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.
- 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**
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.
- 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 Bridgitte Wesson, GP & Kernow RMS Urology Guideline lead
Reviewed: March 2022
Next Review due: March 2023