A testicular lesion is an area of abnormal tissue found within a testicle. Discovering a lump or change in this area can be concerning, but not all lesions are cancerous. Many are benign, meaning non-cancerous, and result from various harmless conditions. The presence of any abnormality, however, warrants a consultation with a healthcare professional for a proper diagnosis.
Benign vs. Malignant Lesions
The primary distinction among testicular lesions is whether they are benign (non-cancerous) or malignant (cancerous). Benign conditions do not spread and are not life-threatening, though they may require management for discomfort. Malignant lesions, or testicular cancer, involve abnormal cells that can invade tissues and spread to other organs. Most testicular cancers are highly treatable, especially when detected early.
Several common conditions cause benign testicular lumps:
- A hydrocele is a collection of fluid around a testicle, often presenting as painless swelling.
- Varicoceles are an enlargement of veins within the scrotum, sometimes described as feeling like a “bag of worms,” and can cause a dull ache.
- Spermatoceles (epididymal cysts) are painless, fluid-filled sacs that form in the epididymis, the coiled tube on the upper part of the testicle.
- Infections like epididymitis (inflammation of the epididymis) or orchitis (inflammation of the testicle) can cause swelling and pain.
Malignant lesions are categorized as germ cell tumors, as over 95% of testicular cancers originate in the cells that produce sperm. These are divided into two main types: seminomas and non-seminomas. Seminomas grow and spread more slowly than non-seminomas, which occur more often in younger men. A small percentage of cancers, known as stromal tumors, develop in the hormone-producing tissues of the testicles.
Symptoms and Detection
The most common sign of a testicular issue is a painless lump or swelling on one testicle. Other symptoms include a feeling of heaviness in the scrotum, a dull ache in the lower abdomen or groin, or a change in testicle size or consistency. A sudden accumulation of fluid in the scrotum can also occur. While pain is a less common symptom, any abnormality should be evaluated.
Regular self-examination helps individuals notice changes early. The best time for a testicular self-exam (TSE) is during or after a warm shower when the scrotal skin is relaxed. Check one testicle at a time by gently rolling it between the thumb and fingers of both hands to feel the entire surface. Testicles should feel firm but slightly spongy, with a smooth surface, and it is normal for one to be slightly larger. Performing this check monthly helps you learn what is normal for your body, making it easier to detect new lumps or other changes.
The Diagnostic Process
The diagnostic process begins with a physical examination. A physician will feel the testicles and scrotum to assess any lumps, swelling, or tenderness. The doctor will also ask about your medical history and specific symptoms.
The primary imaging tool is a scrotal ultrasound, which uses sound waves to create images of the scrotum’s interior. This can determine if a lump is solid or fluid-filled; a solid mass is more likely to be cancerous. A fluid-filled lesion often indicates a benign condition like a cyst or hydrocele. The ultrasound is highly effective in diagnosing testicular issues.
Blood tests are also ordered to check for proteins known as tumor markers, primarily alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH). Elevated levels of these markers can suggest a malignant tumor. However, normal marker levels do not rule out cancer, and some non-cancerous conditions can cause them to be elevated.
Unlike with many other cancers, a biopsy that removes a tissue sample with a needle is avoided for suspected testicular cancer. This procedure carries a risk of piercing the tumor and causing cancer cells to spread into the scrotum or bloodstream. Therefore, a definitive diagnosis is made through the surgical removal of the affected testicle, which is then sent for histological examination.
Medical Management and Treatment
For benign conditions without significant symptoms, a “watchful waiting” approach is recommended, which involves monitoring the lesion over time. If a benign condition like a hydrocele or varicocele becomes large or painful, minor surgery can correct it. Infections such as epididymitis are treated with antibiotics.
If testicular cancer is confirmed, the standard initial treatment is a radical inguinal orchiectomy. In this surgery, the entire testicle and spermatic cord are removed through a groin incision to prevent cancer cells from spreading. The removed tissue is then analyzed to determine the cancer’s type and stage, which guides further treatment.
Additional treatments depend on whether the cancer has spread. For seminomas, radiation therapy might be used. Chemotherapy is a common option for both seminomas and non-seminomas, especially if the cancer has metastasized. With some non-seminoma tumors, a surgery called a retroperitoneal lymph node dissection (RPLND) may be needed to remove abdominal lymph nodes. The outcomes for testicular cancer are excellent, with high cure rates.