Cancers in men: testicular changes to notice and when to seek care

I didn’t plan to write about testicles today. But a small conversation with a friend—half joke, half worry—stuck with me on my walk home. It reminded me how easy it is to ignore a strange new heaviness, a pea-sized lump, or a one-off ache and just… hope it disappears. I wanted a calmer, clearer map for myself: what changes deserve attention, what’s probably benign, what could be serious, and how to move from worry to wise action without spiraling. This post is me laying that map down, as plainly and compassionately as I can.

What finally cut through the noise for me

The most centering fact I learned is simple: there’s no routine screening test for testicular cancer recommended for men without symptoms, and major experts even recommend against scheduled screening exams in people without concerns (see the U.S. Preventive Services Task Force statement here). That initially surprised me. But paired with a second fact—it’s usually men themselves who first notice a change—that recommendation started to make sense. Instead of memorizing complicated self-exam rules, I’m focusing on body awareness: know your baseline, and speak up when something changes.

• High-value takeaway: If you feel a new lump, swelling, firmness, or heavy sensation in a testicle, that’s a reason to contact a clinician soon for an exam and an ultrasound. The National Cancer Institute’s patient guide is a good primer here.
• Many changes are not cancer (hydroceles, epididymal cysts, varicocele), but an ultrasound is the fast, noninvasive way to sort things out. You don’t have to figure it out alone.
• Urgency varies. Sudden, severe scrotal pain is different from a slow-growing, painless lump—know which signals are “today” versus “this week.” MedlinePlus has a clear, non-alarmist overview you can skim here.

Real-world signs I now take seriously

Reading symptom lists is one thing; translating them into “should I call?” is another. These are changes that, if I notice them, I plan to act on rather than watch for weeks.

• A new lump or firm area in one testicle, even if painless.
• Swelling or enlargement of a testicle or a feeling of heaviness in the scrotum.
• Dull ache in the lower abdomen or groin that doesn’t match typical strain or exercise soreness.
• Sudden fluid buildup in the scrotum or a testicle that feels different in size or weight compared to baseline.
• Pain or discomfort in a testicle that lingers or recurs without a clear trigger.
• Less common but noteworthy: breast tenderness or enlargement (can be hormone-related in certain tumors) and back pain that’s new and unexplained. A quick, trustworthy overview of symptoms is on MedlinePlus here and the NCI patient page here.

One more category deserves bold print because it can be urgent: sudden, severe testicular pain, often with swelling, nausea, or a high-riding testicle, can signal testicular torsion, which is a surgical emergency. That’s not about cancer—but it matters. If pain strikes suddenly and intensely, the move is same-day, emergency evaluation. MedlinePlus explains why the first hours matter here.

How I decide when to call and how fast to move

I like simple “traffic light” rules because they cut through anxiety and overthinking. Here’s the version I wrote for my notes:

• Red light (go now): Sudden, severe pain in a testicle; scrotum becomes acutely swollen or very tender; feeling ill with nausea/vomiting plus testicular pain. Reason: could be torsion—time-sensitive. Seek emergency care the same day. More on the emergency angle from MedlinePlus here.
• Amber light (book promptly): A new lump, swelling, heaviness, or firmness that doesn’t go away within a few days; a dull ache that persists; breast tenderness or enlargement without a known cause. Reason: needs exam and ultrasound this week; earlier is fine.
• Green light (monitor with intention): Minor aches after exercise, brief twinges that resolve, or long-standing benign findings already checked. Reason: track changes; if any shift to amber signs, escalate.

This is not a substitute for judgment, but it gives my brain a starting script. And ultimately, a clinician’s hands-on exam plus scrotal ultrasound is what separates guesswork from clarity (see Mayo Clinic’s diagnostic overview here).

Why there’s no routine screening yet the advice is not “do nothing”

The USPSTF recommendation against routine screening (including scheduled clinician or self-exams) in people without symptoms is based on evidence that screening hasn’t shown mortality benefit and that testicular cancer outcomes are already excellent with symptom-driven care. You can read the statement yourself here. For me, this doesn’t mean indifference. It means I’m focusing on awareness over anxiety: know your normal and respond to changes. The NCI’s plain-language PDQ backs this “notice and act” approach with a clear list of symptoms and next steps here.

Risk factors I keep in context

Risk is not destiny, but context helps me adjust my sensitivity to change:

• Undescended testis (cryptorchidism) now or corrected in childhood raises risk.
• Personal or family history of testicular cancer raises risk.
• Some patterns in age and ancestry appear in the data, but cancer can occur at any age in adult men and even in teens and older adults. See risk-factor summaries from the NCI PDQ here.

If I had one of these risk factors, I wouldn’t panic; I’d just be quicker to book the ultrasound if a change shows up.

