Testis cancer is the most common solid tumor for men in their reproductive years. Testis tumors can grow rapidly so prompt detection and treatment are critical. If detected early, most men with testis cancer can be cured of the disease. Although even men with advanced disease are frequently cured, they require more treatment which can have more complications, including infertility.
Testis tumors usually are firm but painless masses. Occasionally, a man will describe a heavy feeling secondary to the tumor. Typically, a man or his partner feel the mass and this leads to his seeking an evaluation. If a man suspects any abnormality of his testes or scrotum, he should see a urologist as soon as possible.
Because testis tumors grow rapidly and early detection is therefore important, it makes sense that regular testicular self-examination is beneficial.
A testicular self examination is not painful or difficult and most men are comfortable performing it. It is suggested that a man perform the examination once a month on a day that is easy to remember, for example, on his birthday.
The examination can be performed either while standing or lying down. A man should hold the testis with one or both hands and then allow it to slide underneath the fingertips. He should examine the testes for size, consistency and any firm or irregular areas. Any difference in the texture or consistency between the two testes should also be noted. The man should also become comfortable separating the testis from the spermatic cords, which contain the blood vessels and vas deferens and are above the testes. Any possible abnormality of the testes or scrotum whatsoever should be evaluated by a urologist. Any possible abnormalities of the scrotum are usually also evaluated by ultrasound.
A testis tumor is usually felt inside rather than on the surface of the testis. Also, many masses or other abnormalities of the scrotum such as hydroceles, spermatoceles and varicoceles are actually outside the testis but can be felt on the testicular self-examination. Hydroceles and spermatoceles are not harmful but can cause discomfort or be concerning to the man because they can feel like “something extra” in the scrotum. Varicoceles, often described as a “bag of worms” are outside the testis and can also be felt on the self examination. One should only be able to feel a varicocele when standing. Varicoceles are associated with infertility and can cause pain. Finally, a hernia can also be felt in some cases as a bulge in the groin or scrotum.
It is strongly recommended that any possible abnormality on the testicular self-examination be evaluated by a urologist. Fortunately, most abnormalities on the self-examination are not cancer, especially those that are outside the testis. It is not expected, however, that the man will be able to determine what is a tumor and what is not. To be on the safe side, all abnormalities on testicular self examination should be evaluated by a urologist. The urologist can then educate the man, initiate any additional testing that is required and reassure the patient about the results if he does not have a tumor. If the man indeed does have a possible tumor, the urologist can discuss this with the man and initiate the next steps in evaluation and treatment. Finally, the urologist can review the testicular self-examination with the man and give him additional tips on performing it.
To sum it up, the testicular exam is painless, easy to perform, free, and has no risk. The potential health benefits are tremendous: the man can possibly detect a significant problem such as a testis tumor it its early stages and literally be life saving. Other conditions that could be detected can also affect the man’s health and fertility. Thus, by performing the testicular self examination, a man can have a significant positive effect on his own health and well being.
