Typical symptoms are a painless swelling or lump in 1 of the testicles, or any change in shape or texture of the testicles. The swelling or lump can be about the size of a pea, but may be larger. Most lumps or swellings in the scrotum are not in the testicle and are not a sign of cancer, but they should never be ignored.

Other symptoms

Testicular cancer can also cause other symptoms, including:

• an increase in the firmness of a testicle
• a difference in apperance between 1 testicle and the other
• a dull ache or sharp pain in your testicles or scrotum, which may come and go
• a feeling of heaviness in your scrotum

See a GP as soon as possible if you notice a swelling, lump or any other change in 1 of your testicles. Most lumps within the scrotum are not cancerous, but it's important to get checked as soon as possible. Treatment for testicular cancer is much more effective when started early.

Physical examination

As well as asking you about your symptoms and looking at your medical history, a GP will usually need to examine your testicles. They may hold a small light or torch against your scrotum to see whether light passes through it. Testicular lumps tend to be solid, which means light is unable to pass through them. A collection of fluid in the scrotum will allow light to pass through it.

Tests for testicular cancer

If you have a non-painful swelling or lump, or a change in the shape or texture of 1 of your testicles, and a GP thinks it may be cancerous, you'll be referred for further testing within 2 weeks. Some of the tests you may have are described below.

Scrotal ultrasound

A scrotal ultrasound scan is a painless procedure that uses high-frequency sound waves to produce an image of the inside of your testicle. It's 1 of the main ways of finding out whether or not a lump is cancerous (malignant) or non-cancerous (benign).

During a scrotal ultrasound, your specialist will be able to determine the position and size of the abnormality in your testicle. It'll also give a clear indication of whether the lump is in the testicle or separate within the scrotum, and whether it's solid or filled with fluid. A fluid-filled lump or collection around the testis is usually harmless. A more solid lump may be a sign the swelling is cancerous.

Blood tests

To help confirm a diagnosis, you may need a series of blood tests to detect certain hormones in your blood, known as markers. Testicular cancer often produces these markers, so it may indicate you have the condition if they're in your blood. Markers in your blood that'll be tested for include:

• alpha feto-protein (AFP)
• human chorionic gonadotrophin (HCG)

A third blood test is also often carried out as it may indicate how active a cancer is. It's called lactate dehydrogenase (LDH), but it's not a specific marker for testicular cancer. Not all people with testicular cancer produce markers. There may still be a chance you have testicular cancer even if your blood test results come back normal.

Histology

The only way to definitively confirm testicular cancer is to examine part of the lump under a microscope. These tests and reports are called histology.

Unlike many cancers where a small piece of the cancer can be removed (a biopsy), in most cases the only way to examine a testicular lump is by removing the affected testicle completely. This is because the combination of the ultrasound and blood marker tests is usually sufficient to make a firm diagnosis.

Also, a biopsy may injure the testicle and spread cancer into the scrotum, which is not usually affected. Your specialist will only recommend removing your testicle if they're relatively certain the lump is cancerous. Losing a testicle will not affect your sex life or ability to have children.

The removal of a testicle is called an orchidectomy. It's the main type of treatment for testicular cancer, so if you have testicular cancer, it's likely you'll need to have an orchidectomy.

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