Lumps in testicular and scrotal area

It’s important to pay attention to your reproductive health. Through regular self-examinations, you may check for any changes to your body, especially in the testicular and scrotal area.

If you find a lump on one or both of your testicles or notice an unexpected change in size, shape or color, it’s best to remain calm and to make an appointment to visit your doctor.

Try not to automatically assume it’s cancer—not all testicular lumps are cancerous. On average, one of every 250 males will develop testicular cancer over their lifetime, according to the American Cancer Society (ACS).

How to look for testicular lumps

Some doctors recommend monthly self-exams to look for changes. If you’re planning to do this, speak with your doctor first to make sure this screening is right for you.

You may do a self-examination either in the shower or right after, when the skin is soft. To self-examine:

• Lift the penis and gently examine each testicle one at a time.
• Hold each testicle between your thumb and fingers, gently rolling it back and forth, feeling for anything out of the ordinary. This may include a lump, firm nodule, a change in the consistency of your skin, or a change in size.
• Keep in mind that it’s normal for one testicle to be slightly larger than the other.
• If one or both testicles feel painful or swollen, this may indicate an abnormality.

What is a testicular lump?

The testicles are an important part of the reproductive system, as they play a role in producing testosterone and sperm. A healthy testicle should feel smooth, without any irregularities. However, sometimes testicular lumps may develop. A testicular lump may feel hard to the touch and vary in size. It also may feel painful, tender or swollen.

Types of testicular lumps

The different types of testicular lumps are categorized based on whether they’re benign (noncancerous), precancerous or cancerous.

Benign

Benign testicular lumps aren’t caused by cancer, and they won’t develop into cancer in the future. Common benign testicular lumps include:

Benign teratoma—This type of germ cell tumor occurs most often before puberty, usually in babies. It may be removed by surgery.

Lipoma—Because this tumor is made of fat cells, it may occur anywhere on the body, and sometimes develops in the testicles. A lipoma also may be surgically removed.

Epididymitis—The epididymis is a coiled tube at the back of the testes that the body uses for storing and transporting sperm. Sometimes, it becomes inflamed, causing swollen or sore testicles. It may be treated with antibiotics.

Epidermoid cyst—This is a fluid-filled cyst that develops in the epididymis and may be surgically removed, if deemed necessary

Orchitis—This is a bacterial or viral infection in the testicle. It may cause pain and swelling, which may be mistaken for a lump. It may be treated with medication.

Hydrocele—This fluid-filled sac occurs around a testicle and is generally painless. If it doesn’t disappear on its own or becomes too large, a hydrocele may require surgery.

Varicocele—This is an enlargement of the veins inside a testicle. Treatment isn’t always needed, but it may be surgically removed if it continues to grow or causes pain.

Other, much rarer testicular lumps include gonadal stromal tumors, which make up less than 5 percent of adult testicular tumors, according to the ACS. They are typically benign and don’t spread.

Precancerous

Sometimes, a testicular lump is precancerous, which means it isn’t cancer but is more likely to develop into cancer in the future.

One of the most common precancerous lumps is known as germ cell neoplasia in situ. This type of abnormal cell growth is thought of as a precursor to testicular cancer. Germ cells are cells in the testicles that make sperm, and neoplasia is a type of abnormal cell growth.

It may only be diagnosed through a biopsy. If your medical team finds germ cell neoplasia in situ, they may discuss treatment options with you.

Cancerous

Testicular cancer is diagnosed through procedures including imaging tests, blood tests for tumor markers, and a type of surgery known as a radical inguinal orchiectomy (in which the testicle is removed and a biopsy is performed to detect cancer).

Cancerous lumps of the testicle usually originate in the germ cells—more than 90 percent of testicular cancers start here, according to the ACS.

Germ cell tumors are broken down into two types:

Seminomas—This type of tumor tends to be slow-growing, compared with non-seminomas. Seminomas are either classical or spermatocytic. According to the ACS, more than 95 percent are classical, while slower-growing spermatocytic tumors tend to be rare and occur in older men (average age is 65).

