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Men's health

How to Check for Testicular Cancer: A Guide to Self-Exam

A testicular self-exam takes about two minutes after a warm shower, and the goal is learning your baseline — not diagnosing yourself. If you find a new, hard, painless lump on a testicle, see a clinician promptly: testicular cancer is the most common cancer in men aged 15 to 40 and is highly curable when caught early [2].

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Who should do a testicular self-exam, and how often?

Testicular cancer is the most commonly diagnosed cancer in men between roughly 15 and 40 years old, though it can appear at any age 2. It is also among the most curable solid-tumor cancers — the five-year survival rate is approximately 95 percent overall and above 99 percent for disease confined to the testicle 2. Earlier detection, however, remains the goal.

Major medical organizations, including the U.S. Preventive Services Task Force, do not recommend routine testicular self-examination for all men, because evidence that self-exam reduces the death rate from this cancer is lacking 3. However, men who have risk factors — a history of undescended testicle (cryptorchidism), a prior germ cell tumor, or a family history of testicular cancer — are commonly advised to be familiar with their baseline and to promptly report any new scrotal change to a clinician 23.

For men who choose to examine themselves, once a month is a reasonable interval — enough to notice change without heightening anxiety.

How to do a testicular self-exam, step by step

The best time is after a warm shower or bath, when the scrotal skin is relaxed.

Step 1 — Look first. Stand in front of a mirror if possible. Check for any visible swelling on the scrotal surface.

Step 2 — Support one testicle at a time. Cradle it gently with both hands — index and middle fingers underneath, thumbs on top. Roll it gently between thumb and fingers.

Step 3 — Feel the entire surface. Move around the entire testicle feeling for any hard lump, change in size or shape, or unusual firmness.

Step 4 — Find the epididymis. This is the soft, bumpy tube-like structure at the back of each testicle that stores and carries sperm. Feeling it is normal — it is not a lump.

Step 5 — Repeat on the other side. Each testicle should be examined separately.

The goal is to learn your own baseline — not to diagnose yourself. If something new is noticed, see a clinician rather than waiting to see if it changes.

What is normal and what actually needs evaluation?

Normal findings: - A small size difference between the two testicles - One hanging slightly lower than the other - The epididymis (soft, bumpy ridge at the back and top of each testicle) - Occasional mild achiness after exercise

See a clinician if you notice: - A hard, painless lump on the testicle itself (not the epididymis) - A feeling of heaviness or dull ache in the lower abdomen or scrotum - A sudden collection of fluid in the scrotum - Any change in size or shape compared to your prior exams - Pain or discomfort in a testicle or the scrotum — even if it comes and goes

Most lumps that prompt an exam turn out to be benign. But a hard, fixed lump on the testicle itself — especially a painless one — is the classic early finding of testicular cancer and requires prompt evaluation 14.

Most lumps are not cancer — but all new lumps need evaluation

The most common cause of a scrotal lump in a young man is a benign condition — an epididymal cyst or spermatocele (a smooth, movable lump attached to the epididymis), a varicocele (enlarged veins that feel like a soft bag of worms, usually on the left), or a hydrocele (fluid around the testicle).

However, because testicular cancer is treated so successfully when caught early, the standard approach is to evaluate any new scrotal finding promptly rather than watch it. The initial evaluation requires a scrotal ultrasound, which can reliably distinguish benign from suspicious lesions 1.

What tests and next steps follow a concerning finding?

If a scrotal lump is found and needs evaluation, a clinician will typically:

  • Order a scrotal ultrasound as the first and most informative step — it locates the lump precisely and characterizes its appearance 14.
  • Draw blood for tumor markers (AFP, beta-hCG, LDH) if cancer is suspected; these help characterize the tumor type, guide staging, and serve as benchmarks after treatment 1.
  • Refer to a urologist if an intratesticular mass suspicious for malignancy is identified. The standard diagnostic and treatment approach is surgical removal of the affected testicle through an inguinal incision (radical inguinal orchiectomy) 14.

Sperm banking before any treatment is discussed during the surgical consent process, since subsequent treatment may affect fertility.

Common questions

What does a testicular cancer lump feel like?

