Scrotal Masses

The cause of a scrotal mass depends on the condition, though an infection, injury or fluid buildup are all culprits.

Regarding 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, groin or in all three places

Many men detect scrotal masses during self-examination, though a physician may detect it during a routine physical exam. If a mass is found, the physician may recommend an ultrasound, or he/she might place a strong light behind the testicle to see whether light passes through. A testicular tumor is too solid, but light will pass through a mass or swelling caused by a hydrocele, which is fluid. The physician will also examine the other testicle for lumps, masses or other abnormalities.

Any mass should be screened. Because other problems can cause symptoms similar to those of testicular cancer, the physician may order tests to screen out other problems, or to be sure the cancer has not spread. These tests may include:

• Blood test: To detect high levels of certain proteins that are often secreted by testicular cancer. These proteins include alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG).
• Imaging or x-ray tests:
  • CT scan: An imaging that screens for and determines the extent of the disease, and if it has reached surrounding tissues or other organs.
  • Ultrasound: Images of the testes taken with a wand-like instrument called a transducer that emits sound waves and picks up the echoes as they bounce off organs.
• Biopsy: Rarely performed given the risk for the spread of cancer; the affected testicle is almost always removed in its entirety for both diagnosis and treatment.

Depending on the condition, different treatments may be necessary:

• Hydrocele: This fluid buildup generally does not require treatment. Hydrocele that become too large or bulky in the scrotum 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 that they cause severe symptoms or infertility.