A cyst is more likely, but you’ll need an exam and a scan to be sure
Finding any lump where it doesn’t belong, such as in your testicle, is concerning to say the least. But don’t panic! It’s more likely to be a benign, non-cancerous cyst than testicular cancer, but it’s important to see your doctor sooner rather than later.
What is a testicular cyst?
A testicular cyst is a fluid-filled sac that can form in or around the testicle. Usually benign, and varying in size and location, testicular cysts occur most commonly in men ages 20 to 50.
While the cause is often unknown, cysts may be related to inflammation, trauma, infection or blockage of ducts in the epididymis, a coiled tube on the back of the testicle where sperm are stored and mature. The good news? Most cysts require no treatment and may resolve on their own or with minimal intervention, says Qiang John Li, MD, PhD, Urologist at Roswell Park Comprehensive Cancer Center.
However, a solid lump in a testicle is considered cancerous until proved otherwise. Testicular cancer is not considered common: about one of every 250 men will develop it at some point in their lifetime. Largely a disease of young and middle-aged men, testicular cancer is highly treatable and curable, especially when detected early.
How can you tell whether it’s a cyst or cancer?
You can’t. Seeing a doctor is your safest bet, and an ultrasound exam is usually necessary, advises Dr. Li. “When men come to me after finding a lump in one of their testicles, we start with a physical exam to assess the size, texture and location of the lump. But the physical exam alone can’t determine whether a lump is cancerous or a benign cyst.”
The reliable way to determine whether a lump is a cyst is through an ultrasound exam of the scrotum, explains Dr. Li. This non-invasive test uses sound waves to create images that reveal whether a lump is solid or fluid-filled, and whether there is blood flow in the lump.
Solid masses are more likely to be cancerous
"Our standard protocol is to treat any solid lump with blood flow in the testis as potential cancer, until proven otherwise,” Dr. Li explains. Be sure to alert your doctor to any other symptoms you may have such as back pain or a feeling of heaviness in the scrotum.
If the ultrasound detects a solid mass, doctors move quickly to the next steps: a blood test to check for specific tumor markers (proteins produced by cancer cells) and a CT scan of the abdomen, pelvis and chest to determine if cancer is in the lymph nodes or other organs, like the lungs or liver.
Should men perform regular self-exams?
Medical opinions differ on whether self-checking reduces mortality rates, but the American Cancer Society recommends monthly self-exams. “It's very easy and as simple as, after a warm shower, gently rolling each testicle between your fingers to feel for any unusual lumps or changes,” says Dr. Li.
Beyond detection, self-checking raises awareness of testicular cancer, especially for men in their 20s to 40s, or with known risk factors — a history of undescended testicles at birth or a family history of testicular cancer, particularly if a father or brother has had testicular cancer.
“This is a highly curable cancer, even in the metastatic setting, but it’s also one of the most common cancers for this age group, so being aware is important,” he emphasizes.
Since testicular cancer primarily affects younger men, sex life and fertility are common concerns. “We’re here to support patients at every level with our multidisciplinary team, including urological surgeons, oncologists, nurses and radiation oncologists as well as primary urology specialists in the Roswell Park Care Network,” says Dr. Li. “While most men are able to resume a normal sex life after having a testicle removed, some men may need testosterone replacement therapy.”
How is testicular cancer treated?
First line of treatment for testicular cancer is an orchiectomy — removal of the affected testicle. In some cases, removal of lymph nodes in the abdomen around big vessels — a procedure called retroperitoneal lymph node dissection — may also be required.
“In the past, these surgeries involved a long incision and patients needed to stay in the hospital for a week. With today’s surgical advances, we perform minimally invasive robotic procedures that spare the nerves and increase the chance of preserving ejaculation. This offers patients a much quicker, less painful experience, with a faster recovery.”
Why Roswell Park for testicular cancer treatment?
From the most-advanced treatment techniques, to extensive supportive care and even our Young Adult Program, you need to come to Roswell Park for testicular cancer treatment.
Special services for young adults
“Men who need chemotherapy and are planning families may choose to undergo fertility preservation and sperm banking. Our survivorship programs provide personalized medical and preventive care, emotional support and help patients manage side effects and emotional stress. Some of our patients are high school age, and they benefit from our young adult programs that provide important support, helping patients stay healthy and plan for their future with confidence.”
Dr. Li recommends cancer survivors maintain long-term surveillance annually with their doctor or urologist. “Men in this age group are typically busy going to school or starting careers and families and they tend to disappear after they are deemed cancer-free. But testicular cancer survivors who had radiation treatment are more likely to develop a new cancer outside the testicle compared to the general population, so we strongly encourage regular checkups.”
