The most common first sign of testicular cancer is a painless lump or swelling on one testicle. Most people notice it themselves, either by accident or during a self-check. The lump is typically hard, feels different from the surrounding tissue, and is located on the testicle itself rather than on the structures behind it. Not every lump turns out to be cancer, but any new, hard lump on the testicle needs a medical evaluation.
What Testicular Cancer Feels Like
A cancerous lump is usually firm or hard, embedded in the testicle rather than floating loosely around it, and painless in most cases. You might also notice that one testicle feels noticeably heavier or larger than the other, even without a distinct lump. Some people describe a general sense of fullness or heaviness in the scrotum.
Pain is less common but does happen. About a third of people with testicular cancer report a dull ache in the lower belly, groin, or scrotum. Because the ache is mild and comes on gradually, it’s easy to dismiss. A sudden, sharp pain in the testicle is more likely caused by something else, like an infection or torsion, but still warrants a same-day medical visit.
Symptoms Beyond the Testicle
Some testicular cancers produce hormones that cause changes elsewhere in the body. Breast tissue can become enlarged or tender, which catches many people off guard. Lower back pain can develop if the cancer has spread to lymph nodes along the spine. These secondary symptoms don’t always mean the cancer is advanced, but they are reasons to get checked promptly rather than waiting.
How to Do a Self-Exam
A monthly self-check, starting around age 15, is the simplest way to notice changes early. The best time is during or after a warm shower, when the scrotal skin is relaxed. Stand up, lift the penis out of the way, and visually inspect the scrotum for any obvious swelling or asymmetry.
Then check each testicle individually:
- Locate the testicle. Gently grip the top of the scrotum and isolate one testicle between your fingers and thumb.
- Roll it slowly. Use both hands to roll the testicle between your fingers. The surface should feel smooth and firm, like a hard-boiled egg. You’re feeling for any hard lumps, areas of unusual firmness, or changes in size.
- Identify normal structures. At the top and back of each testicle, you’ll feel a soft, slightly tender tube called the epididymis. This is normal. Above it, a rope-like cord runs upward. These structures are not lumps.
- Repeat on the other side. It’s normal for one testicle to hang slightly lower or be slightly larger than the other.
You’re looking for anything that wasn’t there before. A lump on the testicle itself, a change in firmness, or a noticeable size difference from month to month are all worth reporting to a doctor.
Common Conditions That Are Not Cancer
Most scrotal lumps and swelling turn out to be something other than cancer. Knowing the common mimics can reduce anxiety, though none of these should be self-diagnosed.
A hydrocele is a buildup of fluid around the testicle that causes painless swelling. It often feels like a water balloon surrounding the testicle and tends to affect the whole scrotum rather than creating a hard, distinct lump. A varicocele is a cluster of enlarged veins, most common on the left side, that can feel like a “bag of worms” above the testicle. Varicoceles are usually painless but can cause a heavy or achy feeling, especially after standing for long periods.
Epididymitis is an infection of the tube behind the testicle. Unlike a cancerous lump, it typically comes on over a few days, causes noticeable pain and tenderness, and the swelling is behind the testicle rather than on it. Bacterial infections, including sexually transmitted ones like chlamydia, are common causes.
The key distinction: lumps located inside the testicle itself are more concerning for cancer. Lumps or swelling outside or around the testicle are more likely to be benign. An ultrasound can sort this out quickly.
Who Is at Higher Risk
Testicular cancer is relatively uncommon overall, but certain factors raise the odds. The biggest single risk factor is a history of an undescended testicle (cryptorchidism), a condition present at birth where one or both testicles don’t move into the scrotum on their own. Even if the condition was surgically corrected in childhood, the risk remains elevated.
Family history matters. Having a father or brother who had testicular cancer increases your risk significantly. The condition is also more common in white men and those living in the United States or Europe compared to men in Africa or Asia. Most cases are diagnosed between ages 15 and 35, making it one of the more common cancers in younger men.
What Happens at the Doctor’s Office
If you find something concerning, a doctor will start with a physical exam and then typically order a scrotal ultrasound. This is a painless, noninvasive test where a probe is moved over the scrotum to create images of the testicle’s interior. The ultrasound can distinguish fluid-filled cysts from solid masses and show whether a lump is inside or outside the testicle. Lumps inside the testicle are more likely to be cancer.
Blood tests check for proteins called tumor markers that certain testicular cancers produce. Elevated levels of these markers don’t confirm cancer on their own, but they give doctors useful information for diagnosis and, later, for tracking how well treatment is working.
If imaging and blood work raise enough suspicion, the next step is surgery to remove the affected testicle. Unlike most cancers, testicular cancer is generally not biopsied first, because the testicle is removed through a small incision in the groin and then examined. If cancer is confirmed, a CT scan of the chest, abdomen, and pelvis checks whether it has spread.
Survival Rates Are High
Testicular cancer is one of the most treatable cancers, even when caught after symptoms appear. Based on data from 2015 to 2021, the five-year survival rate for cancer that hasn’t spread beyond the testicle is 99%. When it has spread to nearby lymph nodes, the rate is 96%. Even in cases where the cancer has reached distant parts of the body, the five-year survival rate is 72%.
These numbers explain why no major medical organization recommends routine screening for testicular cancer in people without symptoms. The U.S. Preventive Services Task Force specifically recommends against screening asymptomatic men, noting that the combination of low incidence and high cure rates, even at symptomatic stages, means formal screening programs don’t add meaningful benefit. That said, this recommendation is not a reason to ignore symptoms. If you notice a lump, swelling, or persistent ache, getting it checked quickly gives you the best possible outcome.