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Men who develop lumps, swelling, or pain in the groin or
scrotal area may be worried they have testicular cancer. Here we will
describe the symptoms of testicular cancer, as well as some other
problems that may cause symptoms in this area 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 to replace the
expertise and judgment of a doctor. Men having any testicular symptoms
should see a doctor so that the cause can be found and treated, if
needed.
What are testicles?
The testicles (also called the testes; a single
testicle is called a testis)
are a part of the male reproductive system. In adult males, these 2
organs are each normally somewhat smaller than a golf ball. They are
contained within a sac of skin called the scrotum which hangs
beneath the base of the penis.
The testicles make male hormones, mostly testosterone. They
also produce sperm. Sperm cells go from the testicle to a coiled tube
inside the scrotum (the epididymis)
where they are stored. Sperm travel from the epididymis through the vas deferens to the
seminal vesicles,
where they are mixed with fluid from the prostate gland. During
ejaculation, sperm cells, seminal vesicle fluid, and prostatic fluid
enter the urethra
and go out the tip of the penis. The urethra is the tube in the center
of the penis through which urine or semen pass.
Signs and symptoms of testicular problems
Like other parts of the body, the testicles can be affected by
certain conditions and diseases, which can lead to symptoms. The most
common signs and symptoms in the testicles and scrotum are:
- lumps (masses)
- swelling
- pain
Some conditions that affect the testicles can also cause a
heavy or aching feeling in the lower belly (abdomen), or can even cause
nausea and vomiting.
Cancer is one possible cause of testicular symptoms, but more
often these symptoms are caused by infection, injury, or something
else. It is important to see a doctor about any changes you notice in
your testicles as soon as possible. This way the cause can be found and
treated, if needed. Other conditions (besides cancer) that affect the
testicles can still be serious and need to be treated.
If you're reading this your main concern is probably whether
or not you have testicular cancer. This is why symptoms of testicular
cancer will be discussed first, followed by a discussion of some of the
non-cancerous causes of testicular symptoms.
Common testicular cancer symptoms
You can't be sure whether or not you have testicular cancer
based on symptoms alone, so it is important to see a doctor about any
bothersome testicular symptoms as soon as possible. (For more detailed
information on the tests doctors may use to diagnose testicular cancer,
see our document, Testicular Cancer.)
The most common symptom of testicular cancer is a painless
lump on a testicle. In some cases the lump is uncomfortable, but severe
pain is rare. Sometimes the testicle may be enlarged or swollen without
a lump. Men with testicular cancer may also have a heavy or aching
feeling in the lower belly (abdomen) or scrotum.
You should be aware that each normal testicle has an
epididymis, which feels like a small bump on the upper or middle outer
side of the testis. Normal testicles also contain blood vessels,
supporting tissues, and tubes that conduct sperm. These can feel bumpy
and sometimes men confuse these structures with cancer. If you have any
doubts, ask a doctor. The doctor may order an ultrasound test to look
at the structures inside the scrotum (see our document, Testicular Cancer).
This is an easy and painless way of finding out whether there is a
tumor.
Types of testicular cancer
There are different types of testicular cancer. Certain types
can cause symptoms in other parts of the body, too.
Germ cell tumors
Germ cell tumors are the most common type of testicular
cancer. They start in the cells that produce sperm. This type of cancer
sometimes makes a hormone called human chorionic gonadotropin (HCG). A
high level of HCG can cause a man's breasts to grow larger or become
tender.
Leydig cell tumors
A less common type of testicular cancer is known as a Leydig
cell tumor. These tumors start in the Leydig cells which normally make
male sex hormones. This type of tumor can produce androgens (male sex
hormones) or estrogens (female sex hormones).
Estrogen-producing
tumors: In men these tumors can cause breast growth and/or
loss of sexual desire.
Androgen-producing
tumors: These might not cause any specific symptoms in
men, but in boys they can cause growth of facial and body hair at an
abnormally early age.
