tumor. But ultrasound alone cannot always tell a benign tumor from a malignant one.
- Alpha-fetoprotein (AFP) blood test: done before surgery. More than 90% of yolk sac tumors produce this substance. In the first months of life AFP is normally high and falls gradually by about one year, so the doctor interprets the result for the child’s age.
- If the tumor turns out to be malignant, an MRI of the abdomen and a CT of the chest are done to look for spread.
Treatment
Treatment is surgery, usually done through the groin.
- Whenever possible, testis-sparing surgery is done: only the tumor is removed and the healthy testicular tissue is kept. This is recommended for all benign tumors.
- The removed tissue can be checked under the microscope during the operation (frozen section). This helps confirm that the tumor is benign and has been completely removed.
- The testicle is removed only if no healthy tissue is left or the tests point to a malignant tumor.
- If the tumor has spread beyond the testicle, treatment is shared with pediatric oncologists.
After surgery
After surgery, a testicular ultrasound is usually done every 3–6 months during the first year. For a yolk sac tumor, AFP and an abdominal MRI are checked regularly during the first 2–3 years under the care of pediatric oncologists.
When to seek urgent care
If any of the following is present, do not wait for a routine appointment: call the doctor or go to the nearest emergency department.
- Sudden, severe pain, swelling or redness of the testicle (this may be torsion)
- Pain together with nausea and vomiting
Call your local emergency number (112 in Europe, 911 in North America)
Note for pediatricians and family doctors
Prepubertal testicular tumors have an incidence of 0.5–2 per 100,000 children, with a peak between 0 and 4 years; 60–75% are benign. Teratomas are the largest group (about 40% of intratesticular tumors, median age 13 months) and behave benignly before puberty. Yolk sac tumor is the main prepubertal malignant germ cell tumor (about 15%) and usually occurs in the first two years of life. More than 90% present with a painless scrotal mass, and 15–50% have a hydrocele; a Leydig cell tumor should be considered in boys with early puberty, high testosterone and low gonadotropins. EAU recommendations (all strong): high-resolution ultrasound (7.5–12.5 MHz), preferably Doppler; AFP before surgery; surgical exploration with the option of frozen section; testis-sparing surgery in all benign tumors; staging (abdominal MRI, chest CT) only in malignant tumors; multidisciplinary treatment with pediatric oncologists for tumors that are not organ-confined. AFP is physiologically high in the first months of life and may take up to 12 months to reach normal values. Surgery is not an emergency but should be scheduled promptly, preferably within the next few days; the panel favors an inguinal approach, with a scrotal approach possible in selected cases. Orchiectomy should be considered only if no normal testicular parenchyma is detectable on ultrasound and/or AFP is above 100 ng/mL in a boy older than 12 months.
What happens at the visit?
- The scrotum and groin are examined, and a Doppler ultrasound of the testicle is done.
- AFP is measured before surgery, and the result is interpreted for the child's age.
- We discuss the surgical plan with the parents, testis-sparing whenever possible, and joint care with pediatric oncologists when needed.
Frequently asked questions
The ultrasound shows a tumor. Does my child have cancer?
Not necessarily. In young children most testicular tumors are benign, and the most common one is a teratoma. The exact type can only be confirmed by examining the tissue removed at surgery.
Will he be able to father children?
With benign tumors the testicle is usually kept. Even if a testicle has to be removed, the other healthy testicle makes enough hormones and sperm.
What does follow-up look like after surgery?
Usually an ultrasound every 3–6 months during the first year. For a malignant tumor, follow-up is closer and shared with pediatric oncologists, including AFP and MRI.
Related topics
- Hydrocele Testicular hydrocele, fluid in the scrotum Condition
- Testicular torsion Twisted testicle, acute testicular pain Condition
- Epididymal cyst Spermatocele, cyst above the testicle Condition
- Undescended testicle Cryptorchidism, testicle not in the scrotum Condition
- Epididymitis and orchitis Inflammation of the testicle and epididymis Condition
Sources
This information is for educational purposes and does not replace medical advice. Decisions about your child’s treatment are made with the doctor after an examination.
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