Men who develop lumps, swelling, or pain in the groin or scrotal area may be worried they have testicular cancer. This document will describe the symptoms of testicular cancer, as well as some other conditions that may cause symptoms in this area of the body. It also includes information on how to perform a testicular self exam for me who want to do so.
This is not meant to be an all-inclusive guide to testicular symptoms, nor is it meant to give medical advice to replace the expertise and judgment of your doctor. Men having any testicular symptoms should see their doctor so that the cause can be found and treated, if necessary.
What are testicles?
The testicles (also called the testes; a single testicle is called a testis) are a part of the male reproductive system. These 2 organs, each normally somewhat smaller than a golf ball in adult males, are contained within a sac of skin called the scrotum which hangs beneath the base of the penis
The testicles make male hormones, most of which is testosterone. They also produce sperm. Sperm cells go from the testicle to a coiled tube inside the scrotum (the epididymis) where they are stored. From the epididymis, sperm travel 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 can pass.
Testicular signs and symptoms
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 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 let your doctor know about any changes you notice in your testicles as soon as possible so that the cause can be found and treated, if needed. Other conditions (besides cancer) that affect the testicles can still be serious and require treatment.
If you’re reading this document, your main concern is probably whether or not you have testicular cancer. For this reason, 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 tell your 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 the American Cancer Society 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 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 your doctor. The doctor may order an ultrasound test to examine the scrotum (see the American Cancer Society document, Testicular Cancer). This is an easy and painless way of finding out whether there is a tumor.
Types of testicular cancer
There are several different types of testicular cancer. Certain types can cause symptoms in other parts of the body as well.
Germ cell tumors
Germ cell tumors are the most common type of testicular cancer. 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. This type 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 frequent symptom of testicle cancer that has spread to lymph nodes in the abdomen. 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
Several non-cancerous conditions may also cause symptoms in the testicles or scrotum. Once again, it is important to see your doctor if you have testicular symptoms.
Torsion (twisting) of the testicle: This happens most often in adolescent 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. Nausea and vomiting may also occur. 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 immediate pain to the area, or may cause gradually developing pain and swelling later on as the scrotum fills with blood (known as a hematocele). Sometimes treatment may be needed to stop the bleeding, but the problem may get better on its own. Although testicular injury can be very painful, it is not a cause of 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. Gradually developing pain and swelling on one side of the scrotum are common, and the pain may spread to the side or back. Pain when urinating 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 continue, you need to return to your doctor.
Inflammation of the testicle(s) is called orchitis. It can cause painful swelling in one or both of the testicles. Viral infections (like mumps) are common causes of orchitis. About 20% of men who contract 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 and is usually painless unless it grows to certain size. Sometimes the pain can spread to the lower abdomen or back. Hydroceles are usually harmless and rarely need treatment.
Varicocele: In this condition, the veins within the scrotum can get very large (dilate). This can cause enlargement and lumpiness around the testicle, which has been described as feeling like a “bag of worms.” It is usually painless, but may be associated with a feeling of heaviness in the scrotum. Varicoceles do not usually need to be treated.
Epididymal cyst/spermatocele: This is a fluid-filled sac similar to a hydrocele but containing sperm cells within the fluid. It is usually a small, painless mass 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 abdominal wall that allow structures in the 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 more obvious when standing or lifting something heavy. It is sometimes painful, especially when straining to urinate or have bowel movement.
Most of the time a hernia isn’t dangerous. Things become more serious if a condition called strangulation develops. In strangulation, a part of the intestine becomes trapped in the groin, cutting of its blood supply. This causes severe pain, nausea, and vomiting. Strangulation must be surgically corrected right away to prevent serious complications.
Kidney stones: Kidney stones are small crystals that form in the kidneys and can become lodged in the tubes leading to the bladder. Pain is usually felt in the back or side, and may extend down to the scrotum. The pain can be intense, and is often accompanied by nausea and vomiting. Blood is often in the urine, although it may not be visible to 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 determine the cause based on symptoms alone, it is important to have any testicular or scrotal abnormality 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. Most cases of testicular cancer occur in men between the ages of 20 and 54. Testicular cancer is not common; a man’s lifetime chance of getting testicular cancer is about 1 in 300. A small increase in risk still makes the chance of ever getting it low, and the risk of dying from this cancer is 1 in 5,000.
Testicular cancer is highly treatable and usually curable, especially when it is found early. If you have any of the signs or symptoms described above, discuss them with your doctor without delay. Your symptom might not be testicular cancer, but if it is, the sooner you start treatment, the more effective it is likely to be. For more information, see the American Cancer Society 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 several, 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, it is impossible to know for sure how much they contributed to developing the cancer. Most men with testicular cancer do not have any of the known risk factors.
Undescended testicle: One of the main risk factors for testicular cancer is a condition called cryptorchidism, or undescended testicle(s). About 10% of cases of testicular cancer occur in men with a history of cryptorchidism. Normally, the testicles develop inside the abdomen of the fetus and they descend into the scrotum before birth. In about 3% of boys, however, 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 remains 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 descended by the time a child turns one year old, it probably won’t go down on its own. Sometimes a surgical procedure known as orchiopexy is necessary to bring the testicle down into the scrotum
Men with a history of 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. Although most cancers develop in the undescended testicle, up to 25% of cases occur in the normally descended testicle. Based on these observations, some doctors conclude that cryptorchidism doesn’t actually cause testicular cancer but that there is something else that leads to both testicular cancer and abnormal positioning of one or both testicles.
There is some evidence that performing orchiopexy at an earlier age can reduce the risk of developing 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: A family history of testicular cancer increases the risk. If a man has the disease, there is an increased risk that one or more of his brothers or sons will also develop it. However, 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 history of testicular cancer is another risk factor. About 3% or 4% of men who have been cured of cancer in one testicle will eventually 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 mass 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 while they have an evaluation for infertility 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 figures for diagnosis and progression to cancer are lower in the United States than in parts of Europe.
Age: Although this cancer can affect males of any age, 90% of testicular cancers occur 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 and 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
Most doctors agree that examination of a man’s testicles should be part of a general physical exam. The American Cancer Society (ACS) recommends a testicular exam by your doctor as part of a routine cancer-related checkup.
The ACS advises men to be aware of testicular cancer and to see a doctor right away if a mass is found. Because regular testicular self-exams have not been studied enough to show a reduction in the death rate from this cancer, the ACS does not recommend regular testicular self-exams for men without specific testicular cancer risk factors.
However, some doctors think that noticing masses promptly is an important factor in getting early treatment, and they recommend that all men do monthly testicular self-exams after puberty.
The choice of whether to do a monthly self-exam is one each man should make himself, so instructions for testicular exam are given here. If you have certain risk factors that increase your chance of developing testicular cancer (such as cryptorchidism or a family history of the disease), you should seriously consider monthly self-exams and discuss this issue with your doctor.
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 the penis out of the way and examine each testicle separately.
— Hold the testicle between the thumbs and fingers with both hands and roll it gently between the fingers.
— Look and feel for any hard lumps or nodules (smooth rounded masses) or any change in the size, shape, or consistency of the testes.
You should be aware that each normal testis has an epididymis, which appears as 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 conditions, such as hydroceles and varicoceles (described above), can sometimes cause enlargement or lumpiness around a testicle. Some men may confuse these with cancer. If you have any doubts, ask your doctor.
If you choose to examine your testicles, you will learn to tell what is normal and what is different.
Additional resources
Additional 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).
Testicular Cancer
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 Apr;97(4):590-4.
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(18):1835-41.
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