Testicular Lump or Swelling

You may assume that every testicular lump is cancer, or that a painless swelling can safely be ignored. Most scrotal lumps have non cancerous causes, including cysts, fluid collections and enlarged veins. However, a new change within a testicle needs prompt assessment because touch alone cannot identify the cause.

Testicular and scrotal changes are common A lump may arise from the testicle itself, the epididymis behind the testicle, fluid surrounding the testicle, enlarged scrotal veins, skin or soft tissues, or a hernia descending from the groin. Most testicular and scrotal lumps have benign causes. NHS guidance still advises arranging a GP examination for every new lump, enlargement or unfamiliar change. Know what is usual for you It is common for one testicle to hang lower than the other and for one testicle to be slightly larger. The epididymis normally feels like a soft tube behind each testicle. The scrotal skin contracts in cold conditions, and the position of the testicles changes with temperature. Knowing your usual appearance and feel makes a new change easier to recognise. There is no national screening programme or required self examination schedule. Becoming familiar with what is usual for you, for example during a bath or shower, can help you notice a new lump, enlargement or texture change. The purpose is awareness rather than repeated searching for disease. A new change deserves assessment Arrange a GP appointment if you notice a lump on or within a testicle, one testicle becoming larger, or a new difference in shape. The same applies to a firmer or harder area, a feeling of heaviness, scrotal enlargement, a change in the epididymis, or an unexplained persistent ache. Do not wait for pain to develop. Testicular cancer often presents with a painless change, while benign conditions can also be painless. Location provides clues but not certainty A lump arising within the body of the testicle generally requires more urgent investigation than an obviously separate fluid filled lump. However, it may be difficult to determine the exact location yourself. A swelling can also surround the testicle and make it difficult to feel, so clinical examination and ultrasound are often needed. Testicular cancer is one possible cause Possible symptoms include a lump or swelling in one testicle, enlargement of a testicle, or a change in shape or texture. A heavy, firm or hard scrotum, an ache or discomfort, or lower abdominal or back discomfort can also occur. Testicular cancer usually affects one testicle. Pain can occur, but the most characteristic presentation is a painless lump or enlargement. Most lumps are not testicular cancer Cysts, hydroceles, varicoceles and infection are more common explanations for scrotal swelling. An urgent referral does not mean that cancer has been diagnosed. It means that specialists need to identify or exclude it promptly. Testicular cancer is often treatable, and surgery may be the only treatment needed when disease is found early. NICE uses a specific referral pattern NICE advises considering a suspected cancer pathway referral when there is a non painful enlargement or change in the shape or texture of a testicle. This applies to men and to trans women or non binary people who have testicles. A suspected cancer pathway is an investigation route. It does not state that cancer is the most likely explanation. A hydrocele is fluid around the testicle A hydrocele is a collection of fluid surrounding a testicle. It may cause smooth scrotal enlargement, a feeling of heaviness, little or no pain, difficulty feeling the testicle clearly, and a swelling that gradually increases. Hydroceles are usually benign. In adults, examination may still be needed to identify why the fluid developed and to assess the testicle beneath it. Hydroceles are also common in newborn boys and often improve during the first year. A baby's scrotal swelling still requires assessment, particularly when it is painful, red, firm or rapidly enlarging. The same applies when it is associated with vomiting, extending from the groin, or not reducing as expected. A groin hernia can sometimes resemble a hydrocele and may require surgery. An epididymal cyst forms outside the testicle An epididymal cyst is a fluid filled swelling arising from the epididymis. It may feel smooth, separate from the testicle, painless, and situated above or behind the testicle. These cysts are usually benign and may not need treatment unless they become uncomfortable or large. You should not assume a lump is an epididymal cyst without examination. A varicocele involves enlarged veins A varicocele is a group of enlarged veins within the scrotum. It is often more noticeable while standing, reduced when lying down, located on the left side, painless, and associated with an ache or dragging sensation. Some varicoceles are associated with reduced testicular size or fertility concerns. Most are harmless and only require treatment when they cause significant problems. A hernia may extend into the scrotum An inguinal hernia occurs when tissue, sometimes bowel, pushes through a weakness in the groin. You may notice a groin or scrotal bulge, swelling that appears when coughing or standing, reduction when lying down, a dragging or aching sensation, or gurgling within the swelling. A