Testicular Lumps

As a Doctor clinic, LDC very often sees male patients concerned about possible lumps in their testicules, who automatically fear the worst and jump to the conclusion that it must be testicular cancer. Thankfully, there are many different causes of groin lumps and bumps, the majority of which are benign. That said, any groin or scrotal lumps are always worth getting checked out by a GP, for medical assessment. 


What Causes Testicular Lumps?

Before you jump straight to the conclusion of testicular cancer, there is a long list of other potential reasons to explain testicular lumps! 

1. Hydrocele:

This is a condition that refers to a build-up of fluid in the scrotum. It is most common in new born babies, but can sometimes occur in older boys or men due to injury or infection. Patients with hydrocele experience painless swelling on either or both sides of the scrotum.


2. Varicocele:

This refers to a condition in which the veins in the scrotum are dilated. It is often described as feeling like a soft lump or “a bag of worms”. If the varicocele is very large it may be visible. You may also experience a heavy sensation or ache in your scrotum. It is possible, but not always necessary to correct it surgically.
varicocele diagram

A varicocele testicle is classically described as feel like a "bag of worms", due to the dilated vessels


3. Hernia:

Hernias from the abdomen can sometimes be felt in the groin area including the scrotum. This may feel like a soft lump, you may even be able to push it back into the tummy/ groin, or a soft lump in the scrotum that you cannot feel where it begins.

Most commonly in men, these are inguinal hernias. These occur when the inside lining of the abdomen, sometimes including abdominal content (e.g. bowel) pushes through a weakness in the abdominal wall. It is often painless and will not always require treating. If a hernia suddenly becomes severely painful it may be that the blood supply to the hernia is impaired. This is a serious condition and you should go to your local A&E department if you suspect you are experiencing these symptoms. 


4. Epididymal Cysts:

An epididymal cyst is a fluid-filled swelling in the epididymis (covering the testis behind). It may feel smooth, round and mobile, above or behind the testicle. They are usually painless, however you may experience some discomfort depending on the exact size and location of the cyst. The cause of epididymal cysts is unknown however it is very common, particularly in middle-aged men.

If you think you may have an epididymal cyst it is still recommended to see your GP about it.


5. Epididymo-orchitis:

This refers to inflammation of the epididymis and the testicle itself. They can occur simultaneously or separately, known as epididymitis or orchitis. Patients with this condition may experience swollen and tender or painful testicles.

The cause of epididymo-orchitis is sometimes unknown, however it can be caused by infections such as sexually transmitted infections (STIs), urinary tract infections (UTIs) or the mumps. It is recommended to see your GP if you experience these symptoms or visit your local GUM/ Sexual health clinic if you think you may have a STI.


6. Testicular Torsion:

Testicular torsion is an extremely painful condition that results from the testes twisting within the scrotum. This condition most commonly occurs in young males aged 13-17 years old and in those who were born with undescended testicles. Torsion impacts the blood flow to the testicle and is important to be treated early or there is a risk of losing the testicle.

Symptoms of testicular torsion include:

  • Sudden & severe testicular pain
  • Swelling in the scrotum
  • Nausea
  • Vomiting
  • Abdominal pain

If you are experiencing these symptoms you should skip the GP route and go straight to your local A&E department for treatment.



Testicular Cancer

After the above have been excluded, by means of a thorough medical history and examination, your GP may begin to consider the possibility of testicular cancer. Testicular cancer is overall a relatively rare type of cancer that can affect men. It is more common in young men between 15-49 years old and those of white ethnicity. Every year, 2200 men are diagnosed with testicular cancer in the UK, although with very effective treatments available, most of these men will be cured.

Different subtypes of testicular cancer exist, broadly these are divided into two categories: Seminomas and non-seminomas. Rarer subtypes include non-Hodgkin’s Lymphoma, Leydig and Sertoli cell tumours.


What Causes Testicular Cancer?

The exact cause of testicular cancer is unknown but certain factors may increase your risk of developing it:

  • Undescended testicles (cryptorchidism) this is a condition where the testes have not fully descended into the scrotum at birth.
  • Family history of testicular cancer or cryptorchidism
  • Previous testicular cancer


What Are The Signs & Symptoms?

The most common symptoms are feeling a lump in the testicle, this may be painless or painful. Patients sometimes experience a dull ache or sensation of heaviness in the scrotum.

Cancer can sometimes spread to other types of the body and produce a variety of symptoms including:

  • Back pain
  • Cough or shortness of breath
  • Nipple/ breast tenderness and sometimes swelling
  • Weight loss

If you experience any of the above symptoms or any changes around your groin, you should contact your GP.


Diagnosing Testicular Cancer

Your GP will go through your medical history with you as well as perform a physical examination, including your testicles, before deciding on further tests. Lumps in the groin are most commonly not cancer, however if your doctor is unsure or suspects it may be cancer you will be referred for further tests within two weeks.

Further tests include:s

  • Blood tests: to look for markers of cancer
  • Scrotal ultrasound: to see the lump clearly and determine whether it looks benign or cancerous
  • Biopsy & Histology: involves taking a sample of the lump and looking at it under a microscope. It is the only test which can definitely confirm cancer and gives information on the cancer subtype also. If there is a strong suspicion, based on the other tests, that it may be cancer, the entire testicle is removed surgically (orchidectomy) in order to sample the lump. This procedure will not affect your sex life or fertility. If the cancer is in its early stages, this procedure may be curative.
  • CT/ MRI scan: to see if cancer has spread outside the testis and to stage the cancer  

 Testicular cancer biopsy histology microscope

Should a biopsy be advised, the cells are scrutinised under a microscope to look for signs of cancer


Testicular Cancer Treatment & Prognosis

The treatment and outlook of testicular cancer depends on what type of testicular cancer it is and its staging.

Surgical removal of the affected testicle is recommended in all cases. Additional chemotherapy or radiotherapy is sometimes recommended in order to decrease the risk of the cancer coming back. If the risk of recurrence is very low, your doctor may decide to simply monitor you carefully and give treatment if and when it does return.

More advanced testicular cancers will require multiple cycles of chemotherapy, as well as further surgery to remove cancer that has spread outside the testicle.

Go here for more detailed information of testicular cancer treatment.

Deciding your treatment plan can be challenging, the health care team treating you will recommend the options they feel are best but the final decision will always be yours.

Even if the treatment is successful, there is a risk the cancer will return and you will therefore be recommended follow up with your healthcare team. This involves regular physical examination, blood tests and X-rays or even CT scans. The duration and frequency of follow ups will depend on what stage the cancer was and how it was treated.

Being diagnosed with cancer and dealing with the various tests, treatments and follow up can be extremely challenging and have long term consequences on your physical and mental health. Many people find counselling useful to help cope with cancer.


 By Anna Kessler