The scrotum contains the male testes, the two male sex organs that produce and store semen as well as the hormone testosterone. A scrotal mass is a lump or bulge that can be felt in the scrotum, and may result from a variety of factors There are several kinds of scrotal masses:
- Hydrocele (non-cancerous): A mass or swelling caused by a buildup of fluid around the testicle. This swelling can occur after testicular injury or after hernia surgery.
- Spermatocele (non-cancerus): A cyst-like growth that contains fluid and dead sperm cells. This is usually located above or behind the testicle in the epididymis (tubing behind the testicle that carries sperm). This is more common in men who have had a vasectomy or testicular injury.
- Epididymitis: This is inflammation of the epididymis, the tubing behind the testicle that carries sperm. This inflammation can form a tender lump or mass behind the testicle.
- Varicocele: An enlargement of the veins behind the testicle, almost always on the left side. These distended veins, also known as varicose veins, are only present when standing, and disappear when lying down. Varicoceles are sometimes associated with infertility. They can cause a “heavy” sensation in the left testicle when standing.
- Testicular Cancer: Testicular cancer occurs when abnormal cells grow out of control in the testes. It usually forms a hard lump in the testicle itself. Testicular cancer is less common than the other causes of scrotal masses, but it is the most serious.
The cause of a scrotal mass depends on the condition, though an infection, an injury, or fluid buildup can cause different types of masses. In regards to testicular cancer, some issues may increase its probability. A family history of testicular cancer; the genetic disorder Klinefelter syndrome, which results in two or more X chromosomes; or an undescended testicle all can increase the probability of scrotal tumors.
The most common symptoms of scrotal masses include:
- Pain in one or both testicles
- Changes in the size or shape of one or both testes
- A heavy feeling in the scrotum
- A dull pressure or pain in the lower back, belly or groin, or in all three places
Many men detect scrotal masses themselves during self-examination, though your physician may also detect it during a routine physical exam. If a mass is found, your physician will place a strong light behind the testicle to see whether light can pass through (called transillumination). A testicular tumor is too solid for light to pass through.
Light will pass through a mass or swelling caused by a hydrocele. The other testicle also will be felt and examined to make sure it does not contain any lumps, masses or other abnormalities.
Any mass should be screened for cancer, or to confirm another diagnosis. Because other problems can cause symptoms similar to those of testicular cancer, your physician may order tests to find out if you have another problem, or to be sure the cancer has not spread. These tests may include:
- Blood work: Blood may be drawn and examined for high levels of certain proteins that are often secreted by testicular cancer. These proteins include alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG).
- Biopsy: An examination of the tissue for abnormal cell growth. Because of the high risk of contamination and the spread of cancer by doing a scrotal biopsy, the affected testicle is almost always removed and the tissue is examined. The sample will show the type of cancer.
Imaging or X-ray tests:
- CT scan: Performed to screen for and determine extent of disease, including involvement of surrounding tissues or other organs.
- Ultrasound: The physician can produce images of the testes using a wand-like instrument called a transducer, which emits sound waves and picks up the echoes as they bounce off organs.
Depending on the condition, different treatments may be needed:
- Hydrocele: This fluid buildup generally does not require treatment. If the hydrocele become too large or bulky in the scrotum they can be surgically removed.
- Spermatocele: These growths also generally do not require treatment. If they become too large or tender they can be surgically removed.
- Testicular cancer: Nearly all men with testicular cancer undergo surgery to remove the affected testicle, a procedure called radical inguinal orchiectomy.
- Epididymitis: This condition is generally treated with antibiotics and anti-inflammatory medications.
- Varicocele: Enlarged veins usually do not require treatment unless they are so large they are causing severe symptoms or infertility.