Testicular cancer screening: self-exams, lumps and the tests that follow
There is no standard screening test for testicular cancer, and the USPSTF recommends against screening men without symptoms. Most testicular cancers are found by men themselves, by chance or during a self-exam, and a lump or swelling should be checked by a doctor. (NCI)(USPSTF, 2011)(NHS, symptoms)
Is testicular cancer screening recommended?
- USPSTF: recommends against screening adolescent or adult men for testicular cancer, by a clinician's exam or by self-exam (grade D). It reviewed the evidence in 2004, found nothing new in 2009 and reaffirmed the advice in 2011, which is still its final statement. The advice is for men without symptoms, and the USPSTF did not review men with a history of an undescended testicle. (USPSTF, 2011)
- NCI: no studies have shown whether self-exams, regular exams by a doctor or other tests in men without symptoms lower the risk of dying, and routine screening probably would not, partly because testicular cancer can usually be cured at any stage. Finding it early may make it easier to treat. (NCI)
- ACS: has no recommendation on regular self-exams for all men, but says most doctors agree a testicular exam should be part of a routine physical, and men with risk factors should seriously consider monthly self-exams and talk about it with their doctor. (ACS)
- NHS: says it is important to check your testicles regularly so you know what is normal for you and notice changes in size, look or feel. (NHS, symptoms)
Why the USPSTF says no: testicular cancer is rare, at about 5.4 new cases per 100,000 men a year, and more than 90% of new cases are cured whatever the stage. The possible harms are false-positive results, worry, and harms from follow-up tests or procedures. (USPSTF, 2011)
Where this fits with other cancer checks: cancer screenings by age. The full list for men: what tests should a man have every year.
If you choose to check yourself
The ACS and MedlinePlus describe the same simple check: during or after a warm bath or shower, when the skin of the scrotum is relaxed, gently roll each testicle in turn between your thumb and fingers and feel the whole surface for hard lumps or changes in size, shape or firmness. Each testicle should feel firm but not rock hard. (ACS)(MedlinePlus, self-exam) It is normal for one testicle to be slightly larger than the other, or to hang lower. (ACS) There are no risks with the self-exam itself. (MedlinePlus, self-exam)
| What you may feel | What it is |
|---|---|
| Epididymis | A small coiled tube on the upper or middle outer side of each testicle. It can feel like a small bump and is normal. (ACS) |
| Blood vessels and tubes | Normal testicles also contain blood vessels, supporting tissue and tubes that carry sperm, which can be mistaken for lumps. (ACS) (MedlinePlus, self-exam) |
| Hydrocele | Fluid that collects around the testicle and makes it larger. (ACS) (ACS, tests) |
| Varicocele | Widened veins that make the testicle larger and lumpy. (ACS) (ACS, tests) |
| Orchitis or epididymitis | Inflammation of the testicle or the epididymis, which can cause swelling and pain and may be caused by an infection. (ACS, symptoms) |
Who is at higher risk
- An undescended testicle (cryptorchidism): one of the main risk factors, now or in the past. When cancer develops it is usually in that testicle, but about 1 in 4 cases occur in the normally placed one. (ACS, risk factors)(NHS, causes)
- Family history: a father or brother who had testicular cancer. Most men with testicular cancer do not have a family history. (ACS, risk factors)(NHS, causes)
- Past testicular cancer: having had testicular cancer before is another risk factor. (ACS, risk factors)(NHS, causes)
- Other factors: HIV infection, Klinefelter syndrome, hypospadias, and being white (the NHS says a white British background; the ACS says white, American Indian and Alaska Native men are several times more likely to get it than Black, Asian American and Pacific Islander men). (ACS, risk factors)(NHS, causes)
- Age: about half of cases occur between 20 and 45, though it can happen at any age, including in infants and older men. (ACS, risk factors)
If you have one of these risk factors, a doctor may suggest a monthly self-exam. (MedlinePlus, self-exam)(ACS)
What a check for a lump usually involves
If you or a doctor finds a lump, tests may be done to check for cancer. Some tests have risks and may cause worry. (NCI)
| Step | What happens |
|---|---|
| Questions and exam | The doctor asks about your symptoms and general health, and feels the testicles for swelling or tenderness and for the size and place of any lump. The lymph nodes at the top of the legs may be checked too. (NHS, symptoms) (ACS, tests) |
