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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Rates of testicular cancer have gone up in recent decades. Healthcare providers aren’t sure why, but due to these rates increasing, they’ve worked hard to raise awareness of testicular cancer symptoms (Baird, 2018; ACS, 2021).
Before we get into those symptoms, you should know that testicular cancer is rare. While it’s one of the most common cancers in young men, your odds of getting it are slim. Only about 9,000 men a year in the U.S. are diagnosed with testicular cancer (Rincones, 2021; Baird, 2018).
It’s also worth pointing out that most causes of testicular pain are not cancer—though they may still require urgent medical attention (Gordhan, 2015).
What is testicular cancer?
Testicular cancer is a type of cancer that causes a solid mass of cancer cells—a.k.a., a testicular tumor or lump—to form in one or both of your testicles (Baird, 2018).
It’s most likely to show up during your early 30s—between the ages of 30 and 34—although it can be diagnosed earlier or later in life, and it’s more common among men who are white, Hispanic, or American Indian than it is among men of other races or ethnicities. It’s also more common among men with a family history of testicular cancer or undescended testicle—a common condition in infants where one or both of the testicles haven’t moved down from the groin into the scrotum (Baird 2018).
Early signs of testicular cancer
Fortunately, most men who develop testicular cancer catch it early. Roughly 65% to 75% of all diagnosed testicular cancers are stage 1, which is the earliest stage and has a very high chance of cure (Oldenburg, 2015).
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The most common symptom of testicular cancer is a painless lump or mass on one of your testicles. It is often small—about the size of a pea or marble (ACS-a, 2018). The mass or lump may be painful, but it’s often painless (Smith, 2018).
According to the American Cancer Society, some other early symptoms of testicular cancer include (ACS-a, 2018; Baird, 2018):
- A swollen or enlarged testicle
- Feeling of heaviness or achiness in the lower belly or scrotum
- Firmness of the testicle
- Dull ache or pain in the scrotum
Though uncommon, some forms of testicular cancer can cause early puberty in young men. This could lead to the premature development of body hair or voice changes (ACS-a, 2018).
Advanced symptoms of testicular cancer
The late-stage symptoms of testicular cancer can look a lot like the early-stage symptoms. For example, scrotal lumps or masses, swollen or firm testicles, and also pain, heaviness, or achiness in your scrotum or lower abdomen can all be later-stage signs of testicular cancer (ACS-a, 2018).
Along with these symptoms, some others tend to show up only when testicular cancer has metastasized—meaning it’s spread to other areas of your body. Symptoms of metastasized testicular cancer are (Gaddam, 2021):
- Stomach discomfort
- Gynecomastia, which is an enlargement, tenderness, or swelling of the breasts
- Low-back pain
- Belly pain
- Neck lumps or masses
- Respiratory symptoms like a cough, a blood cough, chest pain, or shortness of breath
Some of these symptoms, such as enlarged or tender breasts, are related to male hormone shifts caused by cancer (ACS-a, 2018).
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Conditions that may mimic testicular cancer symptoms
A lot of different medical conditions can cause pain in your testicles. Some can also cause a tumor-like lump or mass to form on or around your testicles. So if you find a lump, don’t freak out. There’s a very good chance it’s not cancer (Gordhan, 2015).
Some non-cancer causes of genital pain or symptoms include:
- Testicular torsion: a twisting of the testicles or other scrotal contents (such as blood vessels) that causes pain. The pain can be terrible and often gets worse as time passes. It may also go away and then come back again (Gordhan, 2015). Torsion is common, especially among those 25 and under (Velasquez, 2021). It’s an urgent medical problem. If not treated promptly—within six hours of pain setting in—it can lead to the loss of one or both testicles (Howe, 2017).
- Epididymal cysts and hydroceles: The two most common causes of scrotal lumps are not cancer (Stonier, 2017). They are epididymal cysts (spermatoceles)—a fluid-filled lump that forms around the epididymis—and hydroceles—a mass of fluid that collects in the lining around the testicle. Both can in some cases cause intense pain. Experts aren’t sure why these lumps form, but they suspect that some kind of injury or fluid buildup is to blame. Both can be treated with painkillers, but drainage or surgery may also be necessary (Rioja, 2011).
- Back pain and other health problems: Sensory fibers in the scrotum and testicles connect to the spinal cord and surrounding parts of the body, including the abdomen. As a result, back pain and other health problems can sometimes cause pain or heaviness in the scrotum or testicles. An inguinal hernia, kidney stone, or infection of the abdomen (peritonitis) can all cause pain in your testicles (Gordhan, 2015).
Exercise and other strenuous activities, such as heavy lifting, can also lead to pain in the area of your testicles (Velasquez, 2021). Epididymitis, other scrotum-related conditions, and complications related to a vasectomy can lead to pain as well. So, whatever you’re feeling down there, don’t jump to the conclusion that it’s cancer (Gordhan, 2015).
