Testicular Lumps, Swelling, and Pain in Young Men

This page is for young men who notice a lump, swelling, or pain in a testicle. It explains the difference between an emergency and a lump that needs a call to your provider right away, and what testing, surgery, and follow-up involve.

Both send a young man to the same part of the body. They are treated with different urgency.

Sudden, severe pain in one testicle is a surgical emergency. MedlinePlus puts it plainly. In torsion the testicle twists in the scrotum and loses its blood supply. Losing that supply for only a few hours can kill the tissue and cost the testicle. Call 911 or go to the nearest emergency department right away. Do not drive yourself, and do not wait to see if it settles.

A painless lump is not that. It is still abnormal. MedlinePlus says to contact your provider for any testicle lump, any unexplained scrotal swelling, and any painful swelling. Call right away. Do not wait to see if it goes away.

If you are not sure which one you have, treat it as the emergency.

Not all scrotal swelling is cancer. MedlinePlus lists a long set of causes. They include:

• epididymitis (inflammation of the tube behind the testicle)
• orchitis (inflammation of the testicle)
• hernia
• hydrocele (a buildup of fluid around the testicle)
• varicocele (swollen veins in the scrotum)
• injury or surgery in the genital area
• fluid retention and heart failure Torsion and testicular cancer sit on the same list.

The examining clinician sorts these by feel and by history. Did it come on fast or slowly? Does it feel like fluid or like tissue? Is it one part of the scrotum or the whole thing? Was there recent injury, surgery or infection? Does it go down after you rest in bed?

MedlinePlus says the exam plus that history decides whether any test is needed. A scrotal ultrasound may be done to find where the swelling is coming from.

There is a common belief that young men should run a monthly self-check the way women are told to know their breasts. The USPSTF does not support that.

Its recommendation is a Grade D: it recommends against screening for testicular cancer in adolescent or adult men, by clinician exam or by self-exam. The reasoning is stated in the recommendation itself. Most cases are found by accident, by patients or their partners. There is inadequate evidence that a formal check finds cancer at a more curable stage. And the disease is rare, with a high cure rate even when it is advanced.

The task force was careful about the flip side. After public comment it revised the statement, because some readers worried it might stop men with symptoms from seeking care. A Grade D against routine screening is not advice to ignore a lump that is already there.

For a solid mass inside the testicle, the order of events is fixed. It matters.

NCI states that the blood tumor markers AFP, beta-hCG and LDH should be measured before the involved testicle is removed. The reason is not curiosity. In nonseminoma, NCI says the degree of marker elevation after surgery is one of the most significant predictors of outcome. That comparison is not possible without a number from before.

The markers behave differently. AFP is raised in 40 to 60 percent of men with nonseminoma. Seminomas do not make it at all. So a raised AFP means a mixed germ cell tumor, even when the lab report reads pure seminoma, unless something else explains it, such as liver disease.

Beta-hCG is raised in about 14 percent of stage I pure seminomas before surgery. It is raised in roughly half of metastatic seminomas. LDH rises in both types. It also rises in many conditions that have nothing to do with cancer. NCI cites a study of men on surveillance. In it, 7.7 percent had a raised LDH unrelated to cancer, against 1.4 percent with a cancer-related rise.

One quirk is worth knowing. NCI notes reports of marijuana use raising serum beta-hCG. Some experts retest after a break from it.

The standard operation is a radical inguinal orchiectomy: the testicle is removed through a cut in the groin, and the spermatic cord is tied off high up. The cut is in the groin, not the scrotum.

NCI is explicit about why. A biopsy through the scrotum is not considered appropriate, because the tumor could spread into the scrotum or to nearby lymph nodes. A review of published series using that route found a small but statistically significant rise in local recurrence (2.9% versus 0.4%). Distant recurrence and survival were the same with both approaches.

Fertility belongs in the same conversation. NCI notes that chemotherapy, radiation and retroperitoneal lymph node dissection (surgery to remove lymph nodes at the back of the abdomen) can each cause infertility. Sperm banking can be offered before any treatment other than the orchiectomy itself.

SEER measures 94.6 percent five-year relative survival for testicular cancer among men diagnosed from 2016 through 2022. Alongside it, the American Cancer Society projects 9,810 new cases and 630 deaths in the United States in 2026. The median age at diagnosis is 33. It is found most often between 20 and 34.

That outlook does not make follow-up casual. NCI notes that nearly 20 percent of men with seminoma will relapse without more treatment after orchiectomy, even with normal scans and normal markers. For nonseminoma the figure is 30 percent. A rising AFP or beta-hCG is often the first sign. That is why marker checks carry on after surgery.

For how a symptom becomes a diagnosis, see a symptom is not a diagnosis. For what needs a same-day call, see what symptoms to call the oncology team about today.

• NCI PDQ — Testicular Cancer Treatment (Health Professional Version)
• MedlinePlus — Scrotal swelling
• SEER Cancer Stat Facts — Testicular Cancer
• USPSTF — Testicular Cancer: Screening