If a patient finds a lump inside the scrotum, not arising from the skin of the scrotum itself, they should contact their doctor immediately for further advice. To feel for testicular lumps, it is best for the patient to examine themselves when they are warm and relaxed (e.g. after a bath or shower). Standing in front of a mirror and holding each testicle in turn between fingers to feel the body of the testicle and the structures attached to it is recommended.
- The vast majority of swellings in the scrotum are not cancerous but are benign and should not give cause for concern
- Benign swellings in the scrotum only require surgical treatment if they are causing significant symptoms (e.g. aching, cosmetic embarrassment)
- A simple ultrasound scan will usually differentiate accurately between benign and cancerous swellings
- If the lump is attached to the surface of the testicle, it is probably benign but, if it is in the body of the testis itself, there is a 90% chance that it is a testicular cancer
- Testicular cancer is the commonest malignant tumor in men between 20 and 50 years old
- Whilst testicular cancer is rare in men over age 50, certain forms do occur and the patient should always seek advice from a doctor.
- Testicular cancer is commoner in abnormal testicles e.g. previously undescended testicles, testicles which have been injured or infected and soft, atrophic testicles (sometimes seen in infertile men)
- Early diagnosis and treatment mean that more than 95% of men can be cured of testicular cancer, even if it has spread beyond the testicle itself
Causes of a testicular lump
Swellings of the scrotum are usually cystic (fluid-filled), inflammatory or solid. Clinical examination and ultrasound scanning can usually differentiate between the possible causes
- Cystic (fluid-filled) swellings are the commonest type of swelling and are usually caused by a
- hydrocele (fluid around the testicle)
- a cyst in the epididymis (sperm-carrying mechanism) or
- varicose veins above the testicle (a varicocele).
- They are all benign and only require treatment if they cause significant symptoms.
- Inflammatory swellings
- Infection of the epididymis (sexually-acquired or secondary to a urinary infection),
- twisting of the testicle (torsion, usually in children) or
- infection of the testicle itself (e.g. due to mumps)
- Solid swellings include
- tuberculosis & syphilis (both very rare nowadays)
- sperm granuloma or nodule (usually following previous vasectomy)
- chronic inflammation of the epididymis and
- testicular cancer, if the lump is within the testicle itself
- Hernias arising in the groin can extend down towards the testicle but simple examination will reveal that the swelling does not arise from the scrotum itself. Urologists do not usually treat hernias and referral to a hernia surgeon is usually recommended.
This will normally include some or all of the following:
- A full history paying particular attention to any possible trauma or infection of the testicles in the past. The patient should mention any previous operations on the testicles, especially surgery for an undescended testicle, or previous vasectomy.
- A physical examination including examination of the scrotum, abdomen and lymph glands. Blood pressure will normally be measured as part of this examination.
- General blood tests to measure kidney function & liver function, and to check the blood cells for anemia or other problems.
- Tumor markers are specific blood tests to measure tumor markers (alpha-fetoprotein, beta-human chorionic gonadotrophin, lactate dehydrogenase) if testicular cancer is suspected.
- Ultrasound scan of scrotum to assess exactly where the swelling is in relation to the testicle.
- CT scan of the abdomen & chest depending on the findings of the scrotal ultrasound scan
- Cystic (fluid-filled) swellings may be needed if the patient is experiencing significant symptoms from the swelling.
- Hydrocele repair
- Excision of an epididymal cyst
- Open surgery or laparoscopic surgery for a varicocele
- Otherwise, no treatment is necessary.
- Inflammatory swellings
- Antibiotics are used for infection of the epididymis
- Further urological tests (if urinary infection is suspected)
- Assessment and treatment of STDs (for young patients or if infection may be sexually-acquired)
- Testicular involvement with mumps usually requires no specific treatment apart from painkillers.
- Suspected torsion of the testis requires emergency admission and immediate surgery.
If the patient is found to have testicular cancer, they will normally be advised to
Other solid swellings
- Consider urgent sperm banking at a fertility unit
- The testicle should be surgically removed as soon as possible
- An artificial testicle can be inserted at the same time or at a later date, if the patient wishes.
- Prompt referral to a medical oncologist for any further treatment and for long-term follow up.
- The need for further treatment (radiotherapy or chemotherapy) is determined by the pathology results, the results of tumor marker blood tests & the findings on a CT scan.
- Tuberculosis and syphilis are rarely seen nowadays but are treated with appropriate antibiotics.
- Sperm granulomas in the epididymis may be removed if they are uncomfortable but they rarely require treatment.