How to check for a lump
The U.S. Preventive Services Task Force (USPSTF), the American Academy of Family Physicians, and other organizations do not currently recommend self-exams to check for lumps or testicular cancer (as of 2021). The American Cancer Society (ACS) recommends that men with certain risk factors like a previous testicular cancer diagnosis or a family history of testicular cancer consider conducting a monthly self-exam (ACS-b, 2018).
To perform a self-examination, follow these tips (ACS-b, 2018):
- Perform your exam in a hot shower. This will relax your scrotum and make the exam easier.
- Hold your penis out of the way.
- Roll each testicle around in your fingers, feeling for any lumps, bumps, or painful areas.
- Take note of any changes in size, shape, or feel.
When to see a healthcare provider
If you notice a painful lump or mass in your scrotum, you should see a healthcare provider—typically a urologist (Stonier, 2017). Again, other, likelier conditions could explain your lump. But you won’t be able to determine this on your own. A healthcare professional will likely perform an ultrasound and possibly blood tests or a biopsy to assess your pain or lump (Baird, 2018).
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If testicular cancer is causing your symptoms, the good news is that it’s a very treatable cancer, and the available treatments cure a majority of men (Baird, 2018).
Your healthcare provider will determine the best treatment options for your particular medical needs. Usually, testicular cancer treatment will involve the removal of one or both of your testicles. This procedure is called an orchiectomy. While testicle removal causes infertility, there are now sperm-bank options that can help you prepare and plan for a family following the surgery. There are also prosthetics (fake balls) that give your scrotum a normal feel and appearance (Gaddam, 2021).
You may also have to undergo chemotherapy, radiation therapy, or other treatments with an oncologist (Gaddam, 2021).
And if you don’t have a mass but you’re dealing with other symptoms in the area of your groin, it’s still a good idea to see a healthcare provider. Torsion and other causes of pain can be serious and urgent medical conditions (Baird, 2018).
To sum up, whatever you’re dealing with, it’s probably not cancer. But if it is, rest assured that the cancer is treatable in the vast majority of cases (Baird, 2018).
- American Cancer Society (ACS). (2021). Key statistics for testicular cancer. Retrieved September 30, 2021 from https://www.cancer.org/cancer/testicular-cancer/about/key-statistics.html
- American Cancer Society. (ACS)-a. (2018) Can Testicular Cancer Be Found Early?. Retrieved September 30, 2021 from https://www.cancer.org/cancer/testicular-cancer/detection-diagnosis-staging/detection.html
- American Cancer Society (ACS)-b. (2018). Signs and Symptoms of Testicular Cancer. Retrieved September 23, 2021 from https://www.cancer.org/cancer/testicular-cancer/detection-diagnosis-staging/signs-and-symptoms.html
- Baird, D. C., Meyers, G. J., & Hu, J. S. (2018). Testicular Cancer: Diagnosis and Treatment. American Family Physician, 97(4), 261–268. Retrieved from https://www.aafp.org/afp/2018/0215/p261.html
- Cleveland Clinic. (2016). Testicular Pain. Retrieved September 22, 2021 from https://my.clevelandclinic.org/health/symptoms/16292-testicular-pain
- Gaddam, S., & Chesnut, G. (2021). Testicle Cancer. [Updated Jul 25, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK563159/
- Gordhan, C. G., & Sadeghi-Nejad, H. (2015). Scrotal pain: evaluation and management. Korean Journal of Urology, 56(1), 3–11. doi: 10.4111/kju.2015.56.1.3. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25598931/
- Howe, A. S., Vasudevan, V., Kongnyuy, M., Rychik, K., Thomas, L. A., Matuskova, M., et al. (2017). Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion. Translational Andrology and Urology, 6(6), 1159–1166. doi: 10.21037/tau.2017.09.10. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5760391/
- Oldenburg, J., Aparicio, J., Beyer, J., Cohn-Cedermark, G., Cullen, M., Gilligan, T., et al. (2015). Personalizing, not patronizing: the case for patient autonomy by unbiased presentation of management options in stage I testicular cancer. Annals of oncology : official journal of the European Society for Medical Oncology, 26(5), 833–838. doi: 10.1093/annonc/mdu514. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25378299/
- Rincones, O., Smith, A., Naher, S., Mercieca-Bebber, R., & Stockler, M. (2021). An Updated Systematic Review of Quantitative Studies Assessing Anxiety, Depression, Fear of Cancer Recurrence or Psychological Distress in Testicular Cancer Survivors. Cancer Management and Research, 13, 3803–3816. doi: 10.2147/CMAR.S198039. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8123967/
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.