Finding a lump on a testicle can be alarming, but most testicular masses are not cancerous and are caused by benign, treatable conditions. The immediate priority upon discovering any new lump, swelling, or change in the testicles is to seek prompt medical evaluation. Only a healthcare professional, such as a urologist, can accurately diagnose the cause of the mass and determine the necessary course of action.
Painful Lumps Caused by Infection or Trauma
A lump accompanied by sudden, severe pain, swelling, fever, or redness often points toward an acute medical condition, typically caused by infection or injury. Infections like epididymitis and orchitis are common culprits, resulting from inflammation of the epididymis (the coiled tube behind the testicle) or the testicle itself. Epididymitis is frequently caused by bacterial infections, while orchitis is often triggered by a virus, such as mumps. These conditions cause rapid onset of tenderness, warmth, and swelling in the scrotum, and may also present with symptoms like painful urination or a penile discharge.
Infections cause the body’s immune response to flood the area, leading to the noticeable swelling and redness that forms a palpable mass. Trauma from a direct impact, such as a sports injury, can also cause a significant, painful lump due to bruising and hematoma formation within the scrotum. While these causes are generally not life-threatening, it is crucial to rule out testicular torsion. Testicular torsion is a time-sensitive condition where the spermatic cord twists and cuts off blood supply, causing excruciating, sudden pain that requires immediate emergency surgery.
Painless Lumps Caused by Structural Issues
Many of the most common testicular lumps are painless and are merely structural anomalies or fluid collections that pose no serious threat. A spermatocele, also known as an epididymal cyst, is a benign, fluid-filled sac that forms within the epididymis, often containing old sperm. These cysts are typically smooth, located just above or behind the testicle, and require no treatment unless they become excessively large or cause discomfort.
Another common painless swelling is a hydrocele, which occurs when clear fluid accumulates around the testicle within the tunica vaginalis. This fluid buildup can cause a generalized, smooth enlargement of the scrotum. Varicoceles represent a third type, involving the enlargement of the veins inside the scrotum, similar to varicose veins found in the legs. These often feel like a “bag of worms” and are typically found on the left side, sometimes causing a dull ache or a sensation of heaviness that worsens throughout the day.
Recognizing Testicular Cancer
The primary concern for any new testicular lump is the possibility of malignancy, though testicular cancer remains relatively rare. The most common presentation of a cancerous mass is a lump or swelling in the testicle itself that is notably painless. This lack of pain is a distinguishing feature from many infectious causes, making awareness of non-painful changes important.
A cancerous lump tends to feel hard, firm, and fixed to the testicle, unlike the softer, more mobile masses associated with benign cysts or varicoceles. Other potential symptoms include a change in the size or texture of the testicle, or a feeling of heaviness or dull ache in the scrotum or groin. Because testicular cancer is highly curable when detected early, men should perform regular self-examinations to establish a baseline and promptly detect any new, firm area. The mass usually originates within the testicle tissue, which a physical exam and subsequent imaging can help to confirm.
When to Seek Immediate Medical Evaluation
Any new or unusual change in the testicles warrants a consultation with a healthcare provider, preferably a urologist, for a timely and definitive diagnosis. The diagnostic process begins with a physical examination, where the doctor assesses the lump’s size, consistency, and location. The most critical diagnostic tool is the testicular ultrasound, a non-invasive imaging test that uses sound waves to create detailed images of the scrotal contents.
Ultrasound can definitively determine if the mass is solid, which is concerning for cancer, or fluid-filled, which suggests a benign cause like a hydrocele or spermatocele. If cancer is suspected, blood tests are ordered to check for elevated levels of specific tumor markers, such as alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (HCG). Specific symptoms demand immediate emergency care, including sudden, severe testicular pain, especially if accompanied by nausea, vomiting, or abdominal pain, as these may signal testicular torsion requiring intervention within hours to save the testicle.