Scrotal Masses – Diagnosis and Treatment
Diagnosis
Healthcare providers use a structured approach with examinations and tests to accurately identify scrotal masses.
The first step is typically a physical examination, where the doctor carefully examines the scrotum, testicles, and nearby areas while the person is both standing and lying down.
Sometimes, the doctor performs transillumination by shining a strong light through the scrotal skin to help determine if the mass is solid or filled with fluid.
Ultrasound (ultrasonography) serves as an essential tool, using sound waves to create detailed images of the scrotum and reveal the size, shape, and contents of any lump.
Doppler imaging shows blood flow, helping identify conditions like testicular torsion or tumors.
Doctors often recommend laboratory tests:
- Urine tests identify signs of infection.
- Blood tests detect infections and measure tumor marker levels such as alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH). These markers help recognize testicular cancer.
If a testicular tumor is suspected, doctors may order further imaging tests like CT scans, MRI scans, or a chest X-ray to check if cancer has spread to other parts of the body, such as lymph nodes.
In rare cases, doctors might consider a biopsy. These methods help professionals decide on the next steps for treatment or monitoring.
Table: Common Tests Used in Diagnosing Scrotal Masses
| Test | Purpose |
|---|---|
| Physical Exam | Checks for lumps or swelling. |
| Transillumination | Distinguishes between fluid and solid masses. |
| Ultrasound/Doppler | Provides detailed imaging. |
| Urine Test | Detects infection. |
| Blood Tests | Checks tumor markers (AFP, hCG, LDH). |
| CT/MRI/Chest X-ray | Assesses cancer spread. |
Treatment
Dealing with Infections
Doctors typically treat bacterial infections, such as epididymitis, with antibiotics chosen based on the type of bacteria.
When a virus causes swelling (like viral orchitis), doctors focus on rest, ice packs, and medicine to ease pain, as antibiotics do not help. Severe infection or abscess may require drainage or hospital care.
| Type of Infection | Main Treatment |
|---|---|
| Bacterial epididymitis | Antibiotics |
| Viral orchitis | Rest, pain relief, ice |
| Abscess | Drainage, sometimes surgery |
Symptoms like fever, trouble urinating, or severe pain require immediate medical attention.
Managing Non-Cancerous Scrotal Lumps
Benign masses include hydroceles, varicoceles, spermatoceles, hematoceles, and hernias. If these masses do not cause pain, infection, or affect fertility, doctors may recommend monitoring. If they cause problems, treatment options include:
- Draining fluid (for hydroceles and hematoceles)
- Surgical repair (such as fixing hernias or removing large spermatoceles)
- Pain control and supportive care
| Mass Type | Usual Treatment |
|---|---|
| Hydrocele | Drainage or surgery |
| Varicocele | Sometimes surgery |
| Spermatocele | Surgical removal if painful |
| Hematocele | Drainage or surgery |
| Hernia | Surgical repair |
Treatments for Testicular Tumors
Testicular cancer—including germ cell tumors like seminomas and non-seminomas—usually requires surgery as the first step.
Surgeons perform a radical inguinal orchiectomy, removing the testicle and spermatic cord through an incision in the groin area.
If cancer has spread to other areas, doctors may recommend:
- Chemotherapy: Used if the tumor spreads beyond the testicle. Drugs given through a vein kill cancer cells.
- Radiation Therapy: Usually for certain types like pure seminomas. High-energy beams target cancer in lymph nodes.
- Lymph Node Removal: Sometimes performed if cancer reaches the lymph nodes in the abdomen.
Key treatments for testicular cancer:
- Radical inguinal orchiectomy
- Chemotherapy (if the cancer spreads)
- Radiation (mostly for seminomas)
- Follow-up care to check for recurrence
Everyday Steps and Home Care
Regular self-exams of the testicles help detect unusual lumps or changes early.
Follow these steps for a home testicular exam:
- Choose the Right Time: After a warm bath or shower when the skin is relaxed.
- Use a Mirror: Stand in front of a mirror to look for swelling or changes in the scrotal skin.
- Check with Both Hands: Hold each testicle separately. Use the index and middle fingers under the testicle and your thumbs on top.
- Roll Gently: Roll each testicle gently between your fingers. Feel for any lumps, swelling, or tenderness. It’s normal if one is a bit larger.
- Feel the Epididymis: This soft, tube-like structure at the back and top of the testicle should be checked for swelling.
Anyone who finds a lump or change should seek medical care. Doctors may discuss options like surveillance, sperm banking before treatment, or the use of a prosthesis if removal is needed. Some people might need testosterone replacement therapy.
Getting Ready for Your Visit
Steps You Can Take Before Seeing the Doctor
Making a list before the appointment helps patients share all important details with their care team. This can include:
- Symptoms: Record any new or ongoing symptoms, even those that might not seem connected to the lump.
- Personal and Family Medical History: Note any history of testicular cancer, scrotal masses, undescended testicle, or birth conditions. Add information about relatives with testicular or scrotal problems.
- Daily Medicines and Supplements: List all prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.
- Recent Life Events: Mention any major stress, illness, or lifestyle changes, as stress may impact health.
- Questions to Ask: Bring written questions about the condition, testing, treatment options, and early detection methods. For example:
- What tests will I need?
- When will I know the results?
- What if it’s cancer? What if it is not?
- Will I need treatment if it is not cancer?
Patients should ask about risk factors and how to spot future changes early.
| Information to Share | Examples |
|---|---|
| Symptoms | Lump, pain, swelling, fever |
| Family and personal history | Past masses, cancer in family |
| Injury or trauma | Any recent hits to the groin area |
| Medicines and supplements | All drugs, vitamins, herbs |
| Sexual health history | Recent partners, history of STIs |
What Your Health Provider May Ask
The healthcare team will likely ask some specific questions. Being ready can make the visit go smoothly. These questions might include:
- When did you first notice the lump? Have your symptoms changed since then?
- Do you have groin or scrotal pain? If yes, how severe is it?
- Have you seen blood or pus in your urine?
- Did you recently injure your groin?
- Does anything reduce or increase your symptoms, such as rest or physical activity?
- Do you have any history of undescended testicle or surgical correction?
- Have you had recent or multiple new sexual partners? Any previous sexually transmitted infections?
These questions help the doctor check for risk factors—especially those linked to testicular cancer—and identify ways to catch problems early. Providing honest and complete answers helps the care team suggest the best next steps.
