5. Inguinal hernia
An inguinal hernia occurs when tissue, such as part of the intestine, pushes through a weak area in the lower abdominal wall and into the groin.
It can produce a bulge near the groin or extend toward the scrotum. Some people notice the swelling more when coughing, lifting heavy objects, or standing.
A hernia can cause discomfort or a dragging sensation. If a bulge becomes suddenly very painful, cannot be pushed back, or is accompanied by vomiting or abdominal swelling, urgent medical assessment is necessary.
6. Injury or irritation
A blow to the groin, strenuous exercise, or repeated pressure can cause temporary pain and swelling.
However, a person should not automatically assume that a lump is caused by an old injury. If the swelling persists, grows, or changes the shape of the testicle, a doctor should examine it.
The lists cysts, varicoceles, infections, hernias, and other conditions among the possible causes of testicular lumps and swelling.
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Why ultrasound is important
A physical examination can provide useful clues, but it may not be enough to distinguish all possible causes.
A testicular ultrasound uses sound waves to create images of the testicles and surrounding structures. It can help doctors identify fluid-filled cysts, swelling, changes in blood flow, and solid masses.
The scan is generally non-invasive and does not use ionizing radiation. It is an important investigation when a person has an unexplained lump or swelling.
An illustrative testicular ultrasound examination. The scan helps doctors investigate swelling and identify the nature of an abnormality.
Why waiting for pain is not a reliable strategy
Some testicular cancers are painless. A man may feel completely normal apart from noticing a small lump or a gradual change in size.
Conversely, severe pain may be caused by torsion or infection rather than cancer.
This is why the absence or presence of pain cannot determine the diagnosis. A new lump, persistent swelling, or unusual change should be assessed even if it does not hurt.
The safest approach is to arrange an appointment with a doctor or urologist rather than trying to determine the cause at home.
Chapter 4: How Doctors Diagnose Testicular Cancer
A testicular lump does not automatically mean cancer. When a patient seeks medical attention, doctors follow a series of steps to identify the cause and determine whether further investigation is needed.
The process usually begins with a discussion of symptoms and a physical examination. Imaging and blood tests may follow if a suspicious abnormality is found.
Step 1: Medical history
The doctor may ask when the lump or swelling first appeared, whether it has grown, and whether there is pain or heaviness.
They may also ask about previous testicular conditions, injuries, infections, family history, and whether the patient has ever had an undescended testicle.
These details help guide the next stage of assessment.
Step 2: Physical examination
The clinician examines the testicles and scrotum, checking for differences in size, shape, firmness, and texture.
They may also examine the groin and abdomen for enlarged lymph nodes or other signs that require investigation.
The examination is usually brief. Although it may feel embarrassing, it is a routine part of urological care.
Step 3: Ultrasound
An ultrasound scan is commonly used to examine a testicular lump.
It helps determine whether the abnormality is inside the testicle or in surrounding structures. This distinction is important because different types of lumps have different possible causes.
Ultrasound can also help distinguish a fluid-filled structure from a solid mass.
If the scan suggests a suspicious solid mass within the testicle, the doctor may arrange urgent specialist assessment.
Step 4: Blood tests
Doctors may request blood tests for tumor markers associated with testicular cancer.
Common markers include:
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Alpha-fetoprotein (AFP).
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Beta-human chorionic gonadotropin (beta-hCG).
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Lactate dehydrogenase (LDH).
These markers can help support diagnosis, assess the disease, and monitor response to treatment.
However, normal marker levels do not completely rule out testicular cancer. The results must be interpreted alongside the examination and imaging findings.
Step 5: Further scans and specialist assessment
If cancer is suspected or confirmed, additional imaging may be used to assess whether it has spread beyond the testicle.
A specialist may recommend a CT scan of the abdomen and chest, depending on the clinical situation.
Doctors then use the information from examinations, blood tests, imaging, and pathology to determine the type and stage of the disease.
Why biopsy is different in testicular cancer
For many types of cancer, doctors obtain a tissue sample through a biopsy before deciding on treatment.
For a suspicious testicular mass, the usual initial procedure is often surgery to remove the affected testicle through an incision in the groin. The tissue is then examined by a pathologist to establish the diagnosis.
This approach is different from simply inserting a needle through the scrotum to sample the mass. The specialist decides the safest diagnostic and treatment pathway based on the findings.
What happens if cancer is confirmed?
Treatment depends on the type of testicular cancer, its stage, and the patient's overall health.
Surgery to remove the affected testicle, called an orchidectomy or orchiectomy, is often the first major treatment.
Some patients need no further treatment beyond careful surveillance. Others may require chemotherapy, radiotherapy for selected cancer types, or additional surgery if the disease has spread.