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Do I Have Testicular Cancer?

Men who notice lumps, swelling, or pain in their groin or scrotum may worry they have testicular cancer. Here we describe the symptoms of testicular cancer and some other problems that could cause symptoms in this part of the body. We also include information on how to do a testicular self-exam for men who want to do so.

This is not meant to be a complete guide to testicular symptoms, nor is it meant to give medical advice or replace the expertise and judgment of a health care provider. If you notice any changes in your testicles, you should see a provider so that the cause can be found and treated, if needed.

The testicles

Testicles are a part of the male reproductive system. In adult males, these 2 organs are each normally a little smaller than a golf ball. They are contained within a sac of skin called the scrotum, which hangs beneath the base of the penis.

Testicles have 2 main functions:

  • They make male hormones, like testosterone.
  • They make sperm, the male cells needed to fertilize a female’s egg to start a pregnancy.

Sperm cells form inside the testicle and are then stored in the epididymis (EP-ih-DID-uh-mus), a small coiled tube behind each testicle, where they mature.

When a man ejaculates ( has an orgasm), sperm cells travel from the epididymis through the vas deferens (vass DEF-er-ens) to the seminal vesicles (SIM-uh-nul VES-ih-kuls), where they mix with fluids made by the vesicles, the prostate gland, and other glands to form semen. This fluid then travels through the urethra (yoo-REE-thruh) and out through the penis.

Testicular cancer facts

  • Males of any age can develop testicular cancer, including infants and elderly men.
  • About half of all cases of testicular cancer are in men between the ages of 20 and 34.
  • Testicular cancer is not common; a man’s lifetime chance of getting it is about 1 in 263. The risk of dying from this cancer is about 1 in 5,000.
  • Testicular cancer can be treated and usually cured, especially when it’s found early – when it’s small and hasn’t spread.

For more detailed information, see Testicular Cancer.

Symptoms of testicular cancer

You can’t be sure you have testicular cancer from just symptoms, so it’s important to see a health care provider about any testicular symptoms that concern you. Don’t wait.

  • The most common symptom of testicular cancer is a painless lump on or in a testicle.
  • Sometimes the testicle may become swollen or larger, without a lump. (It’s normal for one testicle to be slightly larger than the other, and for one to hang lower than the other.)
  • Some testicular tumors might cause pain, but most of the time they don’t. Men with testicular cancer may also have a heavy or aching feeling in the lower belly or scrotum.
  • Breast growth or soreness: Rarely, testicular cancers can cause men’s breasts to grow or become sore. This is because certain types of testicular cancer can make high levels of hormones that affect the breasts. Some men might also notice a loss of sexual desire.
  • Signs of early puberty in boys: Some testicular cancers make male sex hormones. This may not cause any specific symptoms in men, but in boys it can cause signs of puberty, such as a deepening of the voice and the growth of facial and body hair, at an early age.

Symptoms of testicular cancer that has spread

If testicular cancer is not found early, it can spread to other parts of the body. Even when testicular cancer has spread, there may still be no symptoms. But some men might have some of the following:

  • Low back pain from cancer that has spread to the lymph nodes in back of the belly. (Lymph nodes are bean-sized collections of immune cells.)
  • Shortness of breath, chest pain, or a cough (even coughing up blood) from cancer spread in the lungs.
  • Belly pain, either from enlarged lymph nodes, or because the cancer has spread to the liver.
  • Headaches or confusion from cancer spread to the brain.

Non-cancer causes of testicular or scrotal symptoms

Problems other than cancer can also cause symptoms. Because it’s hard to figure out the cause based on symptoms alone, it’s important to have any testicular or scrotal change checked by a health care provider.

Some of the conditions that can cause a testicle lump, swelling, and/or pain include:

  • Torsion of the testicle
  • Injury
  • Infection
  • Hydrocele
  • Varicocele
  • Epididymal cyst/spermatocele
  • Inguinal hernia
  • Kidney stones

Torsion of the testicle

In testicular torsion (TOR-shun), one of the testicles gets twisted inside the scrotum. This cuts off the blood supply to the testicle, epididymis, and other structures, leading to sudden, severe pain in the scrotum along with swelling and redness. It can also cause belly pain or nausea and vomiting.

Testicular torsion occurs most often in teen boys, but may occur later in life. It’s often diagnosed using ultrasound of the testicle/scrotum. Torsion is a medical emergency that needs to be treated right away. Surgery is needed to untwist the testicle, which restores the blood supply. If the torsion isn’t treated within several hours, the testicle can die and will have to be removed.

Injury

Physical injury to the scrotum or testicle can cause pain right way, or it may cause slowly worsening pain and swelling later on as the scrotum fills with blood. (This is known as a hematocele [hee-MAT-oh-seel].) Sometimes treatment may be needed to stop the bleeding, but the problem may get better on its own.

A testicular injury can be very painful, but it does not cause cancer.

Infection

Infections in the scrotal area are usually caused by bacteria or viruses.

Epididymitis (EP-ih-did-ih-MY-tis) is inflammation of the epididymis, the coiled tube next to each testicle that stores sperm. This can be caused by a sexually transmitted infection, but it can also be caused by other types of infection. Epididymitis can cause:

  • Pain and swelling on one side of the scrotum. The pain tends to come on slowly, and it may spread to the side or back.
  • Pain when passing urine
  • Fever
  • Milky discharge from the penis

If the infection is caused by bacteria, antibiotics often will make the symptoms go away completely. But if these problems continue after you’ve taken antibiotics, you need to go back to the health care provider.

Orchitis (or-KIE-tis) happens when the testicle(s) becomes inflamed. It can cause painful swelling in one or both testicles. It also can impair fertility (make it harder to get a woman pregnant).

