When It's Not Actually Testicular Cancer

Less-Harmful Conditions That Share the Symptoms of Testicular Cancer

man in pain
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If you feel a lump or notice swelling in your scrotum, you may be worried that you have testicular cancer. However, there are other conditions that share these same symptoms.

Hydrocele

At any point in life, fluid can accumulate around the testes, causing the scrotum to swell. This is known as a hydrocele.

In adults, the cause of hydroceles is unknown. Some hydroceles (called “reactive hydroceles”) can be caused by inflammation, infection, or trauma to the testis or epididymis.

These usually resolve when the underlying condition is treated. In children, hydroceles are caused by normal communication between the peritoneal cavity and the sac around the testes that continues after birth.

The usual adult hydrocele does not need treatment, unless it becomes large or uncomfortable due to its weight and size. When necessary, hydroceles can be treated in a minor outpatient surgical procedure that involves making a slit in the scrotum to drain the fluid. The sac holding the fluid is then removed to prevent the hydrocele from recurring.

Infections

The epididymis is a tube that stores and carries sperm. It runs along the back of each testicle. Bacterial infections in the epididymis (epididymitis) or testicles (orchitis) will cause swelling or pain in the scrotum.

When these infections are caused by the bacteria Neisseria gonorrhoeae and Chlamydia trachomatis, they are known as gonorrhea and chlamydia.

Having sex while infected with these bacteria will transmit the infection. A regular sexual partner will need simultaneous antibiotic treatment to prevent becoming infected or, if already infected, prevent you from being cured while you are taking antibiotics.

If you are sexually active and under age 35, your infection will be treated with a regimen of antibiotics consisting of ceftriaxone plus doxycycline or azithromycin.

If you are over age 35, a fluoroquinolone or trimethoprim-sulfamethoxazole will be added.

It may take several weeks for the bacteria to be eradicated. It is very important that you take all your antibiotics as prescribed. Failure to complete the regimen may cause the bacteria to become resistant to antibiotics, resulting in an infection that cannot be cured.

Epididymitis can also be caused by coliform bacteria introduced when urine refluxes into the opening where the tube (called the vas deferens) that connects the epididymis to the urethra enters the prostate. Such infections are usually treated with a sulfa or fluoroquinolone antibiotic.

In some men, orchitis is caused by a virus and may occur in those with active mumps infections. In these cases, antibiotics will not be effective. Ice packs and non-steroidal anti-inflammatory medications (NSAIDs) may be used as needed for pain relief while the disease runs its course.

Cysts & Benign Tumors

In men ages 15 to 35, a lump in the testis is likely to signify testicular cancer. The lump is generally, but not always, painless. However, lumps that can be felt through the scrotum can also occur outside the testes; these are usually benign.

A simple ultrasound can help distinguish between a lump that is likely to be testicular cancer and a lump that is likely to be harmless.

If it appears to be testicular cancer, surgery to remove the testis is indicated. (A lump outside the testis is usually simply observed.)

Small, solid masses located in the epididymis are assumed to be adenomatoid tumors. No biopsy is needed, as these tumors are rarely, if ever, cancerous.

Cysts are simply benign fluid-filled pockets. They are harmless and require no treatment.

What to Do…and Not Do

Although the diagnosis may not be testicular cancer, you should never try to make the distinction yourself. Let your doctor know immediately if you have a lump, pain, or swelling in your scrotum. He or she will determine what the problem is with an ultrasound.

If the answer is not clear, a biopsy or CT scan will be the next step.

If you do have testicular cancer, take comfort in knowing its cure rate is nearly 100 percent when caught early. Testicular cancer is rare, and testicular cancer that has spread (metastasized) is even rarer. However, a delay in diagnosis increases the likelihood the cancer will have spread by the time it is discovered, lowering the survival rate.

Metastatic testicular cancer is often overlooked because its symptoms can be easily mistaken for those of more common conditions, such as mononucleosis and non-Hodgkins lymphoma. These symptoms may include fatigue, enlarged lymph nodes, loss of appetite, poor sleep, and other symptoms indicative of systemic disease. Mononucleosis can cause a sore throat which does not occur with testicular cancer.

Protect Yourself

The best protection against testicular cancer is to conduct a monthly self-exam in the shower, when the scrotal skin is loose and thin. Learn what your normal testes feel like. Since no two paired organs in the body are exactly alike, one testicle (usually on the right side) may hang lower than the other. The testicles may be slightly different in size and shape, as well.

Feeling your testicles monthly will allow you to identify any change in your normal contours—for example, a lump that wasn’t there before, an enlarged testicle, or swelling anywhere in your scrotum. If you notice the presence of something new, see your primary care physician.

Sources:

www.cancer.org/cancer/testicular-cancer.html

Campbell-Walsh Urology

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