Even when testicular cancer has spread to other organs (called
metastasis),
only about 1 man in 4 has symptoms from the metastases before his
cancer is diagnosed. Lower back pain is a common symptom of testicle
cancer that has spread to lymph nodes in the belly (abdomen). Lymph
nodes are small, bean-shaped collections of immune system tissue. If
the cancer has spread to the lungs, problems like shortness of breath,
chest pain, or cough (even coughing up blood) may develop.
Other causes of testicular/scrotal symptoms
Problems other than cancer may also cause symptoms in the
testicles or scrotum. Once again, it is important to see a doctor if
you have changes in your testicles.
Torsion
(twisting) of the testicle: This happens most often in
teen boys, but may occur later in life. When one of the testicles
becomes twisted within the scrotum, it cuts off the blood supply to the
testicle, epididymis, and other structures. This causes sudden, severe
scrotal pain, along with swelling and redness. Some people have nausea
and vomiting. Testicular torsion can be diagnosed by ultrasound of the
scrotum. If the torsion isn't treated right away, the testicle can die
and will have to be removed. The best chance of saving the testicle is
to have surgery to untwist the testicle within about 6 hours.
Injury: Physical
injury can cause pain to the area right way, or may cause slowly
worsening pain and swelling later on as the scrotum fills with blood
(this is known as a hematocele).
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
is a bacterial infection of the epididymis, the coiled tube next to
each testicle that stores sperm. This infection can be sexually
transmitted (especially in younger men), but it may also have other
causes. Slowly developing pain and swelling on one side of the scrotum
are common. The pain may spread to the side or back. Pain when passing
urine is also common. Fever and a milky discharge from the penis are
other possible symptoms. After treatment with antibiotics, the pain,
swelling, and other symptoms should go away completely. If these
problems persist, you need to so back to the doctor.
Orchitis
happens when the testicle(s) becomes inflamed. It can cause painful
swelling in one or both testicles. Viral infections (like mumps) are
common causes of orchitis. About 1 in 5 men who has mumps as an adult
will get orchitis in one or both testicles. This was much more common
before children started getting a vaccine against the mumps virus.
Hydrocele: Sometimes,
a testicle can become enlarged because fluid has collected around it.
This is called a hydrocele.
It is usually painless unless it grows to certain size. Sometimes the
pain can spread to the lower belly (abdomen) or back. Hydroceles are
usually harmless and rarely need to be treated.
Varicocele:
In this condition, the veins within the scrotum can 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 is
usually painless, but may cause a feeling of heaviness in the scrotum.
Varicoceles do not usually need to be treated.
Epididymal
cyst/spermatocele: This is a fluid-filled sac much like a
hydrocele, but the fluid inside contains sperm cells. It is usually a
small, painless lump in the scrotum that is not connected to the
testicle. These cysts are very common, and rarely need to be treated.
Inguinal hernia:
Hernias are caused by defects in the muscles of the belly (the
abdominal wall). These defects allow structures in the belly (abdomen),
such as a piece of intestine, to enter the scrotum. People with an
inguinal hernia may notice a slight lump or bulge in the groin or
scrotum. The lump from a hernia may be easier to see or feel when the
man stands up or lifts something heavy. It is sometimes painful,
especially when straining to pass urine or have bowel movement.
Most of the time a hernia isn't dangerous. Things become more
serious if a problem called strangulation
develops. In strangulation, a part of the intestine becomes trapped in
the groin, cutting off its blood supply. This causes severe pain,
nausea, and vomiting. Strangulation must be corrected with surgery
right away to prevent serious problems.
Kidney stones:
Kidney stones are small crystals that form in the kidneys and can
become lodged in the tubes leading to the bladder (the ureters). Pain
is usually felt in the back or side, and may extend down to the
scrotum. The pain can be intense, and many people have nausea and
vomiting, too. Blood is often found in the urine, but it may not be
seen with the naked eye. Large stones may need to be removed using
surgery or other procedures.
These are the more common causes of testicular symptoms, but
they are not the only ones. Because it is hard to figure out the cause
based on symptoms alone, it is important to have any testicular or
scrotal change looked at by a health care professional.
