Finding a lump on a testicle can be an immediate cause of concern. While this discovery naturally causes anxiety, the majority of testicular lumps are not cancerous. These masses often arise from benign, common conditions that are easily managed. Regardless of the lump’s initial feel or appearance, any new or growing mass in the scrotum requires a prompt medical evaluation to accurately determine the cause and guide the correct next steps.
Benign and Common Causes
Many testicular lumps or areas of swelling are related to the structures surrounding the testicle and are generally harmless. An epididymal cyst, sometimes called a spermatocele if it contains sperm, is one of the most frequent causes of a lump. These are fluid-filled sacs that develop in the epididymis, the coiled tube behind the testicle that stores and carries sperm. The cyst typically feels distinct, smooth, and separate from the testicle itself, often located on the upper or back side, and usually causes no pain.
Another very common condition is a hydrocele, which is a collection of fluid between the layers of the membrane surrounding the testicle. This condition usually presents as a soft, generalized swelling of the scrotum rather than a distinct lump. A hydrocele is typically painless and its fluid content can often be identified by a doctor using a penlight, a procedure called transillumination.
A varicocele, which affects about 15% of men, is an enlargement of the veins within the spermatic cord, similar to varicose veins found in the legs. This condition is often described as feeling like a “bag of worms” above the testicle and may be more noticeable when a person is standing upright. Varicoceles can sometimes cause a dull ache or heaviness, and in some cases, they are associated with fertility issues due to the resulting slight increase in testicular temperature.
A less common cause of a scrotal lump is an inguinal hernia, where a loop of intestine or abdominal tissue pushes down into the scrotal sac. This mass often changes size or disappears when lying down, and it is a type of lump that originates in the groin area before descending.
Inflammatory and Acute Causes
Some lumps are the result of acute inflammation or injury, and these conditions are typically accompanied by pain and rapid onset. Epididymitis is an inflammation of the epididymis, which can spread to the testicle itself in a condition known as orchitis. This is most commonly caused by a bacterial infection, including sexually transmitted infections. Symptoms involve the gradual onset of scrotal pain, redness, and swelling, sometimes with a fever or burning sensation during urination.
A direct injury to the scrotum can cause swelling or a firm mass due to the accumulation of blood, known as a hematoma. This swelling is usually contained to the area of impact and the pain is directly linked to the trauma.
Testicular torsion occurs when the spermatic cord twists, cutting off the blood supply to the testicle. This is a rare but time-sensitive surgical emergency characterized by the sudden onset of excruciating, severe pain and swelling, often accompanied by nausea or vomiting. Immediate emergency medical attention is required because the viability of the testicle decreases rapidly without restoration of blood flow.
The Primary Concern: Testicular Cancer
Testicular cancer is the most common cancer in men between the ages of 15 and 35, but it is highly curable, especially when detected early.
The lump associated with cancer is typically a firm, hard, and painless mass that feels like an integral part of the testicle itself, rather than a separate structure next to it. It may cause a feeling of heaviness or a dull ache in the lower abdomen or scrotum.
Performing a regular testicular self-examination is the best way to become familiar with the normal texture and size of the testicles, making any new changes easier to detect. The self-examination involves gently rolling each testicle between the thumbs and fingers to check for any firm areas, smooth rounded bumps, or overall changes in consistency. Finding a change, even a painless one, is a sufficient reason to consult a healthcare professional.
Urgent Next Steps and Medical Evaluation
Any new scrotal lump necessitates a medical consultation with a urologist or a primary care physician. If the lump is accompanied by sudden, severe pain, rapid swelling, or fever, immediate emergency care is required to rule out testicular torsion or a severe infection.
The diagnostic process begins with a physical examination and medical history. The primary tool for definitive diagnosis is a scrotal ultrasound, which uses sound waves to create images of the testicles and surrounding structures. The ultrasound is highly effective at distinguishing a fluid-filled cyst from a solid tumor, which raises suspicion for cancer.
If the ultrasound suggests a solid mass, blood tests will be ordered to check for elevated levels of specific tumor markers, such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). The treatment plan is entirely dependent on the diagnosis, ranging from simple watchful monitoring for small cysts and varicoceles, to antibiotics for infection, or surgical removal of the testicle for confirmed cancer or testicular torsion.