Know which pathway you need
Sudden Severe Pain is an Emergency
A new lump or change in a testicle needs prompt medical assessment. However, sudden severe testicular pain is more suggestive of testicular torsion than cancer and requires immediate emergency assessment because blood flow to the testicle may be interrupted.
Seek immediate care for:
- Sudden severe pain in one testicle, especially with nausea, vomiting or abdominal pain.
- Rapid swelling or a testicle that sits higher or differently than usual.
- Severe pain that suddenly settles—intermittent torsion can twist and untwist.
- Fever with severe scrotal pain, spreading redness, weakness or confusion.
- A painful groin or scrotal bulge with vomiting or abdominal swelling.
Arrange a prompt urology assessment for a new firm lump, hard area, persistent enlargement, heaviness or change in consistency even when it is painless. Do not wait to see whether it disappears.
What is Testicular Cancer?
The testicles produce sperm and testosterone. Most testicular cancers are germ-cell tumours, arising from cells involved in sperm development. Pathology divides them into two broad groups because their behaviour and treatment differ.
A Lump Does Not Confirm Cancer—but It Must Be Checked
Cysts, infection, hydrocele and varicocele can also cause scrotal changes. Examination and ultrasound distinguish a mass inside the testicle from fluid or a structure beside it.
What Changes Can Testicular Cancer Cause?
Less common features may include:
- New fluid around a testicle or scrotal enlargement that obscures examination.
- Breast tenderness or enlargement related to hormone production by some tumours.
- Persistent back or abdominal pain from enlarged lymph nodes.
- Unexplained cough, breathlessness, chest symptoms, weight loss or fatigue in advanced disease.
These symptoms have many non-cancerous causes. Their presence does not establish a diagnosis, and their absence does not make a new intratesticular lump safe to ignore.
Who Has a Higher Risk?
- A testicle that did not descend normally into the scrotum, even if corrected surgically.
- Previous cancer in the other testicle.
- A father or brother who has had testicular cancer.
- Abnormal testicular development or a very small, poorly functioning testicle.
- Some disorders of sex development and selected genetic conditions.
Most people diagnosed do not have an obvious risk factor. A knock or sports injury does not cause testicular cancer, although it may draw attention to a lump that was already present. There is no routine population screening programme; those at higher risk should discuss testicular awareness and follow-up with their doctor.
How is a Testicular Lump Assessed?
The assessment normally includes:
- A history of when the change began, pain, previous undescended testis, fertility and family history.
- Examination of both testicles, epididymides, spermatic cords, abdomen, breasts and lymph-node areas.
- High-resolution ultrasound of both testicles, with Doppler assessment when appropriate.
- Blood tests for AFP, beta-hCG and LDH before surgery.
- Semen preservation discussion before treatment, particularly when future fertility is important.
If ultrasound shows a suspicious solid mass inside the testicle, the usual next step is prompt specialist review and surgery through the groin. Antibiotics should not delay this pathway unless the overall findings genuinely support infection and follow-up confirms resolution.
What Does Ultrasound Show?
Ultrasound is painless and does not use radiation. It identifies whether a change is within the testicle or outside it, and whether it is solid, cystic or related to blood flow. Both testicles are scanned because a second lesion or background abnormality may alter care.
Ultrasound can make cancer highly likely, but the exact tumour type is established by pathological examination after surgery.
What Do Tumour-Marker Blood Tests Mean?
Markers should be measured before orchidectomy and repeated afterwards according to their expected fall. Normal markers do not rule out testicular cancer, while a persistent or rising level after surgery may indicate disease elsewhere and changes staging and treatment.
Why is Biopsy Through the Scrotum Usually Avoided?
A suspicious testicular tumour is normally removed through an incision in the groin by radical inguinal orchidectomy. The spermatic cord is controlled and the affected testicle is removed intact. This provides the diagnosis and is also the first treatment for most localised cancers.
A routine needle biopsy or incision through scrotal skin can disrupt normal lymphatic drainage, contaminate a different surgical field and complicate later management. This differs from many other cancers, where a needle biopsy is routinely obtained before treatment.
