Testicular cancer is a rare cancer, but it is especially important because it mainly affects young men. It does not always cause pain, it does not always produce clear general symptoms, and it often begins with one seemingly small change: a lump, hardness, enlargement or a feeling of heaviness in the scrotum.
This article explains what should draw attention, how to perform testicular self-examination, when to see a urologist and which tests are usually performed when a testicular tumour is suspected. If you feel a new change, enlargement, hardness, asymmetry or persistent testicular pain, book a urological consultation.
Author: Jakub Krukowski, MD, PhD, urologist | Medical review: Jakub Gondek, MD, urologist | Publication date: 27.06.2026 | Last updated: 27.06.2026
What is testicular cancer?
Testicular cancer is a malignant tumour that develops within the testicle. It most often arises from germ cells. In medical practice, two main groups of germ cell tumours are often discussed: seminomas and non-seminomas. They differ in their course, tumour markers, treatment and follow-up, so an accurate diagnosis is very important.
Although testicular cancer is not among the most common cancers in men overall, it is one of the most important cancers in young men. In Poland, it is diagnosed in around 1,200 men each year, with the highest number of cases occurring at around 20–44 years of age.
The good news is that testicular cancer is one of the cancers with very high treatment effectiveness, especially when diagnosed early. This does not mean, however, that it can be ignored. The sooner the patient sees a urologist, the sooner ultrasound, tumour markers and further management can be arranged.
“The most important message for the patient is simple: a new lump, hardness, enlargement or a clear change in the testicle requires urological assessment. It is not worth waiting for it to go away on its own.”
— Jakub Krukowski, MD, PhD, urologist
Why is testicular cancer sometimes detected by the patient himself?
There is no universal screening programme for testicular cancer comparable to mammography or cervical screening. In men without symptoms and without particular risk factors, routine screening tests are not standard. In practice, many changes are noticed by the patients themselves — by chance, during bathing, sexual activity, dressing or self-examination.
That is why, instead of talking about “screening” in the strict sense, it is better to talk about awareness of one’s own body. A man should know the usual shape, size and consistency of his testicles so that he can notice a change more quickly.
Self-examination does not replace a doctor and does not provide a definite diagnosis. However, it is a simple habit that may shorten the time between the appearance of a symptom and a urological consultation.
Which symptoms of testicular cancer should be concerning?
The most typical symptom is a painless lump, hard area or enlargement of the testicle. Some patients do not feel pain, so the absence of pain should not be reassuring if a new change has appeared.
Symptoms that should prompt a urological consultation include:
- a new lump felt in the testicle,
- hardness of part or all of the testicle,
- enlargement of one testicle,
- a change in the shape or consistency of the testicle,
- a feeling of heaviness in the scrotum,
- pulling, discomfort or dull pain in the testicle, scrotum, groin or lower abdomen,
- sudden accumulation of fluid in the scrotum,
- asymmetry that was not present before,
- back pain or lower abdominal pain without a clear cause, especially if accompanied by a change in the testicle,
- less commonly: enlargement or tenderness of the breasts in a man.
Important: sudden, severe testicular pain is an urgent situation because it may indicate testicular torsion. In such a case, do not wait for a scheduled appointment — seek urgent medical help.
A testicular symptom — what can it mean?
| Symptom | Possible cause | What to do? |
|---|---|---|
| Hard lump in the testicle | requires exclusion of a testicular tumour | book an urgent urological consultation and scrotal ultrasound |
| Enlargement of the testicle | tumour, hydrocele, inflammation or another cause | do not observe it for months — have it checked |
| Pain and swelling | inflammation, injury, torsion, less commonly a tumour | in sudden severe pain — seek urgent medical help |
| Soft structure at the back of the testicle | often the normal epididymis | if the patient is unsure — consult a doctor |
| Feeling of heaviness in the scrotum | varicocele, hydrocele, tumour or other changes | urological examination and ultrasound are recommended |
How to perform testicular self-examination correctly?
Self-examination is best performed after a warm shower or bath, when the scrotum is relaxed. The examination should be gentle. It is not about pressing hard, but about calmly getting to know the structure of the testicles and noticing any possible change.