Orchitis can be caused by bacteria, including those that cause sexually transmitted infections and epididymitis. In fact, epididymitis and orchitis can happen at the same time. The mumps virus can also cause orchitis.

Hydrocele

Sometimes a testicle can feel enlarged because fluid has collected around it. This is called a hydrocele (HI-dro-seel). It’s usually painless unless it grows too large. Sometimes the pain can spread to the lower belly or back. Hydroceles can have many causes. They’re usually harmless and rarely need to be treated. Hydroceles are often diagnosed with an ultrasound exam of the testicle and scrotum.

Varicocele

In varicocele (VAR-ih-ko-seel), the veins within the scrotum get very large (dilate). This can cause swelling and lumpiness around the testicle. It has been described as the scrotum feeling like a “bag of worms.” It’s usually painless, but it may cause a feeling of heaviness in the scrotum. Varicoceles can be diagnosed by a physical exam or with an ultrasound exam of the testicle and scrotum. They do not usually need to be treated.

Epididymal cyst/spermatocele

An epididymal cyst (EP-ih-DID-ih-mul cist) may also be called a spermatocele (spur-MAT-oh-seel). It’s a fluid-filled sac much like a hydrocele, but the fluid inside contains sperm cells. It’s usually a small, painless lump in the scrotum that’s not connected to the testicle. These cysts are very common, and rarely need to be treated. They are often diagnosed with an ultrasound exam of the testicle and scrotum.

Inguinal hernia

An inguinal hernia (ING-gwin-uhl her-NEE-uh) is in the groin. These hernias are caused by defects or weak spots in the muscles of the lower belly (the abdominal wall), which allow structures in the belly, such as fatty tissues and/or a loop of intestine, to go into the scrotum. There may be a slight lump or bulge in the groin or scrotum. The lump may be easier to see or feel when standing up. It’s sometimes painful, especially when bending over, lifting something heavy, coughing, or straining to pass urine or have a bowel movement.

Most of the time a hernia isn’t dangerous, but your doctor might recommend surgery to repair it, especially if it causes pain or is getting larger. Surgery can help prevent a problem called strangulation (STRANG-you-lay-shun). This is when a part of the intestine gets trapped in the groin, cutting off its blood supply. This causes severe pain, nausea, and vomiting, and needs to be treated right away because it can be life threatening.

Kidney stones

Kidney stones are small crystals that form in the kidneys and can get stuck in the tubes leading to the bladder (the ureters [YUR-uh-ters]). The stones can cause severe pain, most often in the back or belly. This pain can extend down to the scrotum. Many men also have nausea and vomiting. Blood is often found in the urine, but it might not be seen with the naked eye. Large stones may need to be removed using surgery or other procedures.

Check yourself: Testicular self-exam

Most health care providers agree that checking a man’s testicles should be part of a routine physical exam. And some doctors recommend that all men examine their testicles monthly after puberty.

Here’s how to do it if you decide self-exam is right for you.

How to do a testicular self-exam

The best time to do the self-exam is during or after a bath or shower, when the skin of the scrotum is relaxed.

  • Hold your penis out of the way and check one testicle at a time.
  • Hold the testicle between your thumbs and fingers of both hands and roll it gently between your fingers.
  • Look and feel for any hard lumps or smooth rounded bumps or any change in the size, shape, or consistency of the testicles.

It’s normal for one testicle to be slightly larger than the other, and for one to hang lower than the other. You should also know that each normal testicle has a small, coiled tube (epididymis) that can feel like a small bump on the upper or middle outer side of the testicle. Normal testicles also have blood vessels, supporting tissues, and tubes that carry sperm. Some men may confuse these with abnormal lumps at first. If you have any concerns, ask your health care provider.

If you check your testicles regularly, in time you will learn what’s normal for you and will be able to tell when something is different.

What if you find something different?

If you find something unusual or something you’re not sure about, either during a self-exam or at any other time, see a health care provider right away.

The provider will ask if you’re having any symptoms (such as pain) and how long you’ve had them. During a physical exam, the provider will feel your testicles for swelling or tenderness and for the size and location of any lumps. The provider might also examine your abdomen (belly), groin area, and other parts of your body, looking for any possible signs of cancer spread.

If anything abnormal is found, an ultrasound may be done to look at the scrotum and testicles. This is an easy and painless way of finding out whether there’s a tumor or another problem. Other tests might be done as well. (For more details on the tests doctors use to diagnose testicular cancer, see Testicular Cancer.)

To learn more

We have a lot more information that you might find helpful. Explore www.cancer.org or call our National Cancer Information Center toll-free number, 1-800-227-2345. We’re here to help you any time, day or night.

The Testicular Cancer Resource Center (http://tcrc.acor.org) also offers general information and support, lists testicular cancer experts, and posts research and study opportunities

References

American Cancer Society. Testicular Cancer Detailed Guide. Accessed at www.cancer.org/Cancer/TesticularCancer/DetailedGuide/index on March 22, 2016.

Hanna N, Timmerman R, Foster RS, Roth BJ, Einhorn LH, Nichols CR. Testis cancer. In: Kufe DW, Pollock RE, Weichselbaum RR, Bast RC, Gansler TS, Holland JF, Frei E, eds. Cancer Medicine. 6th ed. Hamilton, Ontario: BC Decker Inc.; 2003:1747-1768.

Howlader N, Noone AM, Krapcho M, et al (eds). SEER Cancer Statistics Review, 1975-2012, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER web site, April 2015. Accessed March 22, 2016.

Pagliaro LC, Logothetis CJ. Cancer of the testis. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015:988-1004.


Last Medical Review: 03/29/2016
Last Revised: 05/23/2016