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Testicular Self-Examination

Two minutes once a month could detect testicular cancer at its most curable stage.

Testicular cancer is the most common cancer in men aged 15โ€“35, and it has a 95%+ cure rate when detected early. Monthly self-examination takes two minutes and gives every man a reliable way to spot changes before they become serious. Most lumps found on self-exam are benign โ€” but any new finding should be checked promptly.

Signs and Symptoms

โœ“ New lump or swelling on or inside a testicle
โœ“ Change in size โ€” one testicle becoming noticeably larger
โœ“ Heaviness or dragging sensation in the scrotum
โœ“ Dull ache in the lower abdomen, groin, or back (may indicate lymph node involvement)
โœ“ Breast tenderness or growth (gynaecomastia) โ€” some testicular tumours produce HCG or oestrogen
โœ“ Feeling of fluid collection around a testicle (hydrocele โ€” usually benign)

Risk Factors

When to Seek Help

NowAny new, painless lump on or within the testicle โ€” do not wait to see if it resolves; testicular cancer is usually painless and can be missed for months if dismissed
SoonRapid increase in scrotal size, or a mass that has appeared over days to weeks โ€” see a doctor within the week
RoutineAn annual scrotal ultrasound for men with a history of undescended testicle, regardless of normal self-exam findings

Tests & Diagnosis

๐Ÿงช Scrotal Ultrasound
The primary imaging test โ€” identifies the location (within or outside the testicle), size, and characteristics (solid vs cystic, vascular) of any lesion. An intratesticular solid mass on ultrasound is considered cancer until proven otherwise and requires urgent urological referral. Extratesticular masses (epididymis, vas, scrotal wall) are almost always benign.
๐Ÿงช Tumour Markers (AFP, ฮฒ-HCG, LDH)
Blood tests: Alpha-fetoprotein (AFP), beta-human chorionic gonadotrophin (ฮฒ-HCG), and lactate dehydrogenase (LDH) are elevated in testicular germ cell tumours. Normal markers do not exclude cancer (seminoma rarely elevates AFP or HCG). Elevated markers at diagnosis are used for staging and monitored after treatment.
๐Ÿงช CT Chest, Abdomen, Pelvis
Staging scan performed after the diagnosis is confirmed on ultrasound. Identifies spread to retroperitoneal lymph nodes, lungs, or liver. Determines treatment intensity.

Treatment Options

1
Radical orchidectomy (surgical removal of affected testicle)
The primary treatment for testicular cancer โ€” performed through an inguinal (groin) incision, not a scrotal cut, to prevent lymph node disruption. The testis is sent for histology to confirm type (seminoma vs non-seminoma) and guide further treatment. Fertility is preserved if the other testicle is normal.
2
Surveillance, radiotherapy, or chemotherapy depending on stage
Stage I (confined to testicle): surveillance alone for low-risk cases (one cisplatin chemotherapy cycle or radiotherapy for seminoma). Stage IIโ€“III: 3โ€“4 cycles of BEP chemotherapy (bleomycin, etoposide, cisplatin) achieves cure in 90%+ of cases even with spread. Testicular cancer is one of the most chemotherapy-sensitive solid tumours.
3
Sperm banking before treatment
Orchidectomy of one testicle rarely causes infertility if the other is healthy. However, chemotherapy and radiotherapy can reduce or eliminate sperm production. Sperm banking before treatment is recommended for all men of reproductive age to preserve fertility options.
4
Testosterone replacement if needed
If both testicles are removed (bilateral orchidectomy โ€” rare), testosterone replacement therapy is necessary for energy, libido, bone density, and cardiovascular health. Most men with unilateral orchidectomy have normal testosterone from the remaining testicle.

Frequently Asked Questions

How do I perform a testicular self-examination correctly?
Once a month, ideally after a warm shower when the scrotal skin is relaxed. Stand in front of a mirror. Hold the penis out of the way. Examine each testicle separately: place your index and middle fingers under it, thumbs on top. Gently roll the testicle between thumbs and fingers โ€” feel for any hard lump, change in size, or irregularity. Find the epididymis (a soft, rope-like structure at the back of each testicle) โ€” this is normal and should not be confused with a lump. What you are looking for: anything that feels different from last month, any hard painless lump, any change in consistency.
Most lumps are not cancer โ€” which ones should I worry about?
Epididymal cysts (smooth, pea-sized lumps at the top/back of the testicle) are extremely common and entirely benign. Varicoceles (a bag-of-worms feeling, usually on the left, that reduces when lying down) are also benign. Hydrocele (fluid collection making the whole scrotum feel swollen) is usually benign, especially in older men. The concerning finding is a hard, painless lump within the testicle itself โ€” not behind it or beside it, but embedded in the testicular tissue. Any such finding requires ultrasound within 1 week.
If I have only one testicle, can I still have children?
Yes โ€” a single functioning testicle produces sufficient testosterone and sperm for normal sexual function and fertility in most men. Bilateral orchidectomy (both testicles removed) causes infertility; unilateral (one testicle) does not, if the remaining testicle is healthy. If chemotherapy is also required after surgery, sperm banking before starting treatment is strongly recommended.
Can testicular pain indicate cancer?
Most testicular cancers are painless โ€” which is why they can go unnoticed for months. Testicular pain is more often caused by: epididymitis (infection), orchitis (viral or bacterial inflammation), torsion (twisted testicle โ€” sudden severe pain, emergency), trauma, or varicocele. However, a minority of testicular cancers do cause a dull ache. The rule is: any persistent testicular pain or discomfort that does not resolve in 2โ€“3 weeks warrants an ultrasound โ€” do not assume pain means benign.

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