I Found a Lump on My Testicle — Is It a Cyst or Testicular Cancer?
Finding a lump in or around a testicle can be worrying. The reassuring news is that many scrotal lumps are benign and are not testicular cancer.
Common causes include epididymal cysts, spermatoceles, hydroceles and other conditions arising from structures around the testicle.
However, a new lump arising from within the testicle itself should be assessed promptly, particularly if it is firm or painless. A painless testicular mass is the most common presentation of testicular germ-cell cancer.[1–3]
The difficulty is that it is not always possible to tell what a lump is simply by feeling it. Clinical examination and a scrotal ultrasound are usually the key first steps.[1–4]
Cyst or testicular cancer: what is the main difference?
One of the most important questions is:
Is the lump inside the testicle, or is it beside the testicle?
Lumps arising outside the testicle are much more commonly benign. A solid lump arising within the testicle requires more careful investigation.[1,4]
Epididymal cyst or spermatocele
The epididymis is a small coiled structure that sits behind and above each testicle.
An epididymal cyst or spermatocele is a fluid-filled swelling arising from this area.
It may feel:
smooth or rounded
above or behind the testicle
separate from the testicle itself
soft or slightly firm
painless, although larger cysts can sometimes cause heaviness or discomfort
Epididymal cysts and spermatoceles are benign. They are different conditions from testicular cancer and do not themselves become testicular cancer.[4]
Treatment is not always required. Management depends on factors such as symptoms, size, certainty of the diagnosis and individual circumstances.
What does a testicular cancer lump usually feel like?
Testicular cancer commonly presents as a new firm or solid area within the testicle.[1–3]
Possible signs include:
a new lump within one testicle
an area that feels harder than the surrounding testicle
enlargement of one testicle
a change in testicular shape or consistency
a feeling of heaviness in the scrotum
a persistent dull ache or discomfort
Importantly, testicular cancer is often painless.[1–3]
This means that the absence of pain should not be used as reassurance that a new testicular lump is harmless.
If you have noticed a new testicular mass, more information is available on testicular cancer and testis-sparing surgery.
Can you tell a cyst from cancer by touching it?
Not reliably.
A cyst may feel smooth and separate from the testicle, while a tumour may feel firmer and appear to arise within the testicle. However, there is enough overlap that self-examination cannot establish the diagnosis with certainty.
The main purpose of assessment is therefore to establish where the lump originates.
A lump may arise from:
the testicle itself
the epididymis
the spermatic cord
fluid around the testicle
the scrotal skin or soft tissues
This distinction usually becomes much clearer after examination and ultrasound.[1,4]
You can also explore the broader Scrotal & Testicular Conditions pathway.
What other conditions can cause a scrotal lump?
A testicular or scrotal lump does not automatically mean cancer.
Several benign conditions can cause swelling or a palpable abnormality.
Hydrocele
A hydrocele is a collection of fluid around the testicle.
Rather than producing one small firm lump, a hydrocele more commonly causes gradual enlargement of one side of the scrotum, heaviness or discomfort.
Epididymal cyst or spermatocele
These are common benign fluid-filled swellings arising beside the testicle.
Varicocele
A varicocele is caused by enlarged veins around the testicle. It can sometimes feel like a soft collection of veins or a “bag of worms”, particularly when standing.
Infection or inflammation
Epididymitis or epididymo-orchitis can cause swelling, tenderness and pain. Fever, urinary symptoms or feeling unwell may occur in some cases.
Paratesticular mass
Some solid lumps arise from structures next to the testicle rather than within it. These are called paratesticular masses and include a range of benign and malignant conditions.
Learn more about paratesticular tumours and masses.
What test is used for a testicular lump?
Scrotal ultrasound
A high-frequency scrotal ultrasound is the main imaging investigation used when a testicular mass is suspected.[1,2,4]
Ultrasound can help establish:
whether the lump is inside or outside the testicle
whether it is fluid-filled or solid
its size and location
its blood-flow pattern
whether there are abnormalities in the other testicle
This distinction is important because an epididymal cyst has a very different management pathway from a solid intratesticular mass.
Ultrasound does not, however, provide a perfect answer in every case. Some testicular lesions remain uncertain even after high-quality imaging.[1,5,8]
Does a solid testicular lump always mean cancer?
No.
