Last updated: 09-Oct-2026
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IN SHORT
Which operation depends on the situation: the whole testis taken out through the groin for almost every man, part of it kept in rare cases, or chemotherapy first in an emergency.
An operation that leaves some testis behind is an exception, kept for a man with one remaining testis or tumours on both sides, and checked by frozen section during surgery.
Chemotherapy goes before the operation only in an emergency, such as a very high hCG with breathlessness or bleeding into the lungs.
The operation is called a radical inguinal orchidectomy, also written orchiectomy. Inguinal means through the groin. It is the first treatment and also the final diagnosis, because the whole testis goes to the pathologist.
In a fit man this is day-case surgery or a stay of one night. A blood sample is kept ready for group and cross-match, as for any operation.
The testis develops inside the abdomen and drops into the scrotum before birth, so its lymph channels run back up through the groin to nodes at the back of the abdomen. The scrotal skin drains somewhere else, to the groin and pelvis. A cut through the scrotum, or a needle biopsy through it, opens a route the cancer never had. That changes the staging, the follow-up plan and sometimes the later treatment, and it cannot be undone.
This is the error most often made outside specialist units, which is why it is named here. If you have already had an operation or a biopsy through the scrotum elsewhere, bring the operation note and the pathology report. The tumour board takes it into account when it plans your staging and follow-up.
| Your situation | What is considered |
|---|---|
| One healthy testis on the other side | The whole affected testis is removed through the groin |
| Only one testis left, with a small tumour and the testis still working | Removing only the tumour (partial orchidectomy) may be considered |
| Tumours in both testes | Partial removal may be considered, to keep some testis tissue |
Keeping part of a testis is done only with a frozen section, a quick microscope check during the operation, and only in a plan agreed at the tumour board beforehand. It is an exception, not a choice for every small lump.
The other testis matters too. If it is small, was undescended, or you are young, a biopsy of it is discussed, because a pre-cancerous change can be present without a lump.
In a few young men the cancer has already spread widely when they first come: a large mass in the abdomen, breathlessness, or an hCG in the thousands. Bleeding into the lungs can follow. This is a medical emergency. Chemotherapy is started urgently, and the orchidectomy is done later. Waiting for the operation first would lose time that matters.
Sudden pain in the testis does not rule out a tumour; bleeding inside a tumour can be painful. A young man with a painful swollen testis is assessed the same day.
| When | What happens |
|---|---|
| The day of surgery | Up and walking two hours after recovery; eating and drinking normally; scrotal support, ice and simple painkillers |
| Next day | Usually home; wound and scrotum checked for a collection of blood |
| Days two to three | Review in the clinic or on the phone; the date of the pathology report is given |
Call the team at once if the scrotum or groin becomes tense, tender and keeps swelling. That points to bleeding under the skin and needs an ultrasound, not a wait. Other signs to watch are listed in normal healing or a warning sign.
The markers are repeated after the operation, timed to how fast each falls: about five to seven days for AFP and one to three days for hCG. A CT of the chest, abdomen and pelvis follows. The tumour board then reads the pathology, the markers and the CT together. What each stage changes is set out in testicular cancer stages and risk groups.
RPLND, the operation that clears the lymph nodes at the back of the abdomen, has a defined place:
| Setting | When RPLND is advised |
|---|---|
| Non-seminoma after chemotherapy | Any leftover mass of 1 cm or more once the markers are normal |
| Seminoma after chemotherapy | Only a leftover mass of 3 cm or more that is active on PET-CT, at least six to eight weeks after chemotherapy |
| Stage I non-seminoma | Selected cases only |
| Seminoma with small nodes and normal markers | Nerve-sparing RPLND for nodes up to 3 cm is one accepted option |
| Late return or a growing teratoma | Surgery is the treatment |
Fertility, nerve-sparing and ejaculation after RPLND are covered on the testicular cancer surgery and fertility page.
Reports can be sent ahead, so the consultation starts with them already read. Treatment is decided at the consultation, after examination.
No. A scrotal cut or a needle biopsy through the scrotum opens a new route for spread and changes staging and follow-up. The operation is done through the groin.
In a fit man the orchidectomy is day-case surgery or a one-night stay. Most men are walking the same day and go home the next day.
Yes. It can be placed at the orchidectomy, if the infection risk is low, or at a later operation. Your decision is recorded either way.
It is offered to every man. One orchidectomy usually keeps fertility and testosterone, but not always, and later chemotherapy or RPLND can affect fertility.
That depends on the pathology, the markers after surgery and the CT, read together at the tumour board. For most men with stage I disease, careful surveillance follows.
Testicular cancer as a whole is covered on the testicular cancer surgery page.
Shah’s Gastro, Cancer & Robotic Surgery Centre
Dr Swati Shah — MS, DrNB (Surgical Oncology) · Testicular Cancer Surgeon
Consultation at the Gota OPD, Ahmedabad. Surgery at Apollo Hospital, Bhat, Gandhinagar.
Gota OPD, Ahmedabad — Gota, Ahmedabad, Gujarat
Apollo Hospital, Bhat, Gandhinagar — Apollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar, Gujarat
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