Last updated: 05-Oct-2026
Send your ultrasound and blood reports ahead of your appointment, so the consultation starts with them already read · +91-63590-11009
Dr Swati Shah
MS, DrNB (Surgical Oncology)
Testicular Cancer Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
Shah’s Gastro, Cancer & Robotic Surgery Centre. 18 years of experience in cancer surgery. ★★★★★ 4.99 from 84 Google reviews (Gota clinic) · 5.0 from 33 (Apollo, Bhat)
IN SHORT
A lump or hardness in one testis that does not hurt, in a man aged fifteen to forty-five, needs an ultrasound of both testes.
A swelling called infection or hydrocele that has not settled after one course of antibiotics needs a scan next, not a second course.
Pain does not rule cancer out. Breast swelling, back pain, a lump above the collarbone or breathlessness in a young man can start here.
The commonest first sign of testicular cancer is a swelling or a hard area in one testis that does not hurt, in a man between about fifteen and forty-five. Because there is no pain, it is easy to put off. It is also the sign most often given another name.
The test that settles it is a scrotal ultrasound with a high-frequency probe, of both testes. Both, because a tumour can be present on the other side as well, and tiny specks of calcium in the other testis (microlithiasis) change what is planned. The scan takes a few minutes and does not hurt.
Testicular cancer responds well to treatment, even after it has spread. That is why the delay matters more than the fear. The avoidable harm in this disease is the time between noticing a lump and having it scanned.
If a swelling was treated as an infection of the testis (epididymo-orchitis) or called a hydrocele, and it has not settled after one course of antibiotics, the next step is an ultrasound. Not a second course.
This is the single largest cause of delay in Indian practice. The first diagnosis is often reasonable. The problem is repeating it. Each extra course adds weeks in which a tumour that could have been dealt with early can reach the lymph nodes at the back of the abdomen.
So the rule is simple, and you can hold any doctor to it, including us: one course of antibiotics, then a scan if the swelling is still there.
A painful lump can still be a tumour. Bleeding inside a tumour causes pain, so sudden pain does not mean the cause is harmless.
Sudden, severe pain in one testis in a young man needs to be seen within the hour. A twisted testis (torsion) and a tumour can look alike, and the decision to explore the scrotum is made that same hour. It is not a scan-and-review-tomorrow problem.
In some men the scrotum is not where the trouble first shows. When a young man has any of the following, the testes are examined and scanned, because the cause can start there:
Some men carry a higher chance of a tumour, and a new lump in them should never wait. That includes a man who had an undescended testis as a child (cryptorchidism), a man who has already had a tumour in the other testis, a man with a small, shrunken testis (atrophy), and a man being treated for infertility.
| What you notice | What it may be | How soon |
|---|---|---|
| Lump or hardness in one testis, without pain | A tumour until a scan says otherwise | Ultrasound of both testes this week |
| Swelling treated as infection, still there after one antibiotic course | A tumour given the wrong name | Ultrasound now, before any second course |
| Swelling called a hydrocele that has not gone away | A hydrocele, or a tumour given that name | Ultrasound before any hydrocele treatment |
| Sudden severe pain in one testis | Torsion, or bleeding into a tumour | Within the hour |
| Breast swelling, back pain or a collarbone lump in a young man | Spread from a testicular tumour | Examination and scrotal ultrasound soon |
| Breathlessness or coughing blood | A possible emergency with a very high hCG | Hospital the same day |
The first visit is an examination, an ultrasound of both testes and three blood tests: AFP, beta-hCG and LDH. These are the tumour markers.
The markers must be taken before any operation. They are repeated after the testis is removed, and the value after surgery is what sets the stage and the treatment group. A set missed before the operation cannot be recovered later.
No biopsy or cut through the scrotum. If cancer is likely, the testis is removed through a small cut in the groin. An operation or biopsy through the scrotal skin opens a new route for spread and changes the whole plan afterwards. It cannot be undone.
Sperm banking is raised at this first visit, with its cost, because it has to be done before treatment starts and families need a few days to arrange it. A testicular prosthesis is mentioned too. What happens after the diagnosis is set out on the testicular cancer surgery and fertility page.
A new tumour can appear later in the remaining testis. So every man is taught to examine it himself once a month, and any new lump there is scanned, not watched.
Please do not wait. A lump without pain is the commonest way testicular cancer first shows. An ultrasound of both testes answers the question in minutes.
Get a scrotal ultrasound before any second course. A swelling that has not settled after one course of antibiotics is scanned, not treated again.
Not through the scrotum. A needle or cut through the scrotal skin opens a new route for spread. If the scan and blood tests point to cancer, removing the testis through the groin is both the diagnosis and the first treatment.
AFP, beta-hCG and LDH before surgery are compared with the values after it, and the value after surgery sets the stage. A set missed before the operation cannot be recreated.
It can. Removing one testis usually keeps fertility, but not always, and chemotherapy or abdominal node surgery can reduce it further. Sperm banking is offered to every man at the first visit, married or not, before any treatment.
Testicular cancer as a whole is covered on the testicular cancer surgery page. If the diagnosis is already made, the next decisions are on surgery, sperm banking and fertility.
Shah’s Gastro, Cancer & Robotic Surgery Centre
Dr Swati Shah — MS, DrNB (Surgical Oncology) · Testicular Cancer Surgeon
Consultation at Gota OPD, Ahmedabad. Surgery at Apollo Hospital, Bhat, Gandhinagar.
Phone and WhatsApp: +91-63590-11009
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