Although a solid intratesticular mass requires careful assessment, not every solid testicular lesion is malignant.
Modern ultrasound is increasingly identifying very small testicular lesions that would previously never have been detected.[5–8]
A systematic review of incidental small testicular masses found that a substantial proportion of surgically removed lesions were ultimately benign, with benign pathology becoming more common as lesion size decreased.[5]
The EAU guideline similarly notes that very small incidental masses have a significant likelihood of being benign. In the evidence reviewed by the guideline, approximately:
70% of lesions under 10 mm were benign
87% of lesions under 5 mm were benign
virtually all lesions under 3 mm were benign.[1]
These figures apply particularly to small, often non-palpable ultrasound-detected lesions. They should not be interpreted to mean that a palpable testicular mass can safely be ignored.
A small lesion is not automatically benign, just as a large lump is not automatically cancer.
What happens if the ultrasound looks suspicious?
If an ultrasound shows a lesion suspicious for testicular cancer, further assessment commonly includes blood tests for the tumour markers:
AFP — alpha-fetoprotein
β-hCG — beta-human chorionic gonadotropin
LDH — lactate dehydrogenase.[1–3]
These markers can provide useful information about diagnosis, staging and subsequent follow-up.
However, normal tumour markers do not rule out testicular cancer.[1–3]
A suspicious mass still requires appropriate urological assessment even when blood tests are normal.
If cancer is suspected, does the testicle need to be removed?
For a typical testicular mass strongly suspicious for a germ-cell tumour, the standard initial surgical treatment is usually a radical inguinal orchidectomy.[1–3]
This means removing the affected testicle through an incision in the groin rather than through the scrotum.
The removed tissue is then examined by a pathologist to determine:
whether cancer is present
what type of tumour it is
important features of the tumour
the local pathological stage
Further treatment is determined by the final pathology, tumour markers, staging investigations and individual circumstances.
Does every small testicular mass require removal of the whole testicle?
No — but testis preservation is only appropriate in selected cases.
There is increasing recognition that some small or indeterminate testicular masses are benign.[5–8]
For selected patients, testis-sparing surgery may be considered rather than automatically removing the entire testicle.[1,5,6,8]
Situations where this may be discussed include certain:
small or indeterminate testicular masses
lesions with negative tumour markers and a meaningful possibility of benign pathology
tumours affecting a solitary testicle
bilateral testicular lesions
selected non-germ-cell tumours
A recent comparison of major international guidelines found broad agreement that testis-sparing surgery has a role in appropriately selected small testicular masses, particularly when intraoperative frozen-section pathology is available.[8]
Importantly, testis-sparing surgery is not a routine substitute for radical orchidectomy when a typical germ-cell tumour is strongly suspected.[1,8]
Cancer control remains the priority.
What is frozen-section examination?
When testis-sparing surgery is appropriate, the surgeon removes the abnormal area while attempting to preserve the remaining testicular tissue.
The lesion may then be examined immediately by a pathologist using frozen-section examination.
The result can help determine whether it is reasonable to preserve the remainder of the testicle or whether removal of the testicle is required.[1,5,6,8]
Frozen section is useful but is not infallible. Final pathology may occasionally provide additional information that changes subsequent management.
You can read more about this approach on the Testicular Cancer & Testis-Sparing Surgery page.
Can a very small testicular lesion ever be monitored?
In selected circumstances, yes.
Published series have described ultrasound surveillance of carefully selected small, non-palpable testicular lesions, particularly when they were discovered incidentally during investigation of infertility or another condition.[5,7,8]
For example, Bieniek and colleagues studied subcentimetre testicular lesions detected during male infertility assessment. Most remained stable during follow-up, although some men underwent surgery because of growth, tumour markers, imaging features or other clinical concerns.[7]
This does not mean that every small testicular lump should simply be observed.
Whether monitoring is reasonable depends on factors such as:
whether the lesion can actually be felt
its size
ultrasound appearance
blood flow
tumour markers
whether it is changing over time
previous testicular cancer
the condition of the opposite testicle
fertility considerations
the level of diagnostic uncertainty.[1,5,7,8]
Surveillance should therefore be a specialist decision rather than a reason to delay assessment of a newly discovered lump.
When should I see a doctor about a testicular lump?
