Around 900 men in the Netherlands are diagnosed with testicular cancer each year. It is the most common cancer in young men between 18 and 39, and more than 90 percent of them are still alive ten years after diagnosis. Those figures come from the Netherlands Cancer Registry.
I put those two numbers next to each other on purpose. Rare enough not to panic, serious enough not to wait, and highly treatable if you are early.
And then the question this piece is really about. Can you find this with a blood test? We sell blood tests, and the honest answer is no.
What are the symptoms of testicular cancer?
The best-known sign is a lump in the testicle that feels hard and usually does not hurt. A testicle may also become larger, heavier or firmer than the other one. Some men mainly notice a dull, heavy feeling in the scrotum or lower abdomen. Pain is often exactly what is missing.
That last part is precisely why this goes unnoticed for so long.
We are wired to take pain seriously and to ignore silence. With this organ, that instinct works against you.
According to Thuisarts, the Dutch GP information service, the testicle then feels larger, or has lumps on it. Most men find it themselves, by chance, in the shower.
What does a malignant lump in your testicle feel like?
Usually like a hard, immobile bump on or in the testicle itself, often roughly the size of a pea, and usually painless. It belongs to the testicle rather than sitting behind or above it. Importantly: feel alone establishes nothing, because harmless swellings are far more common.
That last sentence is the heart of it, so let me stay there a moment.
Most lumps and swellings in a scrotum are benign. Cysts, fluid collections and widened veins are together far more common than a tumour. They also feel different, though that difference can never be settled at home.
Below is roughly where those differences sit. Read it as context for the conversation with your GP, not as a test you run on yourself.
| What you feel | Where it sits | Does it hurt | What it often is |
|---|---|---|---|
| Hard, firm bump in the testicle | On or in the testicle itself | Usually not | A reason to always get it checked |
| Soft, round bead above or behind the testicle | At the epididymis, separate from the testicle | Usually not | Often an epididymal cyst |
| Soft swelling that surrounds the whole testicle | Around the testicle | Usually not | Often a fluid collection (hydrocele) |
| A bundle that feels like a bag of worms | Above the testicle, worse when standing | Sometimes nagging | Often a varicocele |
| Warm, painful swelling that built over days | Behind and above the testicle | Yes, clearly | Often epididymitis |
If you see yourself in the top row, the next step is simple and boring: book an appointment with your GP. If you see yourself in any of the other rows, the next step is exactly the same.
That is not laziness on my part. It is that nobody, not even a doctor, reliably makes this distinction on feel alone. That is what an ultrasound is for.
Can a blood test detect testicular cancer?
No. There is no blood test that finds testicular cancer in men without symptoms, and a normal result does not rule a tumour out. The European guideline on testicular cancer states literally that current tumour markers have limitations due to their low sensitivity, because normal levels do not exclude the presence of disease.
That is an awkward sentence for a company that sells blood tests. It stands anyway.
In fact, the US preventive services task force explicitly recommends against routine screening in men without symptoms (PMID 29671528). Not because the disease does not matter, but because testing people without symptoms does more harm than good here.
Picture what a reassuring, normal marker value would do to you while you can feel a hard lump. You wait. You put off the appointment. And that is exactly the risk.
So if you feel something: have a doctor feel it. Do not get a blood draw.
So what do AFP, hCG and LDH actually do?
They belong to diagnosis, staging and follow-up, not to finding disease. Doctors measure AFP, hCG and LDH once there is already a suspicion or a diagnosis. Their level helps estimate the stage and the prognosis, and after treatment, falling or rising values show whether it is working or coming back.
They are measuring tapes for something you have already found.
In non-seminoma tumours, up to roughly 90 percent have a raised AFP or hCG at diagnosis. In pure seminomas it is different: hCG is raised in around 30 percent, and therefore not in most of them.
| Value | What it does do | What it does not do |
|---|---|---|
| AFP | Helps establish tumour type and stage, and track the course | Prove or exclude a tumour in someone without symptoms |
| hCG | Same role, raised in a share of tumours | Staying reliably normal does not mean there is nothing there |
| LDH | Says something about tumour mass and prognosis | Be specific, since LDH also rises from exercise, muscle damage and much else |
That last row is a neat illustration. LDH rises just as happily after a heavy training week, something we work through in our piece on high LDH.
A standalone marker value in a healthy man is therefore mostly a source of needless worry or false calm. Neither one helps you.
Who gets testicular cancer?
Mainly young men. It is the most common cancer in men between 18 and 39, and a major review in JAMA calls it the most common solid tumour in males aged 15 to 40 (PMID 39899286). That makes it unusual: most cancers hit older people.
The Dutch numbers are also climbing.
According to the Netherlands Cancer Registry, incidence doubled between 2000 and 2024, from 5 to 10 per 100,000 men. Why exactly, nobody knows for sure.
And then the number to hold on to if you are reading this with a knot in your stomach: according to Thuisarts, around 95 percent of men recover. In the JAMA review, five-year survival is 99 percent at stage I.
Being early is almost everything here. That is also the only argument I need.
What happens when you go to the GP?
Your GP feels both testicles and compares them. If there is any doubt, an ultrasound of the scrotum follows, usually within a short time, and that scan does not hurt. If something is found, they refer you to a urologist, and only in that pathway do the blood values come into play.
The whole visit takes ten minutes and is less awkward than you are imagining right now.
I know the hesitation. You are 27, you feel something small, and you have invented a hundred reasons why it is nothing. That is human, and it is the most expensive form of delay I know.
What your testicles normally do, and which blood values genuinely report on that, is covered in testicles: how they work. Which pain is urgent is in testicle pain. And the broader story about having children is in our guide to male fertility.
But if, right now, while reading this, you are thinking about a hard lump you felt yesterday: close this tab and call your GP.
References
- Patrikidou A, et al. European Association of Urology Guidelines on Testicular Cancer: 2023 Update. European Urology. 2023. PMID 37183161.
- Baird DC, et al. Testicular Cancer: Diagnosis and Treatment. American Family Physician. 2018. PMID 29671528.
- Singla N, et al. Testicular Germ Cell Tumors: A Review. JAMA. 2025. PMID 39899286.
- Marshall C, et al. Serum tumor markers and testicular germ cell tumors: a primer for radiologists. Abdominal Radiology. 2019. PMID 30539249.
- Netherlands Cancer Registry (IKNL). Figures on testicular cancer. iknl.nl
- Thuisarts. Testicular cancer: tests and treatments. thuisarts.nl
Every blood test result at Caliber includes a professional assessment by a BIG-registered doctor. A blood test is not an examination for cancer. If you feel a lump or a change in a testicle, see your GP.
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