Non-seminomas—These tend to develop in the late teens to early 30s. Non-seminomas may be categorized as one of the following: embryonal carcinoma, yolk sac carcinoma, choriocarcinoma and teratoma.

However, germ cell cancers may be a mix of these two types of cells. They usually respond to treatments for non-seminoma cancers.

Cancer that starts elsewhere in the body and spreads to the testicles is considered a secondary testicular cancer.

What to do if you find a testicular lump

Testicles are an important part of the reproductive system—producing both sperm and hormones such as testosterone.

Sometimes, you may notice a lump or size change in one of your testicles. It’s not always related to testicular cancer, but it could be. If a lump is malignant, it’s reassuring to know that testicular cancer has a very high survival rate, especially if it’s diagnosed early.

If you find a lump in your testicle, it’s crucial to know what to do next.

Should I be doing testicular self-exams?

A monthly testicular self-exam may be a useful way to get to know how your body feels normally, so you may more easily catch any changes. Speak with your doctor first to decide together whether self-exams are right for you, as not enough research has been done to know whether conducting regular self-exams reduces the death rate for testicular cancer overall.

If you decide to perform a self-exam, take a few minutes out of your day to do one either in the shower or just after a shower when the skin is soft. You’ll want to examine each testicle, holding the penis out of the way.

• Gently hold each testicle between your thumb and fingers, rolling it back and forth.
• Feel for any hard lumps, masses, or a change in shape, size or appearance. It’s normal for one testicle to be slightly larger than the other.

Over time, you’ll get to know what the normal variations in your testicles feel like, including blood vessels or the epididymis, a small tube that may feel like a bump on the outer side of your testicle.

What should I do if I find a lump?

If you feel a lump in your testicle, or are concerned about a change in its shape or size, discuss this with your doctor.

Don’t panic: You may feel nervous, scared or worried. These feelings are completely normal, but it’s best to remain calm. Most testicular lumps are benign.

Understand that lumps may be caused by other conditions: Often, testicular lumps are caused by something other than testicular cancer. Sometimes, an infection may cause swelling and tenderness. Other common causes for testicular lumps include:

• Varicocele—This is the enlargement of a vein in the testicle, similar to a varicose vein in your leg. It can often be left untreated, although it can also be surgically removed.
• Epididymal cysts—These are fluid-filled sacs that may develop in the epididymis, a tube that transports sperm out of the testes. Small cysts are often left alone, but larger cysts may be removed.
• Hydrocele—This is another type of fluid-filled sac that forms around a testicle. These usually don’t cause pain but may cause swelling in the scrotum. Often, they go away on their own, but they may also be surgically removed if necessary.

Call your doctor: Visiting your doctor as soon as possible is the best thing to do for your health. Lumps are easier to treat if they’re caught early, while they’re still small.

Ask questions: It’s okay to ask questions. Your doctor may ask you some as well, including how long you’ve had the testicular lump, whether it’s changed over time, and whether you have other symptoms. Your doctor may also ask about personal and family medical history to assess your risk factors for testicular cancer.

Which diagnostic tests will my doctor do?

To learn more about the causes of your testicular lump, the doctor may recommend several tests. Some of the diagnostic tests used for testicular cancer include:

• Physical exam—The doctor will check your overall health and examine your testicles for signs of disease.
• Ultrasound exam—A doctor may request an ultrasound examination, which uses high-energy sound waves to create sonogram images of the inside of the testicles.
• Serum tumor marker test—Another common diagnostic tool, this is a blood test that looks for substances in the body that are linked to testicular cancer, known as “tumor markers.” In the case of testicular cancer, doctors are looking specifically for two markers: alpha-fetoprotein and beta-human chorionic gonadotropin.
• Inguinal orchiectomy—In this procedure, the entire testicle may be removed from an incision in the groin area. Tissue cells from the testicle are then examined under a microscope for cancer cells. This method is safer than a biopsy, because removing the tissue sample during a biopsy may accidentally spread cancer into the lymph nodes or scrotum.