Some facts about testicular cancer
Testicle (or testicular) cancer can develop in one or both
testicles in males of any age, including infants and elderly men. But
most cases of testicular cancer are in men between the ages of 20 and
54.
Testicular cancer is not common; a man's lifetime chance of
getting it is about 1 in 300. A small increase in risk still makes the
chance of ever getting it low. The risk of dying from this cancer is
about 1 in 5,000.
Testicular cancer is highly treatable and usually can be
cured, especially when it is found early. If you have any of the signs
or symptoms described above, see a doctor right away. You may not have
testicular cancer, but if you do, the sooner you start treatment, the
more effective it is likely to be. For more information, see our
document, Testicular
Cancer.
What factors increase your risk for
testicular cancer?
A risk factor
is anything that affects your chance of getting a disease such as
cancer. Different cancers have different risk factors. For example,
exposing skin to strong sunlight is a risk factor for skin cancer.
Smoking is a risk factor for many cancers. But having a risk factor, or
even many, does not mean that you will get the disease.
Scientists have found few risk factors that make a man more
likely to get testicular cancer. Even if a man has one or more risk
factors for this disease, there is no way to know for sure how much
they contributed to developing the cancer. And most men with testicular
cancer do not have any known risk factors.
Undescended
testicle: One of the main risk factors for testicular
cancer is a condition called cryptorchidism,
or undescended testicle(s). About 1 in 10 cases of testicular cancer
happens in men who have had cryptorchidism. Normally, the testicles
develop inside the belly (abdomen) of the fetus, and they move into the
scrotum before birth. But in about 3% of boys the testicles do not make
it all the way down before the child is born. Sometimes the testicle
remains in the abdomen. In other cases, the testicle starts to descend
but stays stuck in the groin area.
Most of the time, undescended testicles continue moving down
into the scrotum during the child's first year of life. If the testicle
has not fully descended by the time a child turns one year old, it is
not likely to descend on its own. Sometimes a surgical procedure known
as orchiopexy
is needed to bring the testicle down into the scrotum
Men who have had an undescended testicle have an increased
risk of testicular cancer. Some experts believe that the risk of
testicular cancer may be somewhat higher for men whose testicle stayed
in the abdomen as opposed to one that has descended at least partway.
Most cancers develop in the undescended testicle, but up to 25% of
cases occur in the normally-descended testicle. Based on this, some
doctors conclude that cryptorchidism doesn't actually cause testicular
cancer, but that there is something else that leads to both testicular
cancer and testicles that don't descend normally.
There is some evidence that having orchiopexy (surgery to
correct an undescended testicle) at an earlier age can reduce the risk
of testicular cancer. For example, a recent large study showed that
those who had this surgery after the age of 12 were more likely to get
testicular cancer than those who had orchiopexy at an earlier age
Still, the best time to do this surgery to reduce the risk of
testicular cancer is not clear. Experts in the United States recommend
that orchiopexy be done soon after the child's first birthday for
reasons (such as fertility) that are not related to cancer.
Family history:
Men with testicular cancer in their families have increased risk. If a
man has the disease, there is an increased risk that his brothers or
sons will also develop it. But only about 3% of testicular cancer cases
are actually found to run in families, so most men are unlikely to pass
this disorder on to their children.
Cancer of the
other testicle: A man who has had testicular cancer is at
higher risk of having it again. About 3% or 4% of men who have been
cured of cancer in one testicle will at some time develop cancer in the
other testicle.
Carcinoma in
situ:
Carcinoma in situ (CIS) of the testicles is an overgrowth
of cells that may progress to cancer. This condition does not usually
produce a tumor or cause any symptoms. It isn't clear how often CIS in
the testicles progresses to cancer. In some cases, CIS is found in men
who have a testicular biopsy as part of an infertility work-up, or have
a testicle removed because of cryptorchidism. Doctors in Europe are
more likely than doctors in this country to look for (and treat) CIS.
This may be why the reported numbers for diagnosis and progression to
cancer are lower in the United States than in parts of Europe.
Age: Testicular
cancer can affect males of any age, but 9 out of 10 cases of are found
in men between the ages of 20 and 54.
