Testicular cancer is uncommon overall but it is the most common solid cancer in men between 15 and 40, the decades when men are least likely to see a doctor about anything. It is also one of the most curable cancers in medicine, with cure rates above 95% when caught while confined to the testicle.

That combination is what makes self-examination worth five minutes a month. There is no national screening programme for testicular cancer anywhere, in Singapore or elsewhere, because the disease is too uncommon for population screening to be efficient. Detection depends almost entirely on the man himself noticing a change.

What normal feels like

You cannot recognise a change without a baseline, and most men have never deliberately examined themselves.

A normal testicle is smooth, firm and oval, roughly the shape and size of a small plum, and moves freely within the scrotum. One usually sits slightly lower than the other (commonly the left) and one is often marginally larger. That asymmetry is normal and lifelong.

Behind and slightly above each testicle you will feel the epididymis, a soft, slightly lumpy, comma-shaped structure running along the back. Almost every man who examines himself for the first time finds it and assumes the worst. It is normal anatomy. Above it, the spermatic cord feels like a firm cord running upward.

Cancer, by contrast, is typically felt as a hard, painless lump on or within the body of the testicle itself, not behind it. Painless is the important word: most men expect cancer to hurt, and its absence is the main reason lumps get ignored for months.

How to examine yourself

Once a month, after a warm shower or bath when the scrotal skin is relaxed:

Stand, ideally in front of a mirror, and look for any visible swelling or change in the scrotal skin.
Examine one testicle at a time. Cup it in the palm and note the weight and size compared with the other side.
Roll the testicle gently between thumb and fingers, covering the entire surface. Use firm but gentle pressure: enough to feel the texture throughout, not enough to hurt.
Feel for anything hard, irregular or fixed within the body of the testicle.
Locate the epididymis behind and above so you can recognise it as normal each time.
Repeat on the other side and compare.

Doing it in the shower each month makes it habitual. What you are looking for is not a specific finding but a change from your own baseline.

What to get checked

Arrange assessment within days, not months, for:

A hard, painless lump on or within a testicle
A change in size, firmness or texture on one side
A feeling of heaviness or dragging in the scrotum
A dull ache in the lower abdomen, groin or scrotum
Sudden fluid accumulation in the scrotum
Breast tenderness or enlargement, which some hormone-producing tumours cause
Unexplained lower back pain, which can indicate spread

Seek same-day emergency care for sudden severe testicular pain, particularly with nausea, vomiting or a testicle that sits high or at an odd angle. That pattern suggests testicular torsion, where the blood supply is twisted off. The testicle can usually be saved within about six hours, and often cannot after twelve. This is a surgical emergency, not a wait-and-see.

Common non-cancerous lumps

Most scrotal lumps are benign, which is worth knowing before you examine yourself.

Epididymal cysts are smooth, fluid-filled and sit behind the testicle. Very common and harmless.

Hydrocele is fluid around the testicle producing a soft, painless swelling that transilluminates: it glows when a light is held against it.

Varicocele is a collection of enlarged veins, classically described as feeling like a bag of worms, usually on the left and more prominent standing. It is associated with reduced fertility and sometimes a dull ache.

Epididymitis is infection or inflammation of the epididymis, producing pain, swelling and sometimes fever. In younger men it is often secondary to chlamydia or gonorrhoea and needs STI testing alongside treatment.

Inguinal hernia produces a groin swelling extending into the scrotum, often more obvious on coughing or standing.

The distinction that matters most: cancerous lumps are typically hard, painless, and part of the testicle itself. Benign lumps are more often soft, tender, or clearly separate from it. But no man can reliably make that call on his own, which is why every new lump warrants a professional examination rather than an internet search.

Risk factors

Undescended testis at birth is the strongest known risk factor, and remains elevated even after surgical correction.

Family history in a father or brother raises risk several-fold.

Previous testicular cancer carries a meaningfully increased risk in the other testicle.

Age 15 to 40 is the peak window, unusually for a cancer.

Ethnicity matters: incidence is higher in men of Caucasian descent, and testicular cancer is relatively uncommon among Chinese, Malay and Indian populations in Singapore. That is a reason for context, not complacency: the disease occurs in every group, and rarity is exactly what makes a lump likely to be dismissed.

Notably, most men diagnosed have no risk factors at all. Absence of risk factors is not reassurance about a lump.

What assessment involves

A doctor will take a history and examine both testicles, the groin, the abdomen and the chest. If anything is uncertain, the next step is a scrotal ultrasound: painless, non-invasive, done in minutes, and highly accurate at distinguishing solid masses from cysts and fluid collections.