What the first medical visit usually looks like

Based on guidelines and patient education resources, the first steps are practical:

• History and exam: A clinician asks when you noticed the change, if there’s pain, if the size has changed, and checks for hernia, varicocele, hydrocele, or epididymal cyst.
• Scrotal ultrasound: This painless test uses sound waves to visualize the testicle and surrounding structures. It’s the cornerstone for triage and can be arranged quickly (Mayo Clinic overview here).
• Blood tests: If cancer is suspected, tumor markers—AFP, β-hCG, and LDH—help with staging and follow-up. The American Urological Association guideline emphasizes checking and trending these at the right intervals (see the AUA guidance PDF here).

If a solid testicular mass is suspected, the standard next step is radical inguinal orchiectomy (surgical removal through the groin, not through the scrotum). It’s both diagnostic and therapeutic and is consistent with the NCI PDQ’s clinical guidance here. After surgery, pathology and tumor marker trends guide whether surveillance, chemotherapy, or other treatments make sense. The point: the pathway is well-trodden, and outcomes are generally very good.

My checklist for noticing change without catastrophizing

Here’s the mini-routine I jotted down for myself—no stopwatches, no pressure, just periodic awareness:

• Know your baseline: During a shower, notice size, weight, and usual bumps (like the soft epididymis behind the testicle). No need for a “perfect” technique.
• Use three questions: Is there something new? Has anything grown or gotten firmer? Is there a heaviness or ache that doesn’t fit recent activity?
• Write one sentence: If you find something, jot a single line with date, side (left/right), and what you felt. This becomes useful data if you call a clinic.
• Decide your next step: Red-amber-green rules above. If unsure, err on the side of a message to your clinician’s office. Patient education from MedlinePlus stays grounded and helpful here.

Signals that make me escalate sooner

Some patterns nudge me to move up my timeline from “this week” to “today”:

• Lump plus breast changes (tenderness or enlargement): possible hormone activity—gets same-week ultrasound.
• Lump with fast growth over days to a couple weeks.
• Persistent ache that keeps cycling back without a clear strain or injury story.
• Systemic symptoms like unexplained back pain or fatigue alongside a scrotal change.
• Any sudden severe pain (that’s torsion-until-proven-otherwise): emergency care now. Details on the time window are on MedlinePlus here.

Questions I would bring to a first appointment

• Does the ultrasound show a solid mass or a fluid-filled cyst?
• Should we check AFP, β-hCG, and LDH today?
• If a mass looks suspicious, what’s the next step and typical timing?
• Should I consider fertility and sperm banking if surgery or chemotherapy is on the table?
• What’s the follow-up plan if the ultrasound is benign but symptoms persist?

What I’m keeping and what I’m letting go

I’m keeping a few principles bookmarked:

• Awareness over anxiety: I don’t need a perfect monthly ritual. I need to notice change and act thoughtfully.
• Ultrasound, not overthinking: When in doubt, book the scan. It’s quick, safe, and definitive for most questions.
• Evidence beats myths: I’m guided by the USPSTF’s screening stance, the NCI PDQ’s plain-language summaries, and specialty guidance from the AUA, not scattered anecdotes.

And I’m letting go of two unhelpful habits: Googling myself into doom, and waiting months hoping a lump will “sort itself out.” If something changes, future-me gets an appointment. That’s the whole point of this post.

FAQ

1) Do I need to do a formal monthly self-exam?
Answer: Major guidelines don’t recommend scheduled screening exams in people without symptoms. Instead, be familiar with your normal and act on changes. The USPSTF summary is available here.

2) I found a small, painless lump. Is it always cancer?
Answer: No. Many scrotal lumps are benign (like cysts or hydroceles). The next step isn’t guessing—it’s a scrotal ultrasound and an exam. A clear overview of what clinicians check is on Mayo Clinic here.

3) How fast should I be seen?
Answer: For a new lump, aim for a prompt appointment (days, not months). For sudden, severe pain, seek emergency care the same day because of torsion risk. See MedlinePlus’ time-sensitive guidance here.

4) What tests might I have if cancer is suspected?
Answer: Scrotal ultrasound and blood tests for tumor markers (AFP, β-hCG, LDH). If a solid mass is found, the usual next step is removal through the groin (radical inguinal orchiectomy) for diagnosis and treatment. NCI’s clinician-facing PDQ discusses this pathway here and the AUA guideline summarizes marker use here.

5) Who is at higher risk and should be extra-alert to changes?
Answer: Men with a history of undescended testis, a personal or family history of testicular cancer, or certain other testicular conditions. A concise risk-factor list is in the NCI PDQ here.

Sources & References

• USPSTF — Testicular Cancer Screening (2011, reaffirmed)
• NCI PDQ — Testicular Cancer Treatment, Patient Version (2023)
• NCI PDQ — Testicular Cancer Treatment, Health Professional (2025)
• AUA — Early-Stage Testicular Cancer Guideline (2019)
• MedlinePlus — Testicular Cancer (2024)

This blog is a personal journal and for general information only. It is not a substitute for professional medical advice, diagnosis, or treatment, and it does not create a doctor–patient relationship. Always seek the advice of a licensed clinician for questions about your health. If you may be experiencing an emergency, call your local emergency number immediately (e.g., 911 [US], 119).