Race and
ethnicity: The risk of testicular cancer among white men
is about 5 times that of black men, and more than 3 times that of Asian
Americans and American Indians. The risk for Hispanics/Latinos falls
between that of Asian and white men. The reason for these differences
is not known. Worldwide, the risk of developing this disease is highest
among men living in the United States and Europe. It is lowest among
men living in Africa or Asia.
HIV infection: Some
research has shown that men infected with the human immunodeficiency
virus (HIV), particularly those with AIDS, have an increased risk. No
other infections have been shown to increase testicular cancer risk.
Body size: Some
studies have found that the risk of testicular cancer is somewhat
higher in tall men, but other studies have not.
Testicular self-exam
Who should do testicular self-exam?
Most doctors agree that examining a man's testicles should be
part of a general physical exam. The American Cancer Society (ACS)
recommends a testicular exam by a doctor as part of a routine
cancer-related check-up.
The ACS advises men to be aware of testicular cancer and to
see a doctor right away if a lump is found. Because regular testicular
self-exams have not been studied enough to show if they reduce the
death rate from this cancer, the ACS does not recommend regular
testicular self-exams for men. But if you have certain risk factors,
such as undescended testicle, previous testicular cancer, or a family
member who has had this cancer, you should think about doing monthly
self-exams and talk about it with a doctor.
Still, some doctors think that noticing lumps early is an
important factor in getting early treatment. They recommend that all
men do monthly testicular self-exams after puberty.
Each man has to decide whether to do a monthly self-exam, so
instructions for testicular exam are given here.
How to do 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. To do a testicular
self-exam:
- 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
(nodules) or any change in the size, shape, or consistency of the
testes.
You should know that each normal testis has an epididymis,
which feels like a small "bump" on the upper or middle outer side of
the testis. Normal testicles also contain blood vessels, supporting
tissues, and tubes that conduct sperm. Other non-cancerous problems,
such as hydroceles and varicoceles (described above), can sometimes
cause swellings or lumpiness around a testicle. Some men may confuse
these with cancer. If you have any doubts, see a doctor.
If you choose to check your testicles, you will learn to tell
what is normal for you and what is different. Always report any changes
to a doctor right away.
Additional resources
More American Cancer Society information
The following information may also be helpful to you. It may
be viewed on our Web site, www.cancer.org, or ordered from our
toll-free number, 1-800-ACS-2345 (1-800-227-2345).
National organizations and Web sites*
Along with the American Cancer Society, other sources of
patient information and support
include:
National Cancer Institute
Toll-free number: 1-800-422-6237 (1-800-4-CANCER)
Web site: www.cancer.gov
Planned Parenthood Federation of America, Inc. (PPFA)
Toll-free number: 1-800-230-7526
Web site: www.plannedparenthood.org
Prevent Cancer Foundation
Toll-free number: 1-800-227-2732
Web site: www.preventcancer.org
The Testicular Cancer Resource Center
Web site: http://tcrc.acor.org
*Inclusion on
this list does not imply endorsement by the American Cancer Society.
No matter who you are, we can help. Contact us anytime, day or
night, for information and
support. Call us at 1-800-ACS-2345
(1-800-227-2345)
or visit www.cancer.org.
References
Bosl GJ, Bajorin DF, Sheinfeld J, Motzer RJ, Chaganti, RSK.
Cancer of the testis. In: DeVita VT, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice
of Oncology. 7th ed. Philadelphia, Pa: Lippincott-Raven;
2005: 1269-1293.
Cook MA. Scrotal pain/mass. In: Rakel RE. Saunders Manual of Medical
Practice. Philadelphia, Pa: W.B. Saunders Company; 1996:
399-401.
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.
Timing of elective surgery on the genitalia of male children
with particular reference to the risks, benefits, and psychological
effects of surgery and anesthesia. American Academy of Pediatrics. Pediatrics.
1996;97:590-594.
Pettersson A, Richiardi L, Nordenskjold A, Kaijser M, Akre O.
Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med. 2007
May 3;356:1835-1841.
Last Medical Review: 01/22/2009
Last Revised: 01/22/2009
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