If a solid mass is found, tumour markers (AFP, beta-hCG and LDH) are measured, and referral to a urologist follows for definitive management. Biopsy through the scrotum is deliberately avoided in suspected testicular cancer because of the risk of seeding, which is why diagnosis is made through imaging, markers and specialist surgery rather than a needle in clinic.

Treatment for early disease is usually surgical removal of the affected testicle, sometimes with chemotherapy or radiotherapy depending on stage and tumour type. Fertility preservation through sperm banking is routinely discussed beforehand. One remaining testicle is generally sufficient for normal testosterone production and fertility, and a prosthesis can be placed if wanted.

Why men delay

Studies of delayed presentation find the same reasons repeatedly: the lump did not hurt, so it did not seem serious; embarrassment about a genital examination; fear of the answer; and a general reluctance among men in their twenties and thirties to attend any clinic.

The cost of that delay is real. Cure rates above 95% for localised disease fall meaningfully once the cancer has spread, and treatment becomes more aggressive. A few weeks of hesitation can be the difference between surgery alone and surgery plus chemotherapy.

A scrotal examination takes under a minute, is not painful, and is entirely routine for the doctor doing it.

Fertility, hormones and life after treatment

Two questions dominate once the immediate fear passes, and both have reassuring answers that are worth knowing in advance.

Fertility. Sperm banking is offered before treatment as standard, because chemotherapy and radiotherapy can impair sperm production. Many men are already sub-fertile at diagnosis (testicular cancer is associated with reduced sperm quality before any treatment begins), which is an argument for banking rather than against it. A single remaining testicle produces enough sperm for natural conception in most men, and semen quality frequently recovers over one to two years after chemotherapy.

Testosterone. One healthy testicle usually maintains normal testosterone levels, and most men need no replacement. Levels are checked during follow-up, and symptoms of low testosterone (persistent fatigue, low libido, low mood, loss of muscle mass) should prompt testing rather than being attributed to the experience of having had cancer.

Appearance and sexual function. A silicone prosthesis can be placed at the time of surgery or later, and is a personal choice rather than a medical necessity. Erectile function and orgasm are not affected by removal of one testicle.

Follow-up continues for several years with examinations, tumour markers and imaging, because relapse is most likely early and is highly treatable when found promptly. Self-examination of the remaining testicle continues to matter throughout, since the risk on that side is elevated.

Building the habit

Advice to self-examine monthly is easy to give and easy to ignore. What makes it stick is attaching it to something you already do rather than relying on intention.

Pick a fixed anchor (the first shower of the month, or the day you pay a recurring bill) and set a repeating phone reminder. The examination itself is under five minutes and, once you know what the epididymis feels like, most of that is simply confirming nothing has changed.

Two things to keep in mind. Frequent checking is not better: examining daily makes small normal variations feel alarming and generates anxiety without improving detection. And a mental note is not a record. If you find something you are unsure about, note the date, and if it is still there in a week, book an appointment rather than continuing to monitor it. Most men who present late did not miss the lump; they found it and decided to watch it.

Assessment at Hisential

Hisential provides confidential men's health assessment across Singapore, including examination of scrotal lumps, referral for ultrasound where indicated, and full comprehensive health screening. We are at 333A Orchard Road, #04-13 Mandarin Gallery, next to Somerset MRT, and see patients from across the island. Consultation is from S$50 after GST.

Frequently asked questions

How often should I check my testicles?

Once a month is the usual recommendation, after a warm shower when the scrotum is relaxed.

Does testicular cancer hurt?

Usually not. Most present as a painless hard lump, which is precisely why they are ignored. Pain is more typical of infection or torsion.

Is it normal for one testicle to be bigger or lower?

Yes. Mild asymmetry is normal and lifelong. What matters is a change from your own baseline.

What is the lumpy structure behind my testicle?

Almost certainly the epididymis, a normal comma-shaped structure. Learning to recognise it prevents unnecessary alarm.

Are most testicular lumps cancer?

No. Cysts, hydroceles and varicoceles are far more common. But a new lump cannot be self-diagnosed and should be examined.

Is testicular cancer common in Singapore?

It is relatively uncommon, particularly among Chinese, Malay and Indian men, but it does occur and rarity makes delayed presentation more likely.

References

Singapore Cancer Registry Annual Report, National Registry of Diseases Office
European Association of Urology, Guidelines on Testicular Cancer
US Centers for Disease Control and Prevention, testicular cancer information
National Cancer Institute, Testicular Cancer Treatment (PDQ)

睾丸自检 - 早期癌症筛查