Scrotal Mass Suspicious for Testicular Cancer & Benign Masses


Diagnosis: 2WW criteria: 

  • Swelling within the body of the testis 

Differential diagnosis:  

  • Testicular cancer – solid mass arising from body of testis.
  • Epididymal cyst –  separate smooth cystic swelling from epididymis,
  • Hydrocoele – smooth swelling, testis impalpable, transilluminates.
  • Varicocoele – bag of worms above testis, usually on left. NB. Needs renal USS to exclude renal mass.


Management prior to referral:  

Physical examination is often unreliable to differentiate testicular malignancy from other scrotal masses; >90% of current referrals are for benign disease, particularly in men >55y.


**Please confirm the diagnosis with a scrotal USS before 2WW referral,

   if confirmed, test serum α-FP, βhCG & LDH** 


Benign disease:   

  • If clinical diagnosis uncertain use USS testes to confirm.
  • Only needs referral if patient symptomatic and bothered.
  • Surgery carries risk of post op haematoma/infection/chronic pain.
  • Aspiration of hydrocoeles and epididymal cysts is generally not advocated as usually recur within short period of time and risk causing infection.