4urology

You can develop scrotal masses at any age. Have your doctor check out any unusual lumps or swelling in, on or around your testicles. Treatment of scrotal masses depends on the cause.

Most testicular cancers develop in men younger than age 40. There are two primary types of testicular cancers: seminoma and non-seminoma. Seminoma arises from young germ cells, grows slowly and stays relatively immobile. Between 30% and 40% of testicular cancers are seminoma. Non-seminoma evolves from more mature germ cells. These tend to be more aggressive tumors. There are also testicular cancers that are a blend of both seminoma and non-seminoma.

The cause of testicular cancer is not known, but men whose testes did not descend into the scrotum (cryptorchidism) by age 3 have a greater chance of developing the disease than do men whose testes descended by that age. Cryptorchidism is best corrected surgically in childhood. Sometimes, removal of a single undescended testis in adults is recommended to reduce the risk of cancer.

Testicular cancer represents only 1 per cent of all cancers in men, but it is the single biggest cause of cancer-related deaths in men aged 15-35 years in the UK. Currently, about 1500 men a year (around 1 in 400) develop the disease in the UK. Unfortunately, the number of UK cases has trebled in the past 25 years and is still rising.

Caught early over 99% are curable.
 

Testicular cancer may cause an enlarged testis or a lump elsewhere in the scrotum. Most lumps elsewhere in the scrotum are not caused by testicular cancer, but most lumps in the testes are. A testis normally feels smooth and oval shaped, with the epididymis attached behind and on top. Testicular cancer produces a firm, growing lump in or attached to the testis. With cancer, the testis loses its normal shape, becoming large, irregular, or bumpy. Although testicular cancer is often painless, the testis or lump may hurt when lightly touched and may even hurt without being touched. A firm lump on the testis requires prompt medical attention. Occasionally, blood vessels rupture within the u, yielding a suddenly enlarged, severely painful swelling.

Things can go wrong with your testicles slowly, quickly or very fast indeed. A few conditions that affect the testicles are serious, but most are not, so being obsessed or frightened for no good reason is undesirable. Knowing what your testicles normally feel and look like makes good sense so that changes can be spotted and advice sought quickly if needed.

Check your testicles monthly in the following manner:

• do the self-examination lying in a warm bath or while having a long shower, as this softens the skin of the scrotum (skin sac that holds the testicles), which makes it easier to feel the testicles inside.
• examine the scrotum, looking for any lumps on the skin or swellings inside.
• cradle the whole scrotum and testicles in the palm of your hand and feel the difference between the testicles. One is almost always larger and lying lower. This is completely normal.
• examine each testicle in turn, and then compare them with each other. Use both hands and gently roll each testicle between thumb and forefinger.
• Check for any lumps or swellings as both testicles should be smooth except where the duct that carries sperm to the penis, the epididymis, runs. This lies along the top and back of the testicle and normally feels bumpy.

• a lump in one testicle
• pain and tenderness in either testicle
• discharge or pus from the penis
• blood in the sperm at ejaculation
• a build-up of fluid inside the scrotum
• a heavy or dragging feeling in the groin or scrotum
• an enlargement of the breasts with or without tenderness
• an increase in size of a testicle (one testicle is normally larger then the other but the size and shape should remain more or less the same).
   

Unlike other cancer in which risks have been linked to smoking, drinking or exposure to environmental chemicals or occupation, there are few known risk factors for testicular cancer. The main risk factors are having had an undescended testicle (cryptorchidism) and Klinefelter’s syndrome, a congenital disorder. Men with a family history of testicular cancer are also at higher risk.

The majority of surgical interventions are rather simple. Healing is rapid and often a patient will return home on the same day as the procedure. Radiation and chemotherapy can have strong side effects. Many men with testicular cancer have oligospermia (insufficient sperm) when they are diagnosed and virtually all of those who complete a course of chemotherapy will become oligospermic. However, many recover and go on to father children. Some radiation treatments also inhibit sperm production but again, sperm counts in many will return to normal in the course of time. There are a host of other temporary side effects that are related to the nature of the radiation treatments or the individual character of the chemotherapy regimens. These pass soon after treatments are completed.

Mumps, a viral infection, usually affects children. If an adult contracts mumps, the testes can become painful and swollen and may sometimes shrink and stop working (atrophy). Mumps can permanently damage the ability of the testes to produce sperm but does not usually cause complete infertility unless it affects both testes.
Epididymo-orchitis, any infection of the testicle causing inflammation (orchitis) can cause the testicle to become enlarged. Infection can also effect the epididymis.

An epididymal cyst is a collection of fluid that develops next to the epididymis. Most are painless. While most epididymal cysts need no treatment, one that becomes large or bothersome can be removed surgically.

A hydrocoele is a collection of fluid that developes around the testicle, which may make it more difficult to examine. A hydrocele is usually benign but can be associated with testicular malignancy.