Scrotal Mass Suspicious for Testicular Cancer & Benign Masses

2WW criteria: 

  • Swelling within the body of the testis 



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** 



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.



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.


NICE, Urological cancers, recognition and referral, November 2015



Mr Christopher Blake, Consultant Urologist, RCHT

Dr Stephanie Jackson, GP Lead Urology


Reviewed: July 2018