A practical self-examination scheme:
- Stand in front of a mirror. Check for visible swelling, asymmetry, redness or skin changes on the scrotum.
- Examine each testicle separately. Hold the testicle between the thumb and fingers of both hands.
- Gently move your fingers over the surface of the testicle. Pay attention to hard lumps, thickening, irregularities or an area clearly different from the rest.
- Compare both testicles. One testicle may naturally be slightly larger or hang lower — what matters is a change compared with what was present before.
- Do not mistake the epididymis for a tumour. At the back of the testicle there is the epididymis — a soft, elongated structure. If you do not know whether you are feeling the epididymis or a change, consult a urologist.
- React to new changes. A lump, hardness, enlargement, pain or heaviness requires medical assessment.
In practice, a few minutes once a month is enough. Regularity and awareness of how the testicles look and feel normally are the most important things.
“Self-examination is not about diagnosing yourself. It is about noticing a change and seeing a doctor quickly. Scrotal ultrasound is simple, accessible and very helpful in differentiating testicular changes.”
— Jakub Gondek, MD, urologist
Does every enlargement or lump mean cancer?
No. Various changes can occur in the scrotum that are not cancer. These may include hydrocele, epididymal cyst, varicocele, inflammation, post-traumatic changes or a hernia. Symptoms may be similar, so based on touch alone the patient cannot safely distinguish the cause.
This is very important: the purpose of consultation is not to frighten the patient with cancer, but to quickly and reasonably explain the symptom. If the change is benign, the patient gains peace of mind. If it is suspicious, quick diagnostics shorten the time to treatment.
The worst solution is to observe a new lump for many months in the hope that “it is probably nothing”. In the case of testicles, it is better to check one change too many than one too late.
Risk factors for testicular cancer
Testicular cancer can also occur in a man without any known risk factors. However, there are situations in which vigilance should be higher.
Known risk factors include:
- cryptorchidism, or undescended testicle — especially if the problem occurred in childhood, even after treatment,
- previous testicular cancer — increases the risk of cancer in the other testicle,
- testicular cancer in close relatives, especially father or brother,
- certain disorders of testicular development,
- infertility or abnormal semen parameters, which may coexist with testicular function disorders,
- age — the greatest vigilance concerns young adult men, although the disease can also occur outside this range.
It is worth emphasising that risk factors do not act like a simple sentence. Their presence does not mean that the patient will become ill. Their absence does not mean that a new change can be ignored. The most important thing is to react to symptoms.
At what age should men start paying attention to their testicles?
Awareness of one’s own body is worth building from puberty. A young man should know that testicles may naturally differ in size and position, but a new lump, hardness, enlargement or pain requires telling a parent, family doctor or urologist.
For adult men, testicular self-examination once a month is a good habit. It is not a formal screening programme, but simple vigilance. It is especially important in men who had an undescended testicle, testicular cancer in the family or previous testicular problems.
If the patient does not know how to examine the testicles correctly or feels something he cannot interpret, it is best to have a urological consultation and scrotal ultrasound.
What does diagnostics look like when testicular cancer is suspected?
Diagnostics usually begins with a conversation and a urological examination. The doctor assesses the testicles, scrotum, groins, sometimes also the abdomen and lymph nodes. The key imaging test is scrotal ultrasound, usually involving both testicles.
If ultrasound raises suspicion of a testicular tumour, the doctor may order tumour markers in the blood:
- AFP, or alpha-fetoprotein,
- beta-hCG, or human chorionic gonadotropin,
- LDH, or lactate dehydrogenase.
Markers help in diagnosis, staging, treatment planning and later follow-up, but not every testicular cancer causes them to increase. A normal marker result does not always exclude disease if the ultrasound is suspicious.
If the suspicion is confirmed, further management should follow the urological-oncological pathway. In selected situations, computed tomography of the chest, abdomen and pelvis, staging assessment and discussion of fertility before treatment are needed.
Is testicular biopsy performed?
Patients often ask whether a suspicious testicular lump can be “simply biopsied”. In suspected testicular cancer, standard management usually differs from many other cancers. Routine percutaneous biopsy of a testicular tumour through the scrotum is not performed, as this may be inappropriate from an oncological point of view.
