Testicular Cancer

Testicular/scrotal lump differential

Confirm diagnosis with scrotal ultrasound scan

  • Testicular cancer
    • Non tender (or even reduced sensation)
    • Arising from testicle
    • Hard without fluctuance or transillumination
    • Irregular
    • Age 15-40
  • Hydrocele
    • Tunica vaginalis is a membrane around each testicle
    • Hydrocele is fluid built up inside this membrane
    • Transilluminated by shining torch into the fluid
    • It is soft, fluctuant and may be large
    • It is irreducible and has no bowel sounds
    • May indicated underlying testicular cancer
    • May require surgical intervention
  • Varicocele
    • Soft “bag of worms”
    • Swollen pampiniform venous plexus (testicular veins)
    • Can cause dragging or soreness
    • Usually harmless
  • Epididymal cyst
    • A cyst (sac of fluid)
    • At the epididymis (at the top of the testicle)
    • Soft, fluctuant lump at the top of the testicle
    • Usually harmless
  • Epididymo-orchitis
    • Tender
    • Generally swollen
  • Inguinal Hernia
    • Separate from testicle
    • Soft
    • Bowel sounds
    • Reducible
  • Testicular Torsion
    • Extremely tender
    • Abnormal lie
    • Suggestive history

The right testicular vein arises from the inferior vena cava. The left testicular vein arises from the left renal vein. Therefore a unilateral left sided varicocele can indicate an obstruction of the left testicular vein, for example caused by a renal cell carcinoma. However, it is worth noting that NICE CKS recommend NOT routinely referring men with a left sided varicoceles for an ultrasound to investigate for renal tumours.


Testicular Cancers (Germ Cell Cancers)

  • Seminoma (50%)
  • Teratoma (50%)
  • Rarely other types


Tumour Markers

  • Alpha-fetoprotein may be raised in teratomas (not seminomas)
  • Beta-hCG may be raised in teratomas and seminomas, but more often in teratomas
  • Lactate dehydrogenase



  • Lymphatics
  • Lungs
  • Liver
  • Brain



  • Good prognosis unless metastatic (>90% cure rate)
  • Even metastatic disease is often curable
  • Slightly better prognosis for seminomas



  • Orchidectomy (offer testicular prosthesis)
  • Chemotherapy / radiotherapy based on staging
  • Monitoring post treatment with tumour markers and imaging
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