Lymph node abnormalities
Non-seminomas metastasize earlier than seminomas. The lymph from the testes drains typically into the para-aortic lymph nodes. When the tumor metastasizes to the para-aortic lymph nodes, they present as a palpable abdominal mass in the epigastric region. Para-aortic lymph nodes are located above the level of the umbilicus and can be palpated superior to the umbilicus. The inguinal lymph nodes may be involved only if the tumor invades the scrotal skin. The tumor may rarely metastasize to the supraclavicular lymph nodes.