Arrange medical assessment if you notice:
a new lump in or around a testicle
a firm area that was not previously present
one testicle becoming larger
a change in testicular shape or consistency
persistent scrotal heaviness or swelling
a lump that appears to be enlarging
an ultrasound showing a new testicular mass.[1–3]
A painless lump still deserves assessment.
You do not need to know whether the lump is a cyst or cancer before seeking medical advice.
What about sudden severe testicular pain?
Sudden severe testicular pain is different and requires urgent medical assessment.
One important cause is testicular torsion, where the spermatic cord twists and reduces the blood supply to the testicle.
Because treatment can be time-sensitive, sudden severe testicular or scrotal pain should not wait for a routine outpatient appointment.
Should I keep checking the lump myself?
It is reasonable to be aware of what is normal for your own body, but repeatedly examining an uncertain lump cannot reliably determine its cause.
The more useful next step is often an examination and ultrasound.
Once imaging establishes whether the lump is arising from the testicle, epididymis or another structure, the appropriate pathway is usually much clearer.
Take home message
If you find a lump in your scrotum, do not assume it is cancer — but do not try to diagnose it yourself either.
Many lumps around the testicle are benign, including epididymal cysts, spermatoceles and hydroceles.
The distinction that matters most is whether the lump arises inside the testicle or from one of the surrounding structures.
For a new or persistent testicular lump, the usual next steps are:
Clinical examination
Scrotal ultrasound
Tumour-marker blood tests if an intratesticular mass is suspicious
Further urological assessment according to the findings.[1–4]
Modern management also recognises that not every small testicular lesion is malignant and that testis-preserving approaches may be appropriate in selected situations.[1,5–8]
Concerned about a testicular lump?
You do not need to determine whether a lump is a cyst or cancer before arranging an assessment.
A consultation can help establish whether the lump arises from the testicle, epididymis or surrounding structures and whether reassurance, monitoring, further investigation or treatment should be considered.
Related information
References
European Association of Urology. EAU Guidelines on Testicular Cancer. Arnhem: EAU Guidelines Office; 2026. Available from: https://uroweb.org/guidelines/testicular-cancer
Stephenson A, Bass EB, Bixler BR, Daneshmand S, Kirkby E, Marianes A, et al. Diagnosis and treatment of early-stage testicular cancer: AUA guideline amendment 2023. J Urol. 2024;211(1):20-25. doi:10.1097/JU.0000000000003694.
Singla N, Bagrodia A, Baraban E, Fankhauser CD, Ged YMA. Testicular germ cell tumors: a review. JAMA. 2025;333(9):793-803. doi:10.1001/jama.2024.27122.
Sommers D, Winter T. Ultrasonography evaluation of scrotal masses. Radiol Clin North Am. 2014;52(6):1265-1281. doi:10.1016/j.rcl.2014.07.014.
Henriques D, Mota Pinto A, Donato H, Leão R. Prevalence and management of incidental testicular masses—a systematic review. J Clin Med. 2022;11(19):5770. doi:10.3390/jcm11195770.
Narayan Y, Brown D, Ivaz S, Das K, Moussa M, Tsampoukas G, et al. Incidental testicular masses and the role of organ-sparing approach. Arch Ital Urol Androl. 2021;93(3):296-300. doi:10.4081/aiua.2021.3.296.
Bieniek JM, Juvet T, Margolis M, Grober ED, Lo KC, Jarvi KA. Prevalence and management of incidental small testicular masses discovered on ultrasonographic evaluation of male infertility. J Urol. 2018;199(2):481-486. doi:10.1016/j.juro.2017.08.004.
Tozzi M, Fallara G, Ferro M, Chierigo F, Bianchi R, Alnajjar HM, et al. Guideline of guidelines: management of small testicular masses. BJU Int. 2026;137(3):444-453. doi:10.1111/bju.70131.
Medical disclaimer
This article provides general educational information only and is not a substitute for individual medical advice, examination, diagnosis or treatment.
A website cannot determine whether a particular testicular or scrotal lump is benign or malignant. Recommendations depend on clinical examination, ultrasound findings, tumour markers, medical history, fertility considerations and individual circumstances.
If you develop sudden severe testicular pain, rapidly increasing swelling, significant redness, fever or acute illness, seek urgent medical assessment rather than waiting for a routine appointment.
