Testicular cancer self-exam

What is a testicular self-exam?

A testicular self-exam means gently checking each testicle for changes in its size, shape, consistency or feel.

There is an important distinction here: self-examination is not the same as a formal cancer-screening test. The American Cancer Society does not recommend routine monthly self-exams for every man because there is not enough evidence that they reduce deaths from testicular cancer. However, some doctors advise men, particularly those with risk factors, to become familiar with how their testicles normally feel.

The practical value is familiarity. If something changes, you are more likely to notice it.

When should you check your testicles?

A warm bath or shower is a good time because the scrotal skin relaxes, making the testicles easier to examine. The NHS advises checking regularly so you know what is normal for you.

You do not need to squeeze or press hard. The examination should be gentle.

If you have testicular cancer risk factors, ask your doctor whether regular self-examination makes sense for you.

How to perform a testicular self-exam

Step 1: Look at the scrotum

Stand in a comfortable position and look for obvious changes.

Notice whether there is:

• new swelling

• a change in the size of one testicle

• an unusual change in the shape of the scrotum

• a visible difference that was not present before

It is normal for one testicle to be slightly larger than the other, and it is also common for one to hang lower.

Step 2: Examine one testicle at a time

Hold the testicle gently between your thumb and fingers.

Roll it carefully between your fingers rather than squeezing it.

A normal testicle generally feels smooth and firm, but it should not feel rock-hard. The important thing is to learn what is normal for you.

Step 3: Look and feel for a lump

Pay attention to a new hard lump or firm area within the testicle.

A lump is one of the most common warning signs of testicular cancer. Some testicular cancers cause swelling or enlargement rather than an obvious separate lump.

Do not try to determine whether a lump is cancer by feeling it yourself. That requires medical assessment.

Step 4: Find the epididymis

Behind the testicle is a soft, coiled tube called the epididymis. It stores and carries sperm.

It can feel like a small, soft structure behind or toward the upper part of the testicle. Finding it can prevent unnecessary alarm when you first examine yourself.

The epididymis can also become swollen or painful, so a persistent change there should still be evaluated.

What should you look for?

The main changes worth paying attention to are:

• a new lump

• swelling

• an increase in testicle size

• unusual firmness or hardness

• a change in shape

• persistent aching or discomfort

• a heavy sensation in the scrotum

• a change that feels clearly different from your usual baseline

The NHS lists a lump or swelling, enlargement, aching or pain, and a scrotum that feels heavy, firm or hard among symptoms that should be checked.

Does a testicular lump always mean cancer?

No.

Many testicular or scrotal lumps are caused by conditions other than cancer, including cysts, inflammation, infection, injury or varicocele.

That reassurance is useful, but it should not become an excuse to ignore a new lump. A doctor may need to examine the testicle and arrange an ultrasound to determine what is causing the change.

What does a testicular cancer lump feel like?

A testicular cancer may present as a firm or hard lump within the testicle, or as an enlargement or change in the testicle itself.

But there is no reliable “cancer feel” that can be identified at home.

Some cancers cause little or no pain. Others can cause an ache or heaviness. The American Cancer Society notes that most testicular cancers are found because of a lump, swelling or enlargement, although symptoms can vary.

So don't wait for pain before taking a change seriously.

Is testicular pain a sign of cancer?

It can be, but pain alone is not usually the typical presentation of testicular cancer.

Infections, injuries, epididymitis, cysts, varicocele and other conditions can cause testicular pain.

There is one important exception: sudden, severe testicular pain is an emergency because testicular torsion can cut off the testicle's blood supply. It requires urgent medical assessment.

Don't perform a self-exam and wait if the pain is sudden and severe.

Who has a higher risk of testicular cancer?

Some factors increase the risk, including:

• an undescended testicle

• a previous testicular cancer

• a close family history of testicular cancer

• certain abnormalities affecting the testicle

The American Cancer Society notes that many men who develop testicular cancer have no known risk factors.

Men with known risk factors should discuss appropriate monitoring with their doctor rather than relying solely on self-examination.

At what age should men be aware of testicular changes?

Testicular cancer can occur at different ages, but it is particularly common in younger and middle-aged men. The NHS says it is most common in men aged 15 to 49, while the American Cancer Society reports that diagnosis is most common among men aged 20 to 34 in the United States.

That is one reason awareness of testicular changes should not be limited to older men.

What happens if you find a lump?

Don't panic, but don't ignore it.

Make an appointment with a doctor, urologist or other qualified healthcare professional. The clinician will examine the testicle and may recommend a scrotal ultrasound. Blood tests for tumour markers may also be used when testicular cancer is suspected.

You do not need to diagnose the lump yourself.

The sooner a suspicious change is assessed, the sooner you can find out what it actually is.

Can testicular cancer affect fertility?

Testicular cancer and its treatment can affect fertility in some men.

This is particularly relevant if cancer treatment involves surgery, chemotherapy or radiation. Fertility preservation, including sperm banking, may be discussed before treatment when appropriate.

A man who is concerned about fertility can also read Doctar's male fertility testing guide and sperm freezing guide.

Testicular self-exam and varicocele

Not every scrotal change is cancer.

A varicocele, which is an enlargement of veins around the testicle, can sometimes feel like a soft collection of veins. It is usually more noticeable when standing.

Doctar's varicocele symptoms and treatment guide explains this condition in more detail.

Still, a new or uncertain scrotal finding deserves professional assessment.

Don't confuse the testicle with surrounding structures

One common mistake during self-examination is assuming every structure that can be felt is a lump.

The epididymis is a normal structure behind each testicle. It can feel different from the testicle itself.

Learning the normal anatomy can make self-checking less frightening.

The goal is not to repeatedly examine yourself because you are worried. It is simply to recognise a meaningful change.

In clinical practice, men sometimes discover a scrotal lump and immediately assume it means cancer. The opposite mistake also happens: a persistent change gets dismissed as “just a vein.” Both reactions are unhelpful. Examination and, when needed, ultrasound provide a much better answer.

When should you see a doctor?

Arrange medical evaluation if you notice:

• a new lump in a testicle

• swelling

• one testicle becoming larger

• a persistent change in firmness or shape

• a heavy feeling in the scrotum

• persistent aching or discomfort

• a change that does not feel normal for you

The NHS recommends medical assessment for these changes even though they are often caused by conditions other than cancer.

When is it an emergency?

Seek urgent medical care for sudden or severe testicular pain, especially when accompanied by nausea, vomiting or abdominal pain. Testicular torsion is one possible cause and needs rapid treatment.