Testicular Masses

Most testicular masses, such as a growth or a swelling, are benign. This means they are not cancerous. Common types of testicular masses include:

  • Hydrocele is the most common benign testicular mass in an adult. Hydroceles are generally soft, painless scrotal swellings that are collections of fluid in the scrotal sac. These can rapidly change size as the fluid enters or leaves.

  • Spermatoceles are generally soft, painless, benign swellings that are cyst-like masses in the scrotum containing fluid. They can rapidly change size as the fluid enters or leaves. They are more prominent while standing or exercising. Sometimes, spermatoceles may cause a sensation of heaviness or a dull ache.

  • Varicocele is an enlargement of the veins that drain the testicles. This condition can increase the risk of infertility. They are more prominent while standing or exercising. Sometimes, varicoceles may cause a sensation of heaviness or a dull ache.

  • Inguinal hernia is a bulge caused by a portion of intestine protruding into the scrotum through a weak area in the abdominal muscles. Hernias may or may not be painful. They are soft and usually enlarge with coughing or straining.

  • Torsion of the testis can cause a testicular mass that develops quickly and is associated with tenderness and/or fever. This is caused by a twisting of the testicle within the sac. It also reduces the blood supply and can destroy the testis if not treated quickly with surgery.

  • Epididymitis is inflammation of the epididymis (a structure attached to the testicle), usually caused by a sexually transmitted infection or a urinary tract infection. This generally shows up as testicular discomfort and swelling, and may include pain during urination.

  • Testicular appendages are remnants of tissue on the testis present since birth. A testicular appendage can twist on its blood supply and cause pain. In most cases, this is seen as a blue dot on the scrotum.

A cancerous growth in the scrotum may first appear as a swelling. There may or may not be pain. The growth usually feels firm and shows up as a growth on the testicle. Any solid, firm growth in a testicle is considered cancer until proven otherwise.

Cancer of the testicle most commonly affects men 20 to 40 years old. Risk factors include prior testicular tumor and cryptorchidism (undescended testis). Occasionally, testicular cancer may appear with symptoms (problems) of metastasis. This means the tumor (abnormal growth) has spread and is causing other problems that may include cough, shortness of breath or weight loss. Monthly testicular self-exams are recommended for all men. Get in the habit of examining your own testicles. A good time is while taking a shower. Get to know what your testicles feel like so you will know if there is a new growth or change in them.

DIAGNOSIS

See your caregiver if you feel a growth in your testicle. Sometimes, all that is needed to make the diagnosis (determine what is wrong) is a physical exam. Your caregiver may shine a bright light through the scrotum to help make the diagnosis. This is called transillumination. The light will shine easily through a collection of fluid but will usually not shine through a tumor. Other testing, including blood tests and an ultrasound exam, may be done. An ultrasound exam bounces harmless sound waves off the testicles and produces a black and white picture almost like that produced by a camera. Diagnosis of testicular cancer can be made by measuring several substances in the blood, called markers), that may indicate the presence of certain cancers.

TREATMENT

What is wrong determines how it is treated. Small hydroceles and spermatoceles often require no treatment. In some cases, however, they may be treated surgically. Hernias are repaired with surgery. Because epididymitis is usually caused by an infection, it is usually treated with antibiotics. Varicoceles may be treated by surgery to tie off the affected veins. Testicular cancer treatment depends upon the type of cancer. Sometimes, some tissue is removed surgically as a way of trying to preserve the testicle but if a tumor is suspected, the preferred treatment is removal of the entire testicle. Further treatment may include watching the growth with strict follow-up, chemotherapy or radiation.

If a growth has been found in a testicle, your caregiver will help you determine the best treatment.