The decision about further treatment is made by the urologist based on examination, ultrasound, tumour markers and assessment of the entire clinical situation. If suspicion of a tumour is high, the patient should be managed according to the principles of testicular cancer treatment.
Fertility and testicular cancer — why is it worth talking about early?
Testicular cancer often affects young men who do not yet have children or plan fatherhood in the future. That is why discussing fertility is important at the beginning of diagnostics and treatment.
The disease itself, previous testicular function disorders, surgery, chemotherapy or radiotherapy may affect fertility. In many situations, sperm banking is considered before oncological treatment. This is a topic worth discussing with the doctor as early as possible, before treatment begins.
Not every patient will require such management, but every young man should be informed that fertility is part of treatment planning, not a topic “for later”.
Key conclusions
| Does testicular cancer always hurt? | No. A testicular tumour may be painless, so absence of pain does not exclude a problem. |
| Does every lump mean cancer? | No. But every new lump or hardness in the testicle requires urological assessment. |
| What is the most important first test? | Urological examination and scrotal ultrasound. |
| Are there blood markers? | Yes. AFP, beta-hCG and LDH are most often checked if a tumour is suspected. |
| Is it worth examining the testicles yourself? | Yes, as a habit of knowing your own body. Self-examination does not replace a doctor, but helps notice changes sooner. |
Frequently asked questions
Does testicular cancer always hurt?
No. Testicular cancer often begins as a painless lump, hardness or enlargement of the testicle. Pain may occur, but its absence does not mean the change is harmless.
How often should testicular self-examination be performed?
A good practical habit is self-examination once a month, preferably after a warm shower. The goal is to notice new changes, not to diagnose yourself.
Does young age exclude testicular cancer?
No. Testicular cancer is especially important in young men. Therefore, a lump, hardness or enlargement of the testicle in a teenager or young adult requires medical assessment.
Is scrotal ultrasound enough to exclude cancer?
Scrotal ultrasound is a basic and very important test when a testicular change is suspected. Final interpretation and next steps are determined by the urologist, sometimes together with blood markers and further diagnostics.
Are AFP, beta-hCG and LDH always elevated?
No. Markers can be helpful, but not every testicular tumour causes them to increase. That is why normal markers do not always exclude disease if examination or ultrasound is suspicious.
When should I urgently see a urologist?
Urgent consultation is needed for a new lump, hardness, enlargement of the testicle, clear asymmetry, heaviness or persistent pain. Sudden severe testicular pain requires urgent medical help because it may indicate testicular torsion.
Do you feel a lump, hardness or change in the testicle?
Do not wait for the symptom to go away on its own. A urological consultation and scrotal ultrasound allow quick assessment of whether the change requires further diagnostics.
Book a urological consultation →Urologist in Gdańsk — who can help?
At Wyspa Medycyny Przyjaznej, urological consultations are provided by doctors who diagnose diseases of the testicles, scrotum, penis, prostate and urinary tract:
During the visit, the doctor will assess the symptom, perform or order appropriate tests and explain whether further diagnostics are needed. If cancer is suspected, quick and organised patient guidance is important.
Summary
Testicular cancer is a rare but very important cancer in young men. It may begin subtly: with a lump, hardness, enlargement of the testicle, a feeling of heaviness or a change noticed by chance. Lack of pain does not exclude disease.
There is no universal screening programme for all men, which is why awareness of one’s own body and quick response to new symptoms are so important. Monthly self-examination may help notice a change, but it does not replace a urological consultation.
If you feel a lump, hardness, enlargement, pain or a concerning change in the testicle, book a urological consultation. In diagnostics, medical examination, scrotal ultrasound and — if a tumour is suspected — AFP, beta-hCG and LDH markers are crucial.
Sources and medical context:
- National Oncology Portal — Testicular cancer: epidemiology
- American Cancer Society — Key Statistics for Testicular Cancer
- National Cancer Institute — Testicular Cancer Screening
- European Association of Urology — Testicular Cancer: Diagnostic Evaluation
- SEER Cancer Stat Facts — Testicular Cancer
This article is for informational purposes only and does not replace medical consultation. A new lump, hardness, enlargement, asymmetry, feeling of heaviness or persistent testicular pain requires urological assessment. Sudden, severe testicular pain requires urgent medical help.