Re: Small Lump on Testical

Posted By HFHS M.D.-JL on May 04, 1998 at 16:28:10:

In Reply to: Small Lump on Testical posted by Peter K on April 29, 1998 at 14:21:21:






Two monthes ago, I discovered a small lump on my right testical. I am a white male, 44 years of age and in good health. The only cancer in my family history that I know of is my dad had prostate cancer and was able to have it treated at it's earliest stages.  There is slight discomfort when I press on the lump and it is about the size of a BB. There is soreness only when I am sitting or lying down. If this is just a cyst, what are the treatments or if in might be the beginning of testical cancer, what should I do?



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Dear Peter K.
Testicular cancer is the most common cancer males age 15-35 years of age.  It is more common in white males than blacks.  It is also more common the right side.  One should suspect testicular cancer when there is a mass in the testis or testicular enlargement.  The mass may or may not be painful.  Other symptoms include heaviness in the scrotum, shortness of breath, chest pain, and hemoptysis (coughing up blood).  The latter three symptoms may be indicative of metastasis (spread of the cancer.)
One risk factor for testis cancer is cryptorchidism (undescended testis).  This increases the risk of testicular cancer 3-10 times.  The risk associated with cryptorchidism is also related to the location of the undescended testis--in the inguinal canal vs intraabdominal location.   There is a 2-3% chance of developing cancer in the opposite testis once one cancer is discovered.   Another risk factor is maternal administration of estrogens. Male infertility should raise suspicion of testicular cancer.
A family history of prostate cancer does not correlate with testicular cancer.
There are other causes of testicular swelling/mass which could be mistaken for cancer.  One of which are testicular appendages which are merely developmental remnants which persist.  They serve no function, but can undergo torsion (twisting upon its blood supply) and can cause pain.  They can be about the size of a "BB."  A benign cystic lesion could also cause these symptoms.  Hydroceles, inguinal hernias and Infection are other causes.
What should you do now?
You should examine the opposite testis to see if there is an abnormality.  Continue checking the right testis to see if the mass is getting bigger.  Then, you should contact your physician to arrange a scrotal ultrasound.  This test will determine if the mass you feel is cystic vs solid or if it is intratesticular (within the testis) or extratesticular (outside the testis).  You should pursue this as soon as possible.  
If the lesion in your testicle is cystic, it is likely benign.  It may be surgically removed  if you remain symptomatic.  If the lesion is solid and intratesticular, there is a high index of suspicion that it is cancer.  If this is the case, you should be referred to a Urologist and she/he will draw tumor markers(special blood tests).  This will clue one into the type of cancer is present.  The definitive diagnosis will be made by the pathologist.
More individualized care is available at the Henry Ford Hospital and its suburban campuses at  (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians notes and lab test results that you may be able to obtain. These will help us greatly.
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.

See your physician right away.
Sincerely, HFHS M.D.-JL
*Keyword: Testicular cancer