| Scrotal ultrasound | Often the first test. Sound waves make a picture that can show whether a change is a benign condition, such as a hydrocele or varicocele, or a solid lump. A solid lump is more likely to be cancer. (ACS, tests) (NHS, tests) |
| Tumor marker blood tests | AFP, hCG and LDH. Many testicular cancers make high levels of these, but some cancers are too small to raise them, and LDH can also be high with many conditions that are not cancer. (ACS, tests) (MedlinePlus) |
| Results | It can take a few weeks to get them. A specialist explains what they mean and what happens next. (NHS, tests) |
- What tumor markers can and cannot tell you: a high level only means cancer is more likely, because conditions that are not cancer can also raise some markers, and some people with cancer do not have high levels. These tests are mostly used after a diagnosis or when a doctor already suspects cancer. (MedlinePlus, tumor markers)
- A biopsy is rarely done on a testicular lump. (ACS, tests) A specialist explains what the results mean and what will happen next. (NHS, tests)
- An urgent referral for more tests does not definitely mean cancer. (NHS, symptoms)
Where they differ:
- Self-exams: the USPSTF recommends against screening by self-exam in men without symptoms, (USPSTF, 2011) the ACS makes no recommendation for all men, (ACS) and the NHS encourages regular checks so you know what is normal for you. (NHS, symptoms)
- The exam at a checkup: the USPSTF recommends against a clinician's exam for screening, (USPSTF, 2011) while the ACS says most doctors agree it should be part of a routine physical. (ACS)
- Men at higher risk: the USPSTF did not review men with a history of an undescended testicle, (USPSTF, 2011) while the ACS and MedlinePlus say men with risk factors may be advised to do monthly self-exams. (ACS)(MedlinePlus, self-exam)
- Most common ages: the NHS says 15 to 49, (NHS) and the ACS says about half of cases are between 20 and 45. (ACS, risk factors)
Signs to report
These are very common and can be caused by many conditions, but get them checked by a doctor: (NHS, symptoms)(ACS, symptoms)
- a lump or swelling in a testicle, or a testicle getting bigger;
- an ache or pain in a testicle or the scrotum, or the scrotum feeling heavy, firm or hard;
- any change in a testicle that is not normal for you;
- breast growth or soreness, which rarely comes from a testicular tumor; (ACS, symptoms)
- an ache in the back or lower belly, losing weight without trying, a cough, or trouble breathing or swallowing. (NHS, symptoms)(ACS, symptoms)
Sudden, severe testicle pain needs immediate medical care. A twisted testicle (testicular torsion) is a medical emergency. (MedlinePlus, testicle pain)
Contact your provider right away or go to an emergency room if:
- Your pain is severe or sudden.
- You have had an injury or trauma to the scrotum, and you still have pain or swelling after 1 hour.
- Your pain is accompanied by nausea or vomiting.
Also contact your provider right away if:
- You feel a lump in the scrotum.
- You have a fever.
- Your scrotum is warm, tender to the touch, or red.
- You have been in contact with someone who has the mumps. (MedlinePlus, testicle pain)
Your doctor decides what your result means for you.
This page does not give surgery, medicine or treatment advice. If you have a flagged result, see after an abnormal screening result for questions to ask.
Questions people ask
Should men do a monthly testicular self-exam?
The USPSTF recommends against screening adolescent and adult men without symptoms, by a doctor or by self-exam (grade D, 2011). The ACS has no recommendation for all men, while the NHS says to check your testicles regularly so you know what is normal for you. Men with a higher risk may be advised to do monthly self-exams. (USPSTF, 2011) (ACS) (NHS, symptoms) (MedlinePlus, self-exam)
Why is screening not recommended?
Testicular cancer is rare, and more than 90% of new cases are cured whatever the stage. Screening has not been shown to lower deaths, and it can lead to false alarms, worry and extra tests. (USPSTF, 2011) (NCI)
Does a lump in my testicle mean cancer?
Not always. Many symptoms are more likely to be caused by something else, such as a hydrocele, a varicocele or inflammation. A lump is often the first sign of testicular cancer, though, so see a doctor promptly. (ACS, symptoms) (ACS) (MedlinePlus, self-exam)
What age does testicular cancer affect?
The NHS says it is most common between 15 and 49. The ACS says about half of cases occur between 20 and 45, but it can happen at any age. (NHS) (ACS, risk factors)
Can a blood test screen for testicular cancer?
No. Tumor marker tests such as AFP and hCG are used when a doctor already suspects testicular cancer or after a diagnosis. Some cancers do not raise them, and conditions that are not cancer can raise some markers. (NCI) (ACS, tests) (MedlinePlus, tumor markers)