A lump associated with testicular cancer is typically hard, painless, and located on the surface of the testicle itself rather than behind it. It often feels like a small pebble or firm area that does not move away from the testicle when touched. That said, feel alone cannot distinguish cancer from benign causes — only a clinician and ultrasound can do that reliably.

Is it normal for one testicle to be bigger than the other?

Yes — a small difference in size between the two testicles is normal and very common. One testicle often hangs slightly lower as well. What matters is a change from your own personal normal, not perfect symmetry.

Can testicular cancer be painful?

Many testicular cancers are painless in the early stages. Some people notice a dull ache or heaviness, but the absence of pain does not mean a lump is safe to ignore. If you find a new, hard lump on a testicle, see a clinician whether or not it hurts.

How quickly does testicular cancer need to be treated?

Testicular cancer is one of the most treatable cancers, with high cure rates even at advanced stages. Finding it early improves outcomes. A clinician appointment for a new testicular lump should happen within a few days, not weeks — not because every lump is cancer, but because prompt evaluation is low-cost and high-value.

What is the epididymis, and can I mistake it for a lump?

The epididymis is a normal, soft, rope-like structure that runs along the back and top of each testicle. It stores and carries sperm. It can feel bumpy or cord-like, and many people mistake it for a concerning lump the first time they feel it. Once you recognize it as part of your normal anatomy, it is easy to distinguish from a new, hard growth on the testicle itself.

Talk to a clinician

Nina Osei, NP — Nurse Practitioner

checkups, refills & skin. Gale can match you with a licensed clinician for a visit.

Find care →

When to seek care for a scrotal change

  • —New hard lump directly on the testicle, especially if painless — see a clinician within a few days, not weeks
  • —Rapid increase in testicular size over days
  • —Severe or sudden scrotal pain — this is a separate emergency (possible testicular torsion); go to the ED immediately
  • —Back or abdominal pain alongside a scrotal change — can indicate spread and warrants prompt evaluation

Sudden, severe testicular pain is a different emergency (possible testicular torsion) — go to the ED immediately. A firm, painless lump is not an emergency but should be evaluated promptly — call your clinician within a few days.

This article provides general health education and is not a substitute for clinical evaluation. If you find any new or changing lump, see a licensed clinician promptly. Only a clinician with examination and imaging can determine what a lump is.

References

  1. 1.Stephenson A, Eggener SE, Bass EB, Chelnick DM, Daneshmand S, Feldman D, Gilligan T, Karam JA, Leibovich B, Liauw SL, Masterson TA, Meeks JJ, Pierorazio PM, Sharma R, Sheinfeld J (2019). Diagnosis and Treatment of Early Stage Testicular Cancer: AUA Guideline. Journal of Urology. doi:10.1097/JU.0000000000000318 ✓Scrotal ultrasound as first diagnostic step for testicular mass; serum tumor markers (AFP, hCG, LDH) drawn before any treatment; radical inguinal orchiectomy as standard of care; sperm banking counseling
  2. 2.Giona S (2022). The Epidemiology of Testicular Cancer. Urologic Cancers (Exon Publications). doi:10.36255/exon-publications-urologic-cancers-epidemiology-testicular-cancer ✓Testicular cancer is the most common neoplasm in men aged 15-40; 5-year overall survival ~95%; localized 5-year survival ~99.2%; cryptorchidism is the strongest modifiable risk factor
  3. 3.U.S. Preventive Services Task Force (2011). Screening for Testicular Cancer: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement. Annals of Internal Medicine. link ✓USPSTF grade D recommendation against routine screening by clinician or self-examination in asymptomatic men; low incidence and high survival regardless of stage are the primary reasons; men with risk factors (cryptorchidism, prior germ cell tumor, family history) are a distinct consideration
  4. 4.Stephenson A, Bass EB, Bixler BR, et al. (2024). Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline Amendment 2023. Journal of Urology. doi:10.1097/JU.0000000000003694 ✓Updated AUA recommendations for early-stage testicular cancer diagnosis and treatment; emphasis on ultrasound, tumor markers, and inguinal orchiectomy; surveillance protocols by stage

4 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.