Is Testicular Pain a Sign of Cancer?

If the pain came on suddenly and severely in one testicle, stop reading and get to an emergency department.

The concern is testicular torsion. MedlinePlus describes it as twisting of the spermatic cord, which cuts off the blood supply to the testicle and nearby tissue, and can cause permanent damage.

Two lines from MedlinePlus set the clock. Surgery should be done as soon as possible after symptoms begin, and if it is performed within six hours, most of the testicle can be saved. The chance the testicle will need to be removed rises when blood flow is reduced for more than six hours.

That is why nobody watches and waits with this one.

MedlinePlus lists these symptoms:

• sudden severe pain in one testicle, sometimes with no clear reason.
• swelling on one side of the scrotum.
• nausea or vomiting.
• the testicle sitting higher than normal.

Go straight to an emergency department. MedlinePlus specifically advises an emergency room rather than urgent care, in case surgery is needed right away.

Torsion is most common in the first year of life and around puberty, but it can happen at any age. It sometimes follows an injury or hard exercise, and often has no trigger at all.

Also treat as an emergency: pain after an injury with fast swelling or bruising, or being unable to pass urine.

Slower-onset testicular pain usually has an everyday cause:

• epididymitis, an infection or inflammation behind the testicle.
• orchitis, inflammation of the testicle itself.
• a knock or sports injury.
• a hernia in the groin.
• a varicocele, which feels like a bag of worms and often aches when standing.
• a hydrocele, a painless fluid collection.
• a kidney stone, which can refer pain down into the groin.

Call your clinician the same day for ache or swelling with a fever, burning when you pee, or discharge. That combination usually means infection, and it responds to treatment.

This is the part that reframes the question for most readers.

NCI lists testicular cancer signs as a painless lump or swelling in either testicle, a change in how the testicle feels, a dull ache in the lower abdomen or groin, a sudden build-up of fluid in the scrotum, and pain or discomfort in a testicle or scrotum.

Pain appears on that list, but it is not the headline. A firm, painless lump on the testicle itself is the classic finding. MedlinePlus notes that testicular cancer is rare and highly treatable, and that it usually occurs between the ages of 15 and 40.

So a lump without pain is not reassuring. It is the reason to book.

The workup is quick and mostly non-invasive.

• An exam distinguishes the testicle from the structures around it.
• Scrotal ultrasound shows whether a lump is solid or fluid. For suspected torsion, a Doppler scan checks blood flow, and MedlinePlus notes there will be no flow with complete torsion.
• Urine tests look for infection.
• Blood tumor marker tests are used when a solid mass is found.

One point worth knowing: testicular lumps are generally not biopsied through the skin, because of the risk of spreading cells. Diagnosis usually comes from imaging, markers and surgery.

MedlinePlus advises examining your testicles monthly and seeking medical attention for lumps, redness, pain or other changes.

A short routine is enough. Do it after a warm shower, when the skin is relaxed. Roll each testicle between thumb and fingers. Learn what is normal for you, including the soft cord behind each testicle, which is often mistaken for a lump.

If you find something new, book. Do not check it obsessively for weeks. Testicular Cancer explains what happens after a suspicious scan.

• MedlinePlus — Testicular torsion
• MedlinePlus — Testicular Disorders
• National Cancer Institute — Testicular Cancer Symptoms