hernia can become trapped and lose its blood supply. Sudden severe pain, vomiting, abdominal swelling or a hard irreducible lump requires urgent hospital assessment. Infection can cause swelling Inflammation of the epididymis is called epididymitis. When the testicle is also inflamed, the term epididymo orchitis may be used. Possible features include pain and swelling, warm or tender scrotal skin, fever, burning when passing urine, urinary frequency, discharge from the penis, and fluid around the testicle. The cause may be a sexually transmitted infection or bacteria from the urinary tract. Infection and torsion can overlap Infection often develops over hours or days, while torsion commonly causes sudden severe pain. However, the patterns are not reliable enough for home diagnosis. Any sudden painful swelling should be treated as possible testicular torsion until urgently assessed. Testicular torsion is a time critical emergency Testicular torsion occurs when a testicle twists and cuts off its blood supply. Possible symptoms include sudden severe pain, rapid swelling, nausea or vomiting, lower abdominal pain, a testicle sitting higher than usual, and redness or marked tenderness. Immediate hospital assessment is required. Delayed treatment can cause permanent damage or loss of the testicle. Torsion can begin during sleep, during sport, after an injury, or without any obvious trigger. Pain may occasionally improve and then return if the testicle twists and untwists. A previous short lived episode does not provide reassurance. It may represent intermittent torsion and still requires urgent assessment. Trauma can cause several types of swelling An injury may cause bruising, blood around the testicle, testicular rupture, inflammation, torsion, or a haematoma within the scrotal tissues. Minor injuries may settle with support and simple pain relief. Severe pain, rapid enlargement, extensive bruising, nausea or a testicle that cannot be felt normally requires urgent assessment. Do not assume that pain following an injury rules out torsion, because torsion can be triggered by, or mistakenly attributed to, trauma. Skin lumps have different causes A lump in the scrotal skin may represent a blocked skin gland, a cyst, an inflamed hair follicle, an abscess, a skin lesion, or a wart. A painful red skin lump may require treatment for infection. A persistent ulcer, unusual skin growth or unexplained bleeding should be examined. Puberty can cause embarrassment and delay Teenagers may be reluctant to mention testicular changes. A parent or trusted adult should take sudden pain, new swelling or abdominal pain with nausea seriously. The same applies to a high or unusually positioned testicle or a new hard lump. Testicular torsion is particularly important around puberty, but it can occur at other ages. Children may present with abdominal pain A child with torsion may complain mainly of lower abdominal pain, groin pain, nausea, vomiting, reluctance to walk, or distress during movement. The scrotum should be considered when a boy or child with testicles has unexplained acute lower abdominal pain. Examination and investigation Your clinician may inspect the scrotum while you stand and lie down, examine each testicle gently, feel the epididymis and spermatic cord, examine the groin for a hernia, check the abdomen, examine lymph nodes, and look for signs of infection. You should be told what the examination involves, and a chaperone should be available. A scrotal ultrasound can distinguish a solid testicular lesion, a cyst, fluid around the testicle, enlarged veins, inflammation, and some complications of trauma. It uses sound waves and does not involve radiation. When torsion is strongly suspected, urgent surgery should not be delayed for imaging that would postpone treatment. Blood tests may assess infection, inflammation, kidney function or certain testicular tumour markers. Tumour markers can support assessment and follow up, but normal markers do not exclude every testicular cancer. A diagnosis depends on examination, imaging and specialist assessment. Treatment depends on the cause Possible management includes observation of a harmless cyst, treatment of infection, hernia repair, treatment of a symptomatic hydrocele, varicocele treatment, emergency surgery for torsion, or specialist cancer treatment. Do not attempt to puncture, drain or compress a scrotal swelling yourself. Fertility questions are legitimate Some conditions and treatments may affect sperm production, fertility, testosterone, body image or sexual function. If treatment for testicular cancer is required, sperm storage may be offered before treatments that could affect fertility. Removal of one testicle does not usually prevent fertility when the remaining testicle functions normally. You can ask about fertility and prosthetic testicle options before treatment.

A scrotal lump or swelling is assessed by asking whether the change is within the testicle or in surrounding tissue, whether it is painful, sudden or increasing, whether there are signs of torsion, infection or a trapped hernia, whether the testicle has changed in size, shape, firmness or texture, and whether imaging is needed to tell a solid from a fluid filled swelling. The safest action is to have a new change examined rather than diagnosing it yourself.