Testis-preserving surgery may be considered in carefully selected situations—such as small or indeterminate lesions, tumours in both testicles or a mass in a solitary testicle—but requires specialist expertise, intra-operative pathology and structured follow-up. It is not the standard approach for a typical suspicious mass in one testicle.
How is the Extent of Cancer Determined?
Pathology reports the tumour type and local features. CT of the chest, abdomen and pelvis looks for lymph-node or organ involvement. Post-operative tumour-marker levels add essential staging and prognostic information. Brain or bone imaging is reserved for selected symptoms or higher-risk disease.
Treatment is not chosen from the stage number alone. Seminoma or non-seminoma pathology, marker level, sites of disease, general health and previous treatment all influence the plan.
How is Testicular Cancer Treated?
Relapsed or complex disease should be managed in a specialist germ-cell tumour service. Even metastatic disease can often be cured, which makes correct first-line chemotherapy, dose timing and experienced surgical planning particularly important.
What About Fertility, Testosterone and Sexual Function?
Fertility may be reduced before any treatment, and chemotherapy, radiotherapy or lymph-node surgery can add further risk. Sperm banking should be discussed before treatment whenever possible, especially before chemotherapy. Urgent cancer treatment should not be dangerously delayed.
- One healthy remaining testicle usually produces enough testosterone and sperm.
- Removing one testicle does not usually prevent erections, orgasm or sexual activity.
- Testosterone should be checked when symptoms or treatment history suggest deficiency.
- Retroperitoneal lymph-node surgery can affect ejaculation; nerve-sparing techniques reduce this risk when suitable.
- A testicular prosthesis can be placed during orchidectomy or later for appearance; it does not produce sperm or hormones.
- People with one testicle, poor semen quality or planned systemic therapy may need early fertility-specialist input.
Fertility, body image and sexual wellbeing should be discussed directly rather than assumed. A prosthesis is a personal choice, and declining one has no effect on cancer treatment.
What Does Follow-up Involve?
The schedule depends on tumour type, stage and treatment. Surveillance is an active treatment strategy and only remains safe when appointments are attended reliably.
- Clinical review and examination of the remaining testicle.
- AFP, beta-hCG and LDH at defined intervals when appropriate.
- CT, MRI, chest imaging or other scans according to relapse risk and previous treatment.
- Assessment of fertility, testosterone, sexual wellbeing and emotional health.
- Review for chemotherapy effects involving hearing, nerves, kidneys, lungs and cardiovascular health.
- Long-term attention to healthy weight, blood pressure, smoking, exercise and second-cancer risk.
Report a new lump in the remaining testicle, persistent back or abdominal pain, unexplained cough, breathlessness, weight loss or other new symptoms between visits rather than waiting for the next appointment.
Myth vs Fact
Frequently Asked Questions
Is every testicular lump cancer?
No. Cysts, inflammation and structures beside the testicle are common causes of lumps. A firm mass within the testicle is more concerning, and examination plus ultrasound is the safest way to distinguish them.
Can testicular cancer cause pain?
Yes, although it more commonly presents as a painless change. Sudden severe pain requires immediate assessment for torsion rather than waiting for a routine cancer appointment.
Can normal tumour markers rule out cancer?
No. Some seminomas and non-seminomas do not raise AFP, beta-hCG or LDH. Ultrasound and pathology remain essential even when all three blood tests are normal.
Why can I not have a needle biopsy first?
Passing a needle or incision through scrotal skin can alter lymphatic drainage and contaminate another surgical field. A suspicious mass is usually removed intact through the groin, which provides both diagnosis and initial treatment.
Can I have sex after removal of one testicle?
Yes. Once healed, removing one testicle does not usually prevent erections, orgasm or sexual activity. Speak with the team about pain, body image, fertility or symptoms of low testosterone.
Is a testicular prosthesis compulsory?
No. It is an optional implant that provides a similar appearance but produces no hormones or sperm. It can be placed at the original operation or later after discussing risks and preferences.
Does surveillance mean the cancer is untreated?
No. The visible tumour has been removed by orchidectomy. Surveillance avoids unnecessary additional treatment while using scheduled tests to find relapse early. Missing follow-up can make it unsafe.