Scrotal Mass Suspicious for Testicular Cancer & Benign Masses

Differential diagnosis of Scrotal Mass  

• 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.

 

2WW criteria: 

• Non painful enlargement/change in shape or texture of testis
• Imaging suspicious of testicular cancer

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

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

 

Routine:

Symptomatic benign disease

 

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. 

If clinical diagnosis uncertain use USS testes to confirm.

 

Benign disease:   

• 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.

 

 

References

NICE, Urological cancers, recognition and referral, November 2015

https://cks.nice.org.uk/topics/scrotal-pain-swelling/, July 2021

 

Contributors

Mr Christopher Blake, Consultant Urologist, RCHT

Dr Bridgitte Wesson, GP & Kernow RMS Urology Guideline lead

 

Reviewed: March